Induction chemotherapy followed by alternating chemo-radiotherapy in non-endemic undifferentiated carcinoma of the nasopharynx: Optimal compliance and promising 4-year results

Nasopharyngeal carcinoma in a low incidence European area : A prospective observational analysis from the Head and Neck Study Group of the Italian Society of Radiation Oncology (AIRO)

PURPOSE

To evaluate the outcomes with respect to long-term survival and toxicity in patients with nasopharyngeal carcinoma (NPC) treated in a European country with low incidence.

MATERIALS AND METHODS

A prospective observational study carried out by the AIRO Head and Neck group in 12 Italian institutions included 136 consecutive patients treated with radiotherapy (RT) ± chemotherapy (CHT) for NPC (without distant metastasis) between January 1, 2008 and December 31, 2010.

RESULTS

The disease-specific survival (DSS), overall survival (OS), and disease-free survival (DFS) at 5 years were 92 (±2), 91 (±3), and 69 % (±5 %), respectively. Distant failure was the most frequent modality of relapse. The local, regional, and locoregional control at 5 years were 89 (±3), 93 (±3), and 84 % (±4 %), respectively. The incidence of acute and late toxicity and the correlations with different clinical/technical variables were analyzed. Neoadjuvant CHT prolongs radiotherapy overall treatment time (OTT) and decreases treatment adherence during concomitant chemoradiotherapy. An adequate minimum dose coverage to PTV(T) is a predictive variable well related to outcome.

CONCLUSION

Our data do not substantially differ in terms of survival and toxicity outcomes from those reported in larger series of patients treated in countries with higher incidences of NPC. The T stage (TNM 2002 UICC classification) is predictive of DSS and OS. The GTV volume (T ± N) and an adequate minimum PTV(T) coverage dose (D95 %) were also identified as potential predictive variables. Sophisticated technologies of dose delivery (IMRT) with image-guided radiotherapy could help to obtain better minimum PTV(T) coverage dose with increased DFS; distant metastasis after treatment still remains an unresolved issue.

Unfavorable clinical implications of circulating CD44+ lymphocytes in patients with nasopharyngeal carcinoma undergoing radiochemotherapy

BACKGROUND

To evaluate the use of cellular immunity parameters as predictors of therapy response.

METHODS

Circulating lymphocytes were measued by flow cytometry in 94 nasopharyngeal carcinoma (NPC) patients following radiochemotherapy.

RESULTS

Significantly decreased percentage of CD3(+), CD4(+), and CD8(+) lymphocytes, significantly increased proportion of CD44(+), CD25(+), NK lymphocytes, and an increased CD4(+)/CD8(+) ratio were indicated in NPC patients as compared with healthy controls. Circulating CD44(+) lymphocytes in both the N2/N3 and III/IV groups were significantly increased as compared to the N0/N1 and I/II groups, respectively (P<0.05). A significant decrease in CD19(+) lymphocytes was observed in the III/IV group as compared with the I/II group (P<0.05). After radiochemotherapy, NPC patients had significantly (P<0.05) decreased percentages of CD4(+), CD44(+), and CD19(+) lymphocytes and a decreased CD4(+)/CD8(+) ratio, whereas the mean percentages of CD8(+) and NK lymphocytes were significantly (P<0.05) increased. However, compared with the pre-radiochemotherapy values, no significant (P>0.05) changes in CD3(+) or CD25(+) lymphocytes were observed in the NPC-treated group. Follow-up analysis indicated significantly lower DFS for patients with high CD44(+) lymphocytes compared to those with low CD44(+) lymphocytes after radiochemotherapy.

CONCLUSION

Circulating CD44(+) lymphocytes seems to be a promising criterion to predict survival in NPC patients undergoing radiochemotherapy.

Does the prognosis of nasopharyngeal cancer differ among endemic and non-endemic regions?

CONCLUSION

The survival rates and prognostic factors for nasopharyngeal cancer (NPC) were found to be similar to the published series from endemic regions.

OBJECTIVES

The purpose of this retrospective study was to evaluate treatment outcome and prognostic factors of NPC patients treated with radiotherapy or chemoradiotherapy in a non-endemic region.

METHODS

We analyzed clinical characteristics, treatment outcome, and prognostic factors of NPC patients in a non-endemic region, and compared our institution's results with the published literature including a similar patient population from endemic and non-endemic regions. Among 248 NPC patients, 71 (28.6%) were female and 177 (71.4%) were male with a median age of 48 years.

RESULTS

Within a median 59 months (range 22-178) of follow-up, local recurrence developed in 22 (8.9%), regional recurrence in 2 (0.8%), locoregional recurrence in 5 (2%), distant metastases in 21 (8.5%), and both locoregional recurrence and distant metastases in 8 (3.2%) patients. Five-year locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates were 83.7%, 73%, 78.5%, and 71.1%, respectively. In multivariate analysis for LRC, cranial nerve involvement (CNI) (p = 0.009) and tumor response (p = 0.004); for DFS, age (p = 0.003), CNI (p = 0.02), AJCC T classification (p = 0.05), and tumor response (p = 0.01); for DSS, age (p = 0.003), CNI (p = 0.04), AJCC T classification (p = 0.04), and tumor response (p = 0.01); for OS, age (p < 0.001), AJCC T classification (p = 0.005), and tumor response (p < 0.001) were significant prognostic factors.