1
|
Liu L, Luo X, Wu W, Li Y, Long J, Luo X, Chen X, Gong X, Zhao C, He Q, Li Z, Shang K, Chen Y, Xinyu X, Jin F. Long-term survival, toxicities, and the role of chrono-chemotherapy with different infusion rates in locally advanced nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy: a retrospective study with a 5-year follow-up. Front Oncol 2024; 14:1371878. [PMID: 38585011 PMCID: PMC10995334 DOI: 10.3389/fonc.2024.1371878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose This study aimed to evaluate 5-year outcomes and the late toxicity profile of chrono-chemotherapy with different infusion rates in patients with locally advanced nasopharyngeal carcinoma (NPC). Methods and materials Our retrospective analysis included 70 patients with locally advanced NPC stages III and IVB (according to the 2010 American Joint Committee on Cancer staging system). Patients were treated with two cycles of induction chemotherapy (IC) before concurrent chemoradiotherapy (CCRT) at Guizhou Cancer Hospital. The IC with docetaxel, cisplatin (DDP) and fluorouracil regimen. Patients were divided into two groups during CCRT. Using a "MELODIE" multi-channel programmed pump, DDP (100 mg/m2) was administered for 12 hours from 10:00 am to 10:00 pm and repeated every 3 weeks for 2-3 cycles. DDP was administered at the peak period of 4:00 pm in the sinusoidal chrono-modulated infusion group (Arm A, n=35). The patients in Arm B received a constant rate of infusion. Both arms received radiotherapy through the same technique and dose fraction. The long-term survival and disease progression were observed. Results After a median follow-up of 82.8 months, the 5-year progression-free survival rate was 81.3% in Arm A and 79.6% in Arm B (P = 0.85). The 5-year overall survival rate was not significantly different between Arm A and Arm B (79.6% vs 85.3%, P = 0.79). The 5-year distant metastasis-free survival rate was 83.6% in Arm A and 84.6% in Arm B (P = 0.75). The 5-year local recurrence-free survival rate was 88.2% in Arm A and 85.3% in Arm B (P = 0.16). There were no late toxicities of grade 3-4 in either group. Both groups had grade 1-2 late toxicities. Dry mouth was the most common late toxic side effect, followed by hearing loss and difficulty in swallowing. There was no statistically significant difference between Arm A and Arm B in terms of side effects. Conclusion Long-term analysis confirmed that in CCRT, cisplatin administration with sinusoidal chrono-modulated infusion was not superior to the constant infusion rate in terms of long-term toxicity and prognosis.
Collapse
Affiliation(s)
- Lina Liu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xunyan Luo
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Weili Wu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yuanyuan Li
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jinhua Long
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiuling Luo
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiaoxiao Chen
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiuyun Gong
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Chaofen Zhao
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Qianyong He
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhuoling Li
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Kai Shang
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yue Chen
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Xu Xinyu
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Feng Jin
- Department of Oncology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China
- Department of Oncology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| |
Collapse
|
2
|
Giambattista J, McVicar N, Hamilton S, Martin M, Maas B, Ho C, Wu J, Tran E, Hay J, Berthelet E. Magnetic Resonance Imaging Volumetry of Primary Nasopharyngeal Cancer in Patients Treated with Induction Gemcitabine and Cisplatin Followed by Concurrent Cisplatin and Volumetric Modulated Arc Therapy. Cureus 2018; 10:e3296. [PMID: 30443466 PMCID: PMC6235650 DOI: 10.7759/cureus.3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction The addition of induction chemotherapy (IC) to the standard concurrent chemoradiotherapy (CCRT) is under consideration in locally advanced nasopharyngeal carcinoma (LANPC). To-date, no studies have reported primary gross tumour volume (GTVp) changes using gemcitabine and cisplatin as the IC phase in LANPC. We investigated the timing and magnitude of GTVp response throughout sequential gemcitabine and cisplatin IC and CCRT for LANPC. Toxicity and tumour control probability (TCP) analyses are also presented Methods Ten patients with LANPC underwent sequential IC and CCRT between 2011 and 2015. All patients had magnetic resonance imaging (MRI) at three time points: before IC (MRI0), after IC (MRI1), and three months after CCRT (MRI3). Five of the 10 patients had an additional MRI four to five weeks into CCRT (MRI2). GTVp contours were delineated retrospectively using contrast-enhanced MRIs, and each GTVp underwent secondary review by a neuroradiologist. Acute toxicities were graded retrospectively via chart review based on the National Cancer Institute Common Terminology for Adverse Events version 4.0 (NCI CTCAE v4.0). Results Mean GTVp reduction between MRI0 - MRI1 was from 68 cc to 47 cc and from 47 cc to 9 cc between MRI1 - MRI3. In patients with MRI2, the mean GTVp reduction between MRI1 - MRI2 was from 57 cc to 32 cc. Tumour control probability estimates increased by 0.11 after IC. Patients tolerated the treatment well with one Grade IV toxicity event. Conclusion The observed GTVp response and improved tumor control probability support further investigation into the use of IC in LANPC.
Collapse
Affiliation(s)
- Joshua Giambattista
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Nevin McVicar
- Medical Physics, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Sarah Hamilton
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Montgomery Martin
- Radiology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Benjamin Maas
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Cheryl Ho
- Medical Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Jonn Wu
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Eric Tran
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - John Hay
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| | - Eric Berthelet
- Radiation Oncology, British Columbia Cancer, Vancouver Cancer Centre, Vancouver, CAN
| |
Collapse
|
3
|
Matsuyama H, Yamazaki K, Okabe R, Ueki Y, Shodo R, Omata J, Sato Y, Ota H, Takahashi T, Tomita M, Yokoyama Y, Togashi T, Aoyama H, Abe E, Saijo Y, Katsura K, Soga M, Sugita T, Matsumoto Y, Tsuchida E, Horii A. Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan. Auris Nasus Larynx 2018; 45:1086-1092. [PMID: 29567334 DOI: 10.1016/j.anl.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).
Collapse
Affiliation(s)
- Hiroshi Matsuyama
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Keisuke Yamazaki
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryuichi Okabe
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yushi Ueki
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryusuke Shodo
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jo Omata
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hisayuki Ota
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takeshi Takahashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Masahiko Tomita
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Yusuke Yokoyama
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Takafumi Togashi
- Department of Otorhinolaryngology, Niigata City General Hospital, Niigata, Japan
| | - Hidefumi Aoyama
- Departments of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eisuke Abe
- Departments of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuo Saijo
- Departments of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kouji Katsura
- Departments of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Marie Soga
- Departments of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadashi Sugita
- Department of Radiation Therapy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasuo Matsumoto
- Department of Radiation Therapy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Emiko Tsuchida
- Department of Radiation Oncology, Niigata City General Hospital, Niigata, Japan
| | - Arata Horii
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
4
|
Xu L, Pan J, Wu J, Pan C, Zhang Y, Lin S, Yang L, Chen C, Zhang C, Zheng W, Lin S, Ni X, Kong FMS. Factors associated with overall survival in 1706 patients with nasopharyngeal carcinoma: significance of intensive neoadjuvant chemotherapy and radiation break. Radiother Oncol 2010; 96:94-9. [PMID: 20435361 DOI: 10.1016/j.radonc.2010.04.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 03/18/2010] [Accepted: 04/05/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE To exam factors associated with overall survival (OS) in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS This study is a retrospective study of a total of 1706 consecutive NPC patients from a single institution between January 1995 and December 1998. One thousand eighty-one patients were treated with radiotherapy (RT) alone and 625 with an intensive course of neoadjuvant chemotherapy followed by RT. Patient, tumor and treatment factors were analyzed for their significance on 5-year overall survival (OS). RESULTS Younger age, female gender, absence of anemia pre-RT, early tumor stage, interruption of RT, and neoadjuvant chemotherapy were significantly associated with survival under multivariate analysis (all P<0.05). The 5-year OS rates were 100%, 75.9% (95%CI 71.6-80.2%), 66.5% (95%CI 62.8-70.2%), and 49.3% (95%CI 45.0-53.6%) for stage I, II, III, and IV (P<0.05); 68.9% (95%CI 66.2-71.5%) and 63.7% (95%CI 61.5-65.8%), for patients treated with or without neoadjuvant chemotherapy (P=0.0051), and 51.7% (95%CI 45.0-58.4%) and 69.5% (95%CI 67.2-71.7%) for patients with or without treatment break (P<0.0001), respectively. CONCLUSION Intensive neoadjuvant chemotherapy and absence of radiation break seem to be favorable factors associated with long-term survival in patients with NPC.
Collapse
Affiliation(s)
- Luying Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University, Fuzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
He XY, Hu CS, Ying HM, Wu YR, Zhu GP, Liu TF. Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2009; 267:773-8. [PMID: 19820959 DOI: 10.1007/s00405-009-1112-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 09/18/2009] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate the efficacy and the toxicity of paclitaxel and cisplatin in patients in concurrent radiotherapy for locally advanced nasopharyngeal carcinoma, and to see whether such a regime would be better tolerated than high dose cisplatin plus fluoracil in Chinese patients. Thirty-one patients with locally advanced nasopharyngeal carcinoma were enrolled. Patients were scheduled to receive two courses of concomitant chemotherapy, starting on day 1 and then day 28 during radiotherapy (70-76 Gy in 35-38 fractions in 7-7.5 weeks). Chemotherapy was given by intravenous infusion, paclitaxel 120 mg/m(2) in 3 h, cisplatin 75 mg/m(2) (25 mg/m(2) days 1-3). Adjuvant therapy was paclitaxel 135 mg/m(2) in 3 h, cisplatin 75 mg/m(2) (25 mg/m(2) days 1-3) on weeks 3, 6, 9 after radiotherapy. All patients completed radiotherapy, but for concomitant chemoradiotherapy, 20 of the 31 patients completed the 2 cycles of chemotherapy, while the other 11 could only receive 1 cycle due to various reasons. The median follow-up was 40 months, 2 patients developed locoregional recurrences, one of whom in the cervical lymph nodes, the other in the nasopharynx. The 3-year overall survival rate was 83.9% and the distant metastasis rate at 3 years was 13.6%. Grade 3-4 toxicities were neutropenia 12.9%, anaemia 6.45%, thrombocytopenia 3.22%, severe arrhythmia 3.2%, and hypersensitivity reaction 3.2%. In conclusion, paclitaxel with cisplatin as concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma is feasible, safe, and might improve regional control and survival rates in Chinese patients.
Collapse
Affiliation(s)
- Xia-Yun He
- Department of Radiation Oncology, Cancer Hospital, Fudan University, 399 Ling Ling Road, 200032, Shanghai, People's Republic of China
| | | | | | | | | | | |
Collapse
|