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Zhang WW, Lin JY, Wang GY, Huang CL, Tang LL, Mao YP, Zhou GQ, Liu LZ, Tian L, Li JB, Ma J, Guo R. Radiotherapy alone versus concurrent chemoradiotherapy in patients with stage II and T3N0 nasopharyngeal carcinoma with adverse features: A propensity score-matched cohort study. Radiother Oncol 2024; 194:110189. [PMID: 38432309 DOI: 10.1016/j.radonc.2024.110189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/10/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Whether concurrent chemoradiotherapy would provide survival benefits in patients with stage II and T3N0 NPC with adverse factors remains unclear in IMRT era. We aimed to assess the value of concurrent chemotherapy compared to IMRT alone in stage II and T3N0 NPC with adverse features. MATERIALS AND METHODS 287 patients with stage II and T3N0 NPC with adverse factors were retrospectively analyzed, including 98 patients who received IMRT alone (IMRT alone group) and 189 patients who received cisplatin-based concurrent chemotherapy (CCRT group). The possible prognostic factors were balanced using propensity score matching (PSM). Kaplan-Meier analysis was used to evaluate the survival rates, and log-rank tests were employed to compare differences between groups. RESULTS The median follow-up duration was 90.8 months (interquartile range = 75.6-114.7 months). The IMRT alone and the CCRT group were well matched; however, for all survival-related endpoints, there were no significant differences between them (5-year failure-free survival: 84.3% vs. 82.7%, P value = 0.68; 5-year overall survival: 87.3% vs. 90.6%, P value = 0.11; 5-year distant metastasis-free survival: 92.8% vs. 92.5%, P value = 0.97; 5-year locoregional relapse-free survival: 93.4% vs. 89.9%, P value = 0.30). The incidence of acute toxicities in the IMRT alone group was significantly lower than that in the CCRT group. CONCLUSION For patients with stage II and T3N0 NPC with adverse features treated using IMRT, no improvement in survival was gained by adding concurrent chemotherapy; however, the occurrence of acute toxicities increased significantly. For those combined with non-single adverse factors, the comprehensive treatment strategy needs further exploration.
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Affiliation(s)
- Wei-Wei Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Jia-Yi Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Gao-Yuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Cheng-Long Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Li-Zhi Liu
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Li Tian
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Ji-Bin Li
- Clinical Trials Centre, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China
| | - Rui Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China.
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Li PJ, Lai YL, He F, Chen YY, Gu ZS, Luo W, Zhang Q. Explore the Usefulness of Concurrent Chemotherapy in Stage II Nasopharyngeal Carcinoma: A Retrospective Study. Front Pharmacol 2021; 12:688528. [PMID: 34621166 PMCID: PMC8490628 DOI: 10.3389/fphar.2021.688528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: This study aims to compare the treatment outcomes of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in stage II nasopharyngeal carcinoma (NPC) patients. Methods: We retrospectively collected 601 stage II NPC patients treated in two hospitals between June 2003 to June 2016. All patients were divided into the CCRT group (n = 255) and the RT group (n = 346). Overall survival (OS), locoregional failure-free survival (LRFFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. The log-rank test was used to compare the differences between the groups. The Cox-regression hazards model was performed to determine potential prognostic factors. Results: The median follow-up was 99 months. No significant difference was found in locoregional recurrence, distant metastasis, disease progression, and death between the two groups (all p > 0.05). In univariate analysis, the 5-years OS, PFS, LRFFS, and DMFS had no significant differences between the CCRT and RT groups (all p > 0.05). Two-dimensional radiotherapy (2DRT) sub-analysis showed that CCRT remarkably increased DMFS, PFS, and OS rates (all p < 0.05) but not LRFFS (p = 0.258) compared with RT alone. While intensity-modulated radiotherapy (IMRT) sub-analysis showed that the prognosis of the two groups had no significant differences (all p > 0.05). In multivariate analyses, age was significantly and inversely related to OS, PFS, LRFFS, and DMFS. IMRT was an independent favorable factor for improving LRFFS, PFS, and OS. Concurrent chemotherapy was an independent protective factor for DMFS. Conclusion: In the context of 2DRT, it is definite that concurrent chemotherapy provides survival benefits for patients with stage II NPC. While in the IMRT era, the impact of chemotherapy on survival in patients with stage II NPC is weakened. Prospective randomized controlled studies are required to confirm these results.
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Affiliation(s)
- Pei-Jing Li
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Zhejiang Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Hangzhou, China
| | - Yu-Lin Lai
- Department of Radiotherapy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fang He
- Department of Radiotherapy, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan-Yuan Chen
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhuo-Sheng Gu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Luo
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qun Zhang
- Department of Radiotherapy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Wu P, Zhao Y, Xiang L, Yang L. Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review. Cancer Manag Res 2020; 12:957-963. [PMID: 32104077 PMCID: PMC7020924 DOI: 10.2147/cmar.s239729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022] Open
Abstract
Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.
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Affiliation(s)
- Peng Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
| | - Yumei Zhao
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
| | - Li Xiang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
| | - Linglin Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
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Sun XS, Xiao BB, Lin C, Liu SL, Chen QY, Tang LQ, Mai HQ. Establishment and validation of two nomograms to predict the benefit of concurrent chemotherapy in stage II-IVa nasopharyngeal carcinoma patients with different risk factors: Analysis based on a large cohort. Cancer Med 2020; 9:1661-1670. [PMID: 31925942 PMCID: PMC7050092 DOI: 10.1002/cam4.2841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022] Open
Abstract
Objective We aimed to establish and validate two nomograms that predict progression‐free survival (PFS) and overall survival (OS) in patients with stage II–IVa nasopharyngeal carcinoma (NPC) while evaluating the benefit of concurrent chemotherapy. Patients and Methods We randomly divided 3412 patients newly diagnosed with stage II‐IVa NPC between 2008 and 2013 into training and validation ‘A’ cohorts (n = 1706 each). Another set of patients diagnosed between 2014 and 2016 served as validation cohort ‘B’ (n = 1503). A Cox multivariate model using the backward stepwise approach was applied to develop the nomograms, which were assessed for accuracy (Harrel C index) and calibration. Results The 3‐ and 5‐year PFS rates in the training cohort were 86.8% (95% confidence interval [CI] 85.0%‐88.6%) and 82.3% (95% CI 80.1%‐84.5%), respectively. For the PFS nomogram, 5 variables were selected based on a backward procedure in the multivariate Cox model (gender, T stage, N stage, Epstein‐Barr virus DNA, and treatment method). The same variables plus patient age and diabetes mellitus were used for the OS nomogram. The Harrell C indices of the training, validation A, and validation B cohorts were 0.711, 0.700, and 0.703, respectively, for PFS, and 0.775, 0.743, and 0.727, respectively, for OS. Both nomograms performed well in terms of calibration in the training and validation cohorts. Conclusions Our nomograms are reliable prognostic predictors of PFS and OS in patients with stage II‐IVa NPC. These nomograms could robustly estimate an individual's benefit from concurrent chemotherapy, which assists in treatment decision‐making.
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Affiliation(s)
- Xue-Song Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Bei-Bei Xiao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Chao Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Sai-Lan Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
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5
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Liu DH, Zhou XY, Pan YG, Chen S, Ye ZH, Chen GD. Survival of stage II nasopharyngeal carcinoma patients with or without concurrent chemotherapy: A propensity score matching study. Cancer Med 2019; 9:1287-1297. [PMID: 31859464 PMCID: PMC7013074 DOI: 10.1002/cam4.2785] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 11/11/2022] Open
Abstract
Background To ascertain if concurrent chemotherapy (CCT) benefits people with stage II nasopharyngeal carcinoma (NPC) treated with two‐dimensional radiotherapy (2DRT) or intensity‐modulated radiotherapy (IMRT). Methods A total of 4157 patients diagnosed with stage II NPC were evaluated. Patients received radiotherapy (RT) with/without CCT. Patients were divided into 2DRT and IMRT subgroups. After propensity score matching, the role of CCT was explored in these two subgroups. Overall survival (OS) was the primary endpoint and progression‐free survival (PFS), locoregional relapse‐free survival (LRFS) and distant metastasis‐free survival (DMFS) were secondary endpoints. Results In the 2DRT subgroup, CCT addition to RT benefited cases with T1N1/T2N1 in OS, PFS and LRFS (P < .001, P = .003 and P = .003, respectively) significantly, but no difference was observed in patients with T2N0. DMFS were similar in the two arms. CCT was a significant protective factor for OS, PFS, and LRFS for patients with stage N1. In the IMRT subgroup, RT alone could maintain equivalent OS, PFS, LRFS and DMFS (P = .209, .448, .477 and .602 respectively) and cause less acute toxicity compared with concurrent chemoradiotherapy (CCRT). Conclusion CCRT was better than 2DRT alone among patients with T1‐2N1M0 stage. CCT application for NPC patients receiving IMRT led to no survival benefit and greater toxic effects.
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Affiliation(s)
- Di-Han Liu
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China.,Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Xiao-Yu Zhou
- The First Affiliated Hospital of Jinan University, Guangzhou, P. R. China
| | - You-Guang Pan
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Si Chen
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Zheng-Hao Ye
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Gang-Dong Chen
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China
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Pan XB, Li L, Qu S, Chen L, Liang SX, Zhu XD. The efficacy of chemotherapy in survival of stage II nasopharyngeal carcinoma. Oral Oncol 2019; 101:104520. [PMID: 31841883 DOI: 10.1016/j.oraloncology.2019.104520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Chemotherapy use remains controversial for stage II nasopharyngeal carcinoma (NPC). This retrospective study was conducted to identify whether chemoradiotherapy was associated with better survival compared to radiotherapy. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for stage II NPC patients between 2004 and 2015. Patients were divided into radiotherapy and chemoradiotherapy groups. Overall survival (OS) and cancer-specific survival (CSS) were examined using the Kaplan-Meier method, Cox proportional hazards models, and propensity score matching analyses. RESULTS This study examined 908 patients, including 102 receiving radiotherapy and 806 receiving chemoradiotherapy. Chemoradiotherapy was associated with 5-year OS (78.01% vs. 75.12%; p = 0.22) and CSS (78.92% vs. 78.26%; p = 0.40) rates comparable to those of radiotherapy. Propensity score matching analyses demonstrated similar OS (HR: 0.63, 95% CI: 0.36--1.10; p = 0.10) and CSS (HR: 0.77, 95% CI: 0.41-1.48; p = 0.44) rates with radiotherapy. Age >60 years and non-Asian patients were associated with worse survival. CONCLUSION This study revealed that chemoradiotherapy showed similar survivals to stage II NPC patients compared with radiotherapy. Due to the limitations of SEER database, further studies should be performed to verify the results.
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Affiliation(s)
- Xin-Bin Pan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Ling Li
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Song Qu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Long Chen
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China.
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Establishment and validation of a nomogram for predicting the benefit of concurrent chemotherapy in stage II nasopharyngeal carcinoma: A study based on a phase III randomized clinical trial with 10-year follow-up. Oral Oncol 2019; 100:104490. [PMID: 31790913 DOI: 10.1016/j.oraloncology.2019.104490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Our previous phase III randomized trial demonstrated that the addition of concurrent chemotherapy to radiotherapy (RT) could improve survival in stage II nasopharyngeal carcinoma (NPC). Based on the study, we sought to develop a nomogram for predicting the 5-year and 10-year survival of patients with stage II NPC and estimating the benefit of concurrent chemoradiotherapy (CCRT) for individual patients. MATERIALS AND METHODS Data of 199 enrolled patients from the original trial was analyzed to build a nomogram. Overall survival (OS) was the primary endpoint. The discrimination and calibration capacities were evaluated using Harrell Concordance Index (C-index) and calibration curves, respectively. Internal validation of the nomogram was performed by a separate cohort of 306 patients from the same cancer center. RESULT In training cohort, patients in CCRT group achieved higher 5-year and 10-year OS compared with patients in RT group. Three independent prognostic factors, which were age, N stage and treatment method from multivariable analysis were extracted to enter the nomogram. T stage was also included due to its importance in clinical decisions. The Harrell C-index of the nomogram in training and validation cohort was 0.748 and 0.653 respectively. The calibration curves showed an acceptable agreement between prediction and observed probability. CONCLUSION We developed and validated a nomogram to predict the 5-year and 10-year OS in stage II NPC patients. The nomogram could serve as a pragmatic tool in clinical decisions to estimate the individual risk of stage II patients and identify those who could benefit from chemotherapy.
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Ding XC, Fan PP, Xie P, Fan BJ, Yang J, Jiang LY, Bai XB, Yu JM, Hu M. Ten-Year Outcomes Of Intensity-Modulated Radiotherapy (IMRT) Combine With Chemotherapy Versus IMRT Alone For Stage II Nasopharyngeal Carcinoma In The Real-World Study (RWD). Cancer Manag Res 2019; 11:8893-8903. [PMID: 31632149 PMCID: PMC6791404 DOI: 10.2147/cmar.s218842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim was to define the role of chemotherapy in stage II nasopharyngeal carcinoma (NPC) and to identify the toxicity of chemotherapy for these patients in the era of intensity-modulated radiotherapy (IMRT). Methods Between January 2002 and December 2013, 169 patients with stage II NPC were analyzed. Of these patients, 149 patients treated with chemotherapy were divided into three groups as follows: neoadjuvant chemotherapy followed by IMRT (NCT) group, concurrent chemotherapy with IMRT (CCRT) group, and neoadjuvant chemotherapy followed by CCRT (NC+CCRT) group. In addition, 20 patients received IMRT alone. We retrospectively assessed the 10-year survival and acute adverse effects in the patients using SPSS software. Results The median follow-up time was 93 months (2–160 months). The 10-year OS of the NCT, CCRT, NC+CCRT groups vs the IMRT alone group was 69.8%, 63.4%, 69.7% vs 72.4%, respectively (P=0.664, 0.940, and 0.998, respectively). Both univariable and multivariable analyses showed that the addition of chemotherapy to IMRT did not significantly improve the 10-year survival outcomes. The hematotoxicity and mucous reaction of patients with chemotherapy were more serious than those with IMRT alone (P=0.007 and 0.049). Distant metastasis for stage II NPC patients mostly occurred within 3 years, which is very different from patients with advanced NPC. Conclusion Patients with stage II NPC who are treated with IMRT may obtain satisfactory long-term survival outcomes. The additional chemotherapy cannot significantly increase survival; however, it may remarkably increase treatment-associated acute toxic reactions.
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Affiliation(s)
- Xing-Chen Ding
- Department of Oncology, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Ping-Ping Fan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Peng Xie
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Bing-Jie Fan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Jia Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Li-Yang Jiang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Xin-Bin Bai
- Department of Oncology, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Jin-Ming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Man Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
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Taxane-based Induction Chemotherapy Plus Concurrent Chemoradiotherapy in Nasopharyngeal Carcinoma: Prospective Results from a Non-endemic Cohort. Clin Oncol (R Coll Radiol) 2019; 31:850-857. [PMID: 31296457 DOI: 10.1016/j.clon.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022]
Abstract
AIMS To report the outcomes of induction chemotherapy (ICT) followed by chemoradiotherapy (CTRT) for a large cohort of locoregionally advanced nasopharyngeal cancer (LA-NPC) from a non-endemic region. MATERIALS AND METHODS Between January 2008 and July 2015, 201 patients with histologically proven, non-metastatic NPC were treated with ICT followed by CTRT at our institute. All the patients received two to three cycles of a taxane-based ICT regimen. Radiotherapy was delivered using an intensity-modulated radiotherapy (IMRT) technique in all patients. RESULTS After a median follow-up of 37 months (range: 7-110 months), the 3-year disease-free survival (DFS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival of the entire cohort was 72, 85, 83 and 87.4%, respectively. On multivariate analysis, histology was an independent predictor of DFS, LRFS and overall survival, with keratinising squamous cell carcinoma histologies predicting a worse outcome. The nodal stage was an independent predictor of DFS, DMFS and overall survival. Age, gender, ethnicity, tumour stage and response to ICT did not significantly affect any of the outcomes. Grade 2 or worse subcutaneous fibrosis was seen in 19% of patients at last follow-up and grade 2 or worse xerostomia was seen in 24% of patients. Thirty-nine per cent of patients developed clinical hypothyroidism at last follow-up. CONCLUSION ICT followed by concurrent CTRT in the IMRT era provides excellent locoregional control, distant control and overall survival rates in patients with LA-NPC. However, distant failure continues to be a problem and may require further systemic intensification.
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10
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Sun XS, Chen WH, Liu SL, Liang YJ, Chen QY, Guo SS, Wen YF, Liu LT, Xie HJ, Tang QN, Li XY, Yan JJ, Mai HQ, Tang LQ. Individualized concurrent chemotherapy by pretreatment plasma Epstein-Barr viral DNA in II-III stage nasopharyngeal carcinoma: A propensity score matching analysis using a large cohort. Cancer Med 2019; 8:4214-4225. [PMID: 31210417 PMCID: PMC6675745 DOI: 10.1002/cam4.2343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022] Open
Abstract
Object To ascertain the treatment effect of concurrent chemotherapy (CCT) in stage II‐III nasopharyngeal carcinoma (NPC) patients with different Epstein‐Barr virus (EBV) DNA level in intensity‐modulated radiotherapy (IMRT) era. Methods A total of 2742 patients diagnosed with stage II‐III NPC were involved in this study. Patients received IMRT with/without CCT. Overall survival (OS) was the primary endpoint. Receiver operating characteristics curve was used to determine the cut‐off value of pre‐DNA based on OS. After propensity score matching, the role of CCT was explored in patients with different EBV DNA level. Results In our cohort, the cut‐off value of pre EBV DNA was 1460 copies/mL (area under curve [AUC], 0.695‐0.769; sensitivity, 0.766; specificity, 0.599). Patients with high EBV DNA level showed poor survival in OS, progression free survival (PFS), locoregional relapse‐free survival (LRFS) and distant metastasis‐free survival (DMFS). In patients with EBV DNA level >1460 copies/mL, the concurrent chemoradiotherapy (CCRT) group achieved higher 3‐year OS compared with IMRT groups. However, the CCRT and IMRT groups showed comparable OS in patients with EBV DNA ≤1460 copies/mL. In multivariate analyses, CCT was a protective factor for OS, PFS, and LRFS in high‐risk patients (EBV DNA level >1460 copies/mL), while not an independent prognostic factor among the low‐risk patients (EBV DNA level ≤1460 copies/mL). Conclusion Pre‐EBV DNA could be a useful tool to guide individualized treatment for stage II‐III NPC patients. Additional CCT to IMRT improved the survival for patients with high pre‐EBV DNA, while those with low pre‐EBV DNA could not.
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Affiliation(s)
- Xue-Song Sun
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Wen-Hui Chen
- Department of Oncology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Sai-Lan Liu
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Yu-Jing Liang
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Shan-Shan Guo
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Yue-Feng Wen
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Hao-Jun Xie
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Qing-Nan Tang
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Xiao-Yun Li
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Jin-Jie Yan
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, P. R. China.,Collaborative Innovation Centre for Cancer Medicine, Guangzhou, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, P. R. China
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11
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Hu Y, Lu T, Huang SH, Lin S, Chen Y, Fang Y, Zhou H, Chen Y, Zong J, Zhang Y, Chen Y, Pan J, Xiao Y, Guo Q. High‐grade radiologic extra‐nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma. Head Neck 2019; 41:3317-3327. [PMID: 31206864 DOI: 10.1002/hed.25842] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Yujun Hu
- Department of Radiation OncologyFujian Medical University Cancer Hospital Fuzhou China
| | - Tianzhu Lu
- Department of Radiation OncologyFujian Medical University Cancer Hospital Fuzhou China
| | - Shao Hui Huang
- Department of Radiation OncologyPrincess Margaret Cancer Centre/University of Toronto Toronto Ontario Canada
| | - Shaojun Lin
- Department of Radiation OncologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospital Fuzhou Fujian China
| | - Yunbin Chen
- Department of RadiologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Yanhong Fang
- Department of RadiologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Han Zhou
- Department of Radiation OncologyFujian Medical University Cancer Hospital Fuzhou China
| | - Yiping Chen
- Department of Radiation OncologyFujian Medical University Cancer Hospital Fuzhou China
| | - Jingfeng Zong
- Department of Radiation OncologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Yu Zhang
- Department of Radiation OncologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Ying Chen
- Department of RadiologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Jianji Pan
- Department of Radiation OncologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospital Fuzhou Fujian China
| | - Youping Xiao
- Department of RadiologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
| | - Qiaojuan Guo
- Department of Radiation OncologyFujian Medical University Cancer Hospital & Fujian Cancer Hospital Fuzhou China
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospital Fuzhou Fujian China
- Key Laboratory of Systems Biomedicine (Ministry of Education)Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University Shanghai China
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12
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He SS, Wang CT, Peng ZW, Ren YF, Lu LX, Chen RW, Liang SB, Wang Y, Chen Y. Development and external validation of a nomogram for predicting the overall survival of patients with stage II nasopharyngeal carcinoma after curative treatment. Cancer Manag Res 2019; 11:4403-4412. [PMID: 31191003 PMCID: PMC6519021 DOI: 10.2147/cmar.s202151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/29/2019] [Indexed: 01/16/2023] Open
Abstract
Objective: To facilitate decision-making support for individual patients, development and external validation of a nomogram was undertaken to reveal prognostic factors and predict the value of concurrent chemoradiotherapy (CCRT) compared with radiotherapy (RT) for stage-II nasopharyngeal carcinoma (NPC) patients. Methods: Clinical data of 419 and 309 patients with American Joint Committee on Cancer (2017) stage-II NPC in two institutions in China were collected retrospectively. Overall survival (OS) and progression-free survival were compared using Kaplan-Meier estimates. Cox regression analysis was used to identify the prognostic factors for building the nomogram. Predictive accuracy and discriminative ability were measured using the Concordance Index. Results: Finally, there were 24 and 20 deaths in the development and validation group, respectively. Patients with stage T2N1, N1 stage, involvement of retropharyngeal and unilateral cervical lymph nodes, and who had RT alone had worse OS (P=0.019, 0.035, 0.003 and 0.010, respectively; log-rank test) than patients with stage T1N1 and T2N0, N0 stage, involvement of retropharyngeal or unilateral cervical lymph nodes, and CCRT, respectively. After multivariate analysis of the training set, age, neutrophil-to-lymphocyte ratio, therapy type, and pretreatment plasma concentration of Epstein-Barr virus DNA were independent prognostic factors of OS. A nomogram was established externally by involving all the factors stated above. The Concordance Index for the established nomogram to predict the OS of the training set was 0.793 (95% CI 0.689-0.897), and 0.803 (95% CI 0.696-0.910) in the validation set. Conclusion: These data suggest that the nomogram was validated externally, could predict long-term outcome accurately, and enable accurate stratification of risk groups for stage-II NPC. Our model facilitated individualized care of NPC patients.
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Affiliation(s)
- Sha-Sha He
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Cheng-Tao Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Zhen-Wei Peng
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Yu-Feng Ren
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Li-Xia Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510080, People's Republic of China
| | - Rui-Wan Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Shao-Bo Liang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510080, People's Republic of China.,Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan, Guangdong 510080, People's Republic of China
| | - Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, People's Republic of China
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13
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Huang CJ, Huang MY, Shih MCP, Cheng KY, Lee KW, Lu TY, Yuan SS, Fang PT. Post-radiation sinusitis is associated with recurrence in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Radiat Oncol 2019; 14:61. [PMID: 30971260 PMCID: PMC6458621 DOI: 10.1186/s13014-019-1261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study investigated the impact of post-radiation sinusitis on the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). METHODS Two hundred and thirty patients with non-metastatic NPC were analyzed in terms of freedom from local failure (FFLF), freedom from distant failure (FFDF), overall survival (OS), and disease-free survival (DFS). For each patient, the status of the sinus mucosa was flexibly assessed by documenting mucosal changes as indicated by differences between images obtained before radiotherapy and more than 6 months post-radiation. RESULTS With a median follow-up of 39.7 months (8 to 81 months), 19 (8.26%) patients relapsed locally, 13 (5.65%) patients failed in the neck, and 26 (11.3%) patients developed distant metastases. The presence of sinusitis noted in images post-radiation was a significant predictor for DFS (p = 0.001), FFLF (p = 0.004), and FFDF (p = 0.015), in addition to having high negative predictive value for local relapse (97.5%). CONCLUSIONS This is the first study to investigate the prognostic value of post-radiation sinusitis in NPC patients treated with IMRT. Post-radiation sinusitis was found to be a significant predictor for DFS, FFLF, and FFDF, and was also found to have high negative predictive value for local recurrence (97.5%). It may thus be used as an additional tool for clinicians to determine the possibility of recurrence.
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Affiliation(s)
- Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Medical imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Radiology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-yuan Cheng
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ka-Wo Lee
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzu-Ying Lu
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyng-Shiou Yuan
- Translational Research Center, Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pen-Tzu Fang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Radiation Oncology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Pan XB, Huang ST, Chen KH, Jiang YM, Zhu XD. Predictive factors of chemotherapy use in stage II nasopharyngeal carcinoma: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14512. [PMID: 30762786 PMCID: PMC6408135 DOI: 10.1097/md.0000000000014512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Identification of predictive factors of chemotherapy use and assessment of the roles of these factors in prognosis will aid therapeutic decision-making in stage II nasopharyngeal carcinoma (NPC).Using logistic regression, we retrospectively assessed factors predicting chemotherapy use in 251 stage II (2010 UICC/AJCC staging system) NPC patients. Five-year overall survival (OS), locoregional-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed based on the predictive factors.Logistic regression found that N1 stage was an independent factor predicting chemotherapy use in stage II NPC patients. However, 5-year OS (96.5% vs 94.9%, P = .564), LRFS (98.2% vs 96.9%, P = .652), and DMFS (95.9% vs 97.6%, P = .560) did not differ between N0 and N1 stage patients. Moreover, addition of chemotherapy use did not improve treatment outcomes in N1 stage compared with radiotherapy alone.N1 stage predicted chemotherapy use in stage II NPC patients. But, the addition of chemotherapy did not provide a survival benefit.
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15
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Tian YM, Liu MZ, Zeng L, Bai L, Lin CG, Huang SM, Deng XW, Chong-Zhao, Lu TX, Han F. Long-term outcome and pattern of failure for patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Head Neck 2018; 41:1246-1252. [PMID: 30593728 DOI: 10.1002/hed.25545] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To analyze the long-term outcome and pattern of failure for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS Patients with NPC after IMRT from 2001 to 2008 were recruited (n = 865). Clinical features, laboratory data, and treatments were collected. RESULTS The 10-year local recurrence-free survival, distant metastasis-free survival, and disease-specific survival (DSS) were 92.0%, 83.4%, and 78.6%, respectively. A total of 209 patients died: 59% of whom died from distant metastasis. The 10-year DSS was higher in patients who received chemoradiotherapy than those who received IMRT alone for patients with high-risk stage III disease, while there was no survival difference for patients with stage II and low-risk stage III disease. CONCLUSIONS IMRT provides satisfactory long-term survival for patients with NPC. Distant metastasis has been the most common reason for failure. Adding chemotherapy did not improve survival in patients with stage II and low-risk stage III disease.
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Affiliation(s)
- Yun-Ming Tian
- Department of Radiation Oncology, Hui Zhou Municipal Central Hospital.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Ming-Zhu Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Lei Zeng
- Department of Radiation Oncology, Jiangxi Cancer Hospital
| | - Li Bai
- Department of Radiation Oncology, Hui Zhou Municipal Central Hospital
| | - Cheng-Guang Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Shao-Min Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Xiao-Wu Deng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Chong-Zhao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Tai-Xiang Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
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16
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Yu Y, Liang H, Lv X, Ke L, Qiu W, Huang X, Liu G, Li W, Guo X, Xiang Y, Xia W. Platinum-based concurrent chemotherapy remains the optimal regimen for nasopharyngeal carcinoma: a large institutional-based cohort study from an endemic area. J Cancer Res Clin Oncol 2018; 144:2231-2243. [PMID: 30109501 DOI: 10.1007/s00432-018-2721-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To retrospectively investigate the optimal regimen of concurrent chemotherapy for nasopharyngeal carcinoma (NPC) by comparing clinical outcomes of patients who received platinum-based and non-platinum-based concurrent chemoradiotherapy (CCRT) regimens. METHODS Based on a prospectively maintained database from 1998 to 2013 in an endemic area, a total of 4608 newly diagnosed, biopsy-proven, and non-disseminated NPC patients were identified and allocated into three cohorts based on concurrent chemotherapy regimens: cisplatin-based (CP) chemotherapy cohort, other platinum-based (OP) chemotherapy cohort, and non-platinum-based (NP) chemotherapy cohort. Overall survival (OS) and disease-free survival (DFS) were estimated using the Cox proportional hazards model and propensity score analysis of treatment using an inverse probability weighting model (PSA/IPTW). Finally, sensitivity analysis estimated the effects of potential unmeasured confounders. RESULTS The median follow-up time was 68.5 months (range 2-194 months). The multivariate Cox model showed that NP regimens were significantly related with worse survival compared with CP or OP regimens (OS: HR 1.51, 95% CI 1.16-2.00, P = 0.002; HR 1.68, 95% CI 1.24-2.27, P = 0.001; DFS: HR 1.31, 95% CI 1.03-1.66, P = 0.031; HR 1.50, 95% CI 1.14-1.97, P = 0.004, respectively). Meanwhile, no significant survival difference was found between OP and CP regimens. The PSA/IPTW method, CCRT-specific and III-IVB NPC cohort subgroup analysis showed similar results. Sensitivity analysis confirmed the robustness of our results. CONCLUSIONS Platinum-based concurrent chemotherapy, including both CP and OP regimens, yields better survival benefits for non-metastatic NPC patients than the NP regimen and remains the optimal regimen for these patients.
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Affiliation(s)
- Yahui Yu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Hu Liang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xing Lv
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Liangru Ke
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wenze Qiu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xinjun Huang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Guoying Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wangzhong Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiang Guo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Yanqun Xiang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Weixiong Xia
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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Fangzheng W, Chuner J, Quanquan S, Zhimin Y, Tongxin L, Jiping L, Sakamoto M, Peng W, Kaiyuan S, Weifeng Q, Zhenfu F, Yangming J. Addition of chemotherapy to intensity-modulated radiotherapy does not improve survival in stage II nasopharyngeal carcinoma patients. J Cancer 2018; 9:2030-2037. [PMID: 29896288 PMCID: PMC5995949 DOI: 10.7150/jca.25042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/28/2018] [Indexed: 01/16/2023] Open
Abstract
In this study, we examined whether combining neoadjuvant chemotherapy (NAC) and/or concurrent chemotherapy (CC) with intensity-modulated radiotherapy (IMRT) improved survival in patients with stage II nasopharyngeal carcinoma (NPC). Two hundred forty-two stage II NPC patients were enrolled between May 2008 and April 2014 and received radical IMRT with simultaneous integrated boost technique using 6 MV photons; some patient groups also received chemotherapy every 3 weeks for 2-3 cycles. The median follow-up duration was 69 months for all patients. At the last follow-up, 18 patients had experienced treatment failure; locoregional relapse among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT occurred in 3, 3, 4 and 5, respectively; distant metastases in 0, 0, 2 and 1, respectively, and there was a statistically significant difference among four groups (P=0.019). The 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates for all patients were 94.7%, 98.7%, 92.9%, and 93.4%, respectively. Five-year LRRFS, DMFS, PFS, and OS were similar among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT treatment groups. Univariate and multivariate analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received IMRT plus chemotherapy experienced more acute adverse events than those who received IMRT alone. Thus, the addition of NAC and/or CC to IMRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than IMRT alone in patients with stage II NPC.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Jiang Chuner
- Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Liu Jiping
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Masoto Sakamoto
- Department of Radiology, Fukui Red Cross Hospital, Fukui Japan
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Shi Kaiyuan
- Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Qin Weifeng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, 100101, People's Republic of, China
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Wang S, Li S, Shen L. Combined chemoradiation vs radiation therapy alone in stage-II nasopharyngeal carcinoma: A meta-analysis of the published literature. Curr Probl Cancer 2018; 42:302-318. [PMID: 29759802 DOI: 10.1016/j.currproblcancer.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
The aim of this meta-analysis was to evaluate the efficacy and toxicity of adding chemotherapy to radiotherapy (RT) in the treatment of stage-II nasopharyngeal carcinoma (NPC). We searched Pubmed, Cochrane Library, Embase, China National Knowledge Internet, China Biology Medicine, VIP, and Wanfang database for studies of the RT with or without chemotherapy in patients with stage-II NPC that were published in any language. Analyses were carried out using RevMan 5.3 software. The relative risk was used to evaluate the data, the I2 test was used to compare heterogeneity, sensitivity analysis was used to evaluate the stability and reliability of the results. There were 16 studies with 3038 patients that were included in this analysis. Risk ratios (RR) of 1.04 (95% CI: 1.01-1.06), 1.05 (95% CI: 1.00-1.10), 1.05 (95% CI: 1.02-1.07), and 1.00 (95% CI: 0.97-1.03) were observed for overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS). Subgroup analysis showed that compared with conventional RT alone, chemoradiation (CRT) could significantly improve OS (RR = 1.09, 95% CI: 1.03-1.15), PFS (RR = 1.20, 95% CI: 1.08-1.35), and LRFS (RR = 1.09, 95% CI: 1.04-1.14), but did not significantly improve the rate of DMFS (RR = 1.03, 95% CI: 0.94-1.12). However, compared with intensity modulated radiation therapy alone, CRT did not significantly improve the rate of OS (RR = 1.01, 95% CI: 0.99-1.03), PFS (RR = 0.99, 95% CI: 0.95-1.03), LRFS (RR = 1.02, 95% CI: 0.99-1.05), and DMFS (RR = 0.99, 95% CI: 0.96-1.01). Compared with conventional RT alone, CRT could significantly improve patients' prognoses in terms of OS, PFS, and LRFS for stage-II NPC, but not DMFS, and CRT can provide greater benefits from concurrent chemotherapy than neoadjuvant chemotherapy. With intensity modulated radiation therapy, the stage-II NPC patients did not benefit from the addition of chemotherapy.
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Affiliation(s)
- Sufang Wang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Shan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China.
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The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis. PLoS One 2018; 13:e0194733. [PMID: 29566078 PMCID: PMC5864049 DOI: 10.1371/journal.pone.0194733] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/08/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives To compare clinical outcomes of concurrent chemoradiotherapy (CCRT) with those of radiotherapy alone for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy (IMRT) era. Materials and methods We comprehensively searched PubMed, Embase, and the Cochrane Library to identify eligible studies. Overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRRFS) with hazard ratios (HRs), and toxicities with odd ratios (ORs) were analyzed. Results A total of seven studies met the criteria, with 1302 patients who were treated with IMRT alone or IMRT plus concurrent chemotherapy. No significant survival benefit was shown by CCRT regardless of OS (HR = 1.17, 95% CI 0.73–1.89, P = 0.508), PFS (HR = 0.76, 95% CI 0.38–1.50, P = 0.430), DMFS (HR = 0.89, 95% CI 0.33–2.41, P = 0.816), or LRRFS (HR = 1.03, 95% CI 0.95–1.12, P = 0.498). Additionally, CCRT notably increased the risk of acute grade 3–4 leukopenia (OR = 4.432, 95% CI 2.195–8.952, P < 0.001), compared to IMRT alone. Conclusion Adding concurrent chemotherapy to IMRT led to no survival benefit and increased acute toxicity reactions for stage II nasopharyngeal carcinoma.
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Chemotherapy use and survival in stage II nasopharyngeal carcinoma. Oncotarget 2017; 8:102573-102580. [PMID: 29254272 PMCID: PMC5731982 DOI: 10.18632/oncotarget.21751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/21/2017] [Indexed: 11/25/2022] Open
Abstract
Although common, the use of chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We therefore conducted a retrospective cohort study to investigate whether chemotherapy confers survival gains to stage II NPC patients. A total of 251 stage II (2010 UICC/AJCC staging system) NPC patients treated between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity-score matching method. The primary endpoint was overall survival (OS). Secondary endpoints were locoregional-free survival (LRFS) and distant metastasis-free survival (DMFS). Our analyses revealed no significant differences in OS, LRFS, or DMFS for stage II NPC patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC). T2N1 (OR = 6.690; 95% CI, 3.091–14.481) and T1N1 (OR = 5.857; 95% CI, 2.278–15.061) patients were more likely to receive CCRT than T2N0 patients. Similarly, both T2N1 (OR = 10.513; 95% CI, 3.439–32.137) and T1N1 (OR = 7.321; 95% CI, 1.978–27.098) patients were more likely to receive CCRT + AC than T2N0 patients. The present matched survival analysis suggests potential overuse of chemotherapy in stage II NPC, as the addition of chemotherapy did not provide a survival benefit in this group of patients.
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Li G, Jiang XY, Qiu B, Shen LJ, Chen C, Xia YF. Vicious circle of acute radiation toxicities and weight loss predicts poor prognosis for nasopharyngeal carcinoma patients receiving intensity modulated radiotherapy. J Cancer 2017; 8:832-838. [PMID: 28382146 PMCID: PMC5381172 DOI: 10.7150/jca.17458] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 12/22/2016] [Indexed: 12/30/2022] Open
Abstract
Background: Weight loss during radiotherapy has been known as a negative prognostic factor for nasopharyngeal carcinoma (NPC) patients, but the factors related to weight loss during radiotherapy were not fully understood. Methods: A total of 322 newly diagnosed NPC patients receiving intensity modulated radiotherapy (IMRT) in Sun Yat-sen University Cancer Center between June 2002 and August 2006 were enrolled. Kaplan-Meier methods and log-rank test were applied for survival analysis; a multiple regression was used to identify the factors related to weight loss during radiotherapy. Results: The mean and median values of weight loss (%) during radiotherapy were 6.85% and 6.70%. NPC patients with critical weight loss (> 5.4%) have poorer overall survival (OS) and distant metastasis-free survival (DMFS) than the patients without critical weight loss (p = 0.002 and 0.021, respectively). Pre-radiotherapy weight, acute mucosal toxicity, acute pharynx and esophagus toxicity, and acute upper gastrointestinal toxicity were related to the weight loss during radiotherapy independently (p = 0.01, p < 0.001, p < 0.001, and p = 0.009, respectively). Conclusions: Acute radiation toxicities had significant and independent impact on weight loss during radiotherapy. The vicious circle of acute radiation toxicities and weight loss had bad effect on prognosis of NPC patients.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong 510095, P. R. China;; State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Xiong-Ying Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong 510120, P. R. China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Lu-Jun Shen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
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Concurrent chemoradiotherapy degrades the quality of life of patients with stage II nasopharyngeal carcinoma as compared to radiotherapy. Oncotarget 2017; 8:14029-14038. [PMID: 28152511 PMCID: PMC5355159 DOI: 10.18632/oncotarget.14932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/28/2016] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to compare the quality of life (QoL) of stage II nasopharyngeal carcinoma (NPC) patients treated with radiotherapy (RT) versus concurrent chemoradiotherapy (CCRT). In a cross-sectional study, these patients were treated with RT (n = 55) or CCRT (n = 51) between June 2008 and June 2013. For all subjects, disease-free survival was more than 3 years. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questions and the Head and Neck 35 (EORTC QLQ-H&N35) questions. RT had better outcomes than CCRT for global QoL, functional scales, symptom scales of fatigue and insomnia, financial problems, and weight gain. Survivors receiving 1 cycle of concurrent chemotherapy had worse QoL outcomes than survivors receiving 2 cycles of concurrent chemotherapy. Patients receiving 3 cycles of concurrent chemotherapy had the best QoL outcomes. Thus, CCRT adversely affects the QoL of patients with stage II NPC as compared to radiotherapy.
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Xu C, Zhang LH, Chen YP, Liu X, Zhou GQ, Lin AH, Sun Y, Ma J. Chemoradiotherapy Versus Radiotherapy Alone in Stage II Nasopharyngeal Carcinoma: A Systemic Review and Meta-analysis of 2138 Patients. J Cancer 2017; 8:287-297. [PMID: 28243333 PMCID: PMC5327378 DOI: 10.7150/jca.17317] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/13/2016] [Indexed: 12/03/2022] Open
Abstract
Background: To explore the value of chemoradiotherapy (CRT) in stage II nasopharyngeal carcinoma (NPC) compared to radiotherapy (RT) alone which includes two-dimensional radiotherapy (2D-RT) and intensity-modulated radiotherapy (IMRT). Methods:All topic-related comparative articles were identified by a comprehensive search of public databases (MEDLINE, EMBASE, Cochrane Library and CBMdisc). The primary outcomes were overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Secondary outcomes were grade 3-4 acute toxicity events. We performed subgroup analysis of CRT versus 2D-RT/IMRT alone to investigate the optimal modality. Sensitivity analysis focused on CRT versus IMRT alone was used to assess stability of the study results. Results:Eleven comparative studies (2138 patients) were eligible. CRT had significantly higher OS (HR = 0.67, 95% CI = 0.45-0.98, P = 0.04) and LRRFS (HR = 0.61, 95% CI = 0.46-0.80, P = 0.0003) than RT alone, but no significant difference was observed in DMFS (HR = 0.83, 95% CI = 0.52-1.31, P = 0.41). Meanwhile, CRT was associated with higher frequencies of grade 3-4 leukopenia, mucositis and nausea (P = 0.005, 0.03, < 0.0001, respectively). Subgroup analysis showed that IMRT alone could achieve equivalent OS, LRRFS and DMFS compared to CRT (P = 0.14, 0.06, 0.89, respectively). Significant value was only observed in LRRFS for CRT compared to 2D-RT alone (P = 0.01). Sensitivity analysis for the comparison of CRT and IMRT alone demonstrated generally stable outcomes, in support of the final conclusions. Conclusions:In the treatment of patients with stage II NPC, CRT was better than 2D-RT alone with significant benefit in LRRFS. IMRT alone was superior to CRT with equivalent survival outcomes and fewer grade 3-4 acute toxicities.
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Affiliation(s)
- Cheng Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Li-He Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Yu-Pei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Chen KH, Zhu XD, Li L, Qu S, Liang ZQ, Liang X, Pan XB, Liang ZG, Jiang YM. Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy and intensity-modulated radiotherapy alone for stage II nasopharyngeal carcinoma. Oncotarget 2016; 7:69041-69050. [PMID: 27634892 PMCID: PMC5356610 DOI: 10.18632/oncotarget.11978] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to explore whether concurrent chemoradiotherapy (CCRT) with or without Adjuvant Chemotherapy (AC) could improved the survival in stage II nasopharyngeal carcinoma (NPC). METHODS Patients with stage II NPC treated with CCRT (n=80) or CCRT+AC (n=40) or IMRT alone (n=42) between January 2007 and September 2014 were retrospectively analyzed. The three patient groups were matched based on prognostic factors. All patients were treated with IMRT. The endpoints were overall survival (OS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS), and failure-free survival (FFS). The treatment-related acute toxicity reactions between the three groups were compared also. RESULTS The three groups indicated similar outcomes: survival of the CCRT group, CCRT+AC group and RT alone group were (93.9%, 95.0%, 95.2%, P=0.937) for OS, (96.8%, 94.9%, 93.0%, P=0.756) for LRRFS, (91.1%, 97.5%, 100%, P=0.185) for DMFS and (84.9%, 92.5%, 93.0%, P=0.597) for FFS. Both the univariate and multivariate analysis indicated that older age predicted lower LRRFS and FFS. The CCRT and CCRT+AC groups showed more acute toxicity reactions, especially in bone marrow suppression, Liver dysfunction, gastrointestinal reactions (nausea/vomiting) and weight loss. CONCLUSION CCRT with/without AC could not improve the survival conditions of patients with stage II NPC, but remarkably increased treatment-associated acute toxic reactions when compared with IMRT alone.
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Affiliation(s)
- Kai-Hua Chen
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China
- Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University, Nanning, Guangxi, China
| | - Ling Li
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China
- Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University, Nanning, Guangxi, China
| | - Song Qu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, China
- Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University, Nanning, Guangxi, China
| | - Zhen-Qiang Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xia Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yan-Ming Jiang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Propensity score matching analysis of cisplatin-based concurrent chemotherapy in low risk nasopharyngeal carcinoma in the intensity-modulated radiotherapy era. Oncotarget 2016; 6:44019-29. [PMID: 26528755 PMCID: PMC4791283 DOI: 10.18632/oncotarget.5806] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Patients with stage II nasopharyngeal carcinoma were reported to benefit from adding cisplatin-based concurrent chemotherapy to two-dimensional conventional radiotherapy. But this benefit becomes uncertain in the intensity-modulated radiotherapy (IMRT) era, owing to its significant advantage. Methods We enrolled 661 low risk (T1N1M0, T2N0-1M0 or T3N0M0, the 2010 UICC/AJCC staging system) patients who underwent IMRT with or without concurrent chemotherapy. Particularly, patients with IMRT alone or IMRT plus cisplatin-based concurrent chemotherapy were equally matched using propensity-score matching method. Overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRFS) were assessed with Kaplan-Meier method, log-rank test and Cox regression. Results Among 661 patients, IMRT alone achieved parallel OS (P = 0.379), DMFS (P = 0.169) and LRFS (P = 0.849) to IMRT plus concurrent chemotherapy. In the propensity-matched cohort of 482 patients, similar survival were observed between both arms (4-years OS 97.4% vs 96.1%, P = 0.134; DMFS 96.5% vs 95.1%, P = 0.763; LRFS 93.8% vs 91.5%, P = 0.715). In multivariate analysis, cisplatin-based concurrent chemotherapy did not lower the risk of death, distant metastasis or locoregional relapse. And this association remained unchanged in subgroups by age, sex, histology and stage. Conclusions In this study, low risk nasopharyngeal carcinoma patients who underwent IMRT could not benefit from cisplatin-based concurrent chemotherapy.
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Chen X, Lei H, Liang Z, Li L, Qu S, Zhu X. Intensity-modulated radiotherapy controls nasopharyngeal carcinoma distant metastasis and improves survival of patients. SPRINGERPLUS 2016; 5:1459. [PMID: 27652034 PMCID: PMC5007237 DOI: 10.1186/s40064-016-3117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study evaluated the distant metastatic outcomes in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) plus chemotherapy. METHODS 530 Non-metastatic NPC patients were retrospectively collected and reviewed after receiving IMRT with or without chemotherapy between June 2006 and December 2011. Patients were treated with one fraction of IMRT daily for 5 days a week for 69.96-74.09 Gy, while 473 (89.2 %) of patients also received chemotherapy. RESULTS Patients were followed up for a median follow-up duration of 49 months (range from 5 to 98 months). After treatment, 91 (17.3 %) patients developed distant metastasis. Distant metastasis after treatment was significantly associated with advanced 2010 Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) T staging (p = 0.034), N stage (p < 0.001), 2010 UICC/AJCC stage (p < 0.001), and tumor recurrence (p = 0.029). However, chemotherapy failed to reduce cancer distant metastasis in early stage patients, the distant metastasis rate was 17.5 % in stage III and 24.2 % in stage IVA-B diseases, after IMRT and chemotherapy. The multivariate analysis showed that cancer remission duration, treatment modality, and metastatic site (p < 0.001, p = 0.027 and p = 0.022, respectively) were all independent predictors for overall survival of NPC patients after IMRT and chemotherapy. CONCLUSIONS This study provided insight into the effects of IMRT plus chemotherapy in the treatment of NPC. Future studies will explore the efficacy of more aggressive systemic therapies for high-risk patients with distant metastasis.
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Affiliation(s)
- Xiaoqian Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
| | - Hao Lei
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
| | - Zhongguo Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
| | - Xiaodong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China
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Guo Q, Lu T, Lin S, Zong J, Chen Z, Cui X, Zhang Y, Pan J. Long-term survival of nasopharyngeal carcinoma patients with Stage II in intensity-modulated radiation therapy era. Jpn J Clin Oncol 2016; 46:241-7. [DOI: 10.1093/jjco/hyv192] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/22/2015] [Indexed: 11/14/2022] Open
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Efficacy of Concurrent Chemotherapy for Intermediate Risk NPC in the Intensity-Modulated Radiotherapy Era: a Propensity-Matched Analysis. Sci Rep 2015; 5:17378. [PMID: 26611462 PMCID: PMC4661698 DOI: 10.1038/srep17378] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023] Open
Abstract
This study is to evaluate the efficacy of additional concurrent chemotherapy for intermediate risk (stage II and T3N0M0) NPC patients treated with intensity-modulated radiotherapy (IMRT).440 patients with intermediate risk NPC were studied retrospectively, including 128 patients treated with IMRT alone [radiotherapy group (RT group)] and 312 paitents treated with IMRT plus concurrent chemotherapy [chemoradiotherapy group (CRT group)]. Propensity score matching was carried out to create RT and CRT cohorts equally matched for host and tumor factor. Significantly more severe acute toxicities were observed in the CRT group than in the RT group. Multivariate analyses of 440 patients failed to demonstrate concurrent chemotherapy as an independent prognostic factor for FFS, LR-FFS, and D-FFS. Between the well-matched RT cohort and the CRT cohort, no significant difference was demonstrated in all survival endpoints (FFS: 92.8% versus 91.2%, P = 0.801; LR-FFS: 95.2% versus 94.4%, P = 0.755; D-FFS: 96.4% versus 96.3%, P = 0.803; OS: 98.2% versus 98.9%, P = 0.276). Our results demonstrated that for patients with intermediate risk NPC treated with IMRT, additional concurrent chemotherapy did not provide any significant survival benefit but significantly more severe acute toxicities. However, prospective randomized trials are warranted for the ultimate confirm of our findings.
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Long-term outcomes of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma treated with IMRT: a retrospective study. Tumour Biol 2015; 37:4429-38. [PMID: 26499947 DOI: 10.1007/s13277-015-4266-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022] Open
Abstract
This study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) for stage II nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). A total of 249 patients were retrospectively reviewed. All patients were treated with IMRT. One hundred forty-three patients treated with CCRT and 106 patients treated with IMRT alone. With a median follow-up of 59.4 months, adding concurrent chemotherapy did not statistically significantly improve the 5-year overall survival (OS) (89.7 % vs 99.0 %, p = 0.278), locoregional relapse-free survival (LRFS) (94.8 % vs 89.3 %, p = 0.167), and distant metastases-free survival (DMFS) (93.4 % vs 97.5 %, p = 0.349). The patients with CCRT significantly experienced more acute toxic effects. The main grades 3-4 toxicity reactions were mucositis (26.6 % vs 15.1 %, p = 0.03) and leukopenia/neutropenia (9.1 % vs 0.9 %, p = 0.005). In subgroup analysis of patients with concurrent platinum single-agent chemotherapy the 5-year OS (98.4 % vs 81.9 %, p = 0.013) and DMFS (96.9 % vs 84.4 %, p = 0.043) of patients with platinum every 3 weeks (Q3W) were significantly higher than those with platinum weekly (QW) and no significant difference for LRFS (96.8 % vs 90.4 %, p = 0.150). CCRT did not improve the survival of patients with stage II NPC but increased the acute toxicity reactions. Patients with platinum Q3W improved the 5-year OS and DMFS, compared with those with platinum QW.
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Zheng W, Qiu S, Huang L, Pan J. Is Gemcitabine and Cisplatin Induction Chemotherapy Superior in Locoregionally Advanced Nasopharyngeal Carcinoma? Pak J Med Sci 2015; 31:781-6. [PMID: 26430402 PMCID: PMC4590383 DOI: 10.12669/pjms.314.7374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the outcome of locoregionally advanced nasopharyngeal carcinoma (NPC) treated with induction chemotherapy followed by chemoradiotherapy. Methods: Between June 2005 and October 2007, 604 patients with locoregionally advanced NPC were analyzed, of whom 399 and 205 were treated with conventional radiotherapy and intensity-modulated radiotherapy (IMRT) respectively. Meanwhile, 153 patients received concurrent chemotherapy, and 520 were given induction chemotherapy. Results: With a median follow-up time of 65 months, the 3-, and 5-year overall survival (OS), locoregional free survival (LRFS), and distant-metastasis free survival (DMFS) rates were 82.5% vs. 72.6%, 90.6% vs. 87.1%, and 82.5% vs. 81.2%, respectively. Induction chemotherapy was not an independent prognostic factor for OS (P=0.193) or LRFS, but there was a positive tendency for DMFS (P=0.088). GP regimen (gemcitabine + cisplatin) was an independent prognostic factor for OS (P = 0.038) and it had a trend toward improved DMFS (P = 0.109). TP regimen (taxol + cisplatin) was only a significant prognostic factor for DMFS (P =0.038). Conclusions: Adding induction chemotherapy had no survival benefit, but GP regimen benefited overall survival and had a trend toward improved DMFS. GP regimen may be superior to TP/FP regimen (fluorouracil + cisplatin) in treating locoregionally advanced NPC.
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Affiliation(s)
- Wei Zheng
- Wei Zheng, Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, China. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China. Teaching Hospital of Fujian Health College, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
| | - Sufang Qiu
- Sufang Qiu, Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, China. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China. Teaching Hospital of Fujian Health College, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
| | - Lingling Huang
- Lingling Huang, Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, China. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Jianji Pan
- Jianji Pan, Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, China. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China. Teaching Hospital of Fujian Health College, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
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Li AC, Xiao WW, Shen GZ, Wang L, Xu AA, Cao YQ, Huang SM, Lin CG, Han F, Deng XW, Zhao C. Distant metastasis risk and patterns of nasopharyngeal carcinoma in the era of IMRT: long-term results and benefits of chemotherapy. Oncotarget 2015; 6:24511-21. [PMID: 26087194 PMCID: PMC4695202 DOI: 10.18632/oncotarget.4312] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/22/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the distant metastasis (DM) risk and patterns for nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) and to analyze the benefits of chemotherapy based on DM risk. MATERIALS AND METHODS 576 NPC patients were analyzed. The DM rates were calculated using the Kaplan-Meier method, and the log-rank test was used to compare differences. The patients were divided into different risk subclassifications according to DM hazard ratios. RESULTS 91 patients developed DM after treatment, with bone as the most common metastatic sites. 82.4% of DMs occurred within 3 years of treatment. Patients were classified as low-risk, intermediate-risk and high-risk, and the corresponding 5-year DM rates were 5.1%, 13.1% and 32.4%, respectively (P < 0.001). Chemotherapy failed to decrease the DM rate in the low-risk subclassification, but decreased the DM risk in the intermediate-risk subclassification (P = 0.025). In the high-risk subclassification, the DM rate was 31.9% though chemotherapy was used, which was significantly higher than that of other two subclassifications. CONCLUSIONS DM is the dominant treatment failure in NPC treated by IMRT, with similar occurrence times and distributions to those that occurred in the era of conventional radiotherapy. Further studies on treatment optimization are needed in high-risk patients.
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Affiliation(s)
- An-Chuan Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei-Wei Xiao
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guan-Zhu Shen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lin Wang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - An-An Xu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Radiation Oncology, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Yan-Qing Cao
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Radiation Oncology, The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shao-Min Huang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Cheng-Guang Lin
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fei Han
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Wu Deng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chong Zhao
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Xu T, Shen C, Zhu G, Hu C. Omission of Chemotherapy in Early Stage Nasopharyngeal Carcinoma Treated with IMRT: A Paired Cohort Study. Medicine (Baltimore) 2015; 94:e1457. [PMID: 26426610 PMCID: PMC4616822 DOI: 10.1097/md.0000000000001457] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to evaluate the necessity of concurrent chemotherapy in T1-2N1 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). The retrospective analysis was conducted using the paired comparison method. We matched cases to controls using the greedy matching algorithm with 1:1 control to case ratio. Controls were matched to cases by factors including age, gender, T stage, and duration of RT. The control group included patients received IMRT alone. In another group, concurrent chemotherapy (DDP 40 mg2/m/w) was administrated to each paired patient. From Jan 2009 to Dec 2011, a total of 86 well-balanced T1-2N1 (2002 UICC staging system) NPC patients were retrospectively analyzed. Half of them (43 patients) received radical IMRT alone and another 43 received concurrent chemotherapy with IMRT (CCRT). Median follow-up is 37.4 months (4.8-66.2 months). All patients received a radiation dose of 66 Gy/30Fx. In the CCRT group, all patients received a cumulative dose of ≥ 200 mg/m2. The differences of 3-year overall survival (OS), 3-year progression-free survival (PFS), 3-year relapse-free survival (RFS), and 3-year metastasis-free survival (MFS) between 2 groups were not significant (P > 0.05). The most frequently increased toxicities related to chemotherapy were mild to moderate leukopenia (P = 0.003) and mild anemia (P = 0.008).Omission of weekly cisplatin chemotherapy resulted in comparable survival outcomes to CCRT in IMRT populations. More data from future randomized trials are warranted to further confirm it.
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Affiliation(s)
- Tingting Xu
- From the Department of radiation oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Takiar V, Ma D, Garden AS, Li J, Rosenthal DI, Beadle BM, Frank SJ, Fuller CD, Gunn GB, Morrison WH, Hutcheson K, El-Naggar AK, Gold KA, Kupferman ME, Phan J. Disease control and toxicity outcomes for T4 carcinoma of the nasopharynx treated with intensity-modulated radiotherapy. Head Neck 2015; 38 Suppl 1:E925-33. [PMID: 25994561 DOI: 10.1002/hed.24128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Treatment of T4 nasopharyngeal carcinoma (NPC) is challenging because of the proximity of the tumor to the central nervous system. The purpose of this study was to present our evaluation of disease control and toxicity outcomes for patients with T4 NPC treated with intensity-modulated radiation therapy (IMRT) and chemotherapy. METHODS The medical records of 66 patients with T4 NPC treated from 2002 to 2012 with IMRT were reviewed. Endpoints included tumor control and toxicity outcomes (Common Terminology Criteria for Adverse Events [CTCAE v4.0]). RESULTS Median follow-up was 38 months. Five-year rates of locoregional control, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) were 80%, 62%, 57%, and 69%, respectively. Nodal involvement was associated with worse PFS (p = .015). Gross target volume (GTV) volume >100 cm and planning target volume (PTV) volume >400 cm were associated with worse OS (p = .038 and p = .004, respectively). Four patients had significant cognitive impairment, and 9 had MRI evidence of brain necrosis. CONCLUSION For patients with T4 NPC treated with IMRT and chemotherapy, survival and locoregional disease control rates have improved; however, late treatment toxicity remains a concern. © 2015 Wiley Periodicals, Inc. Head Neck 38: E925-E933, 2016.
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Affiliation(s)
- Vinita Takiar
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dominic Ma
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kate Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Kathryn A Gold
- Department of Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Kang MK, Oh D, Cho KH, Moon SH, Wu HG, Heo DS, Ahn YC, Park K, Park HJ, Park JS, Keum KC, Cha J, Kim JW, Kim YS, Kang JH, Oh YT, Kim JY, Kim SH, Kim JH, Lee CG. Role of Chemotherapy in Stage II Nasopharyngeal Carcinoma Treated with Curative Radiotherapy. Cancer Res Treat 2015; 47:871-8. [PMID: 25687858 PMCID: PMC4614208 DOI: 10.4143/crt.2014.141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To define the role of neoadjuvant and concurrent chemotherapy in stage II nasopharyngeal carcinoma, we compared the treatment outcomes of patients treated with curative radiotherapy with or without chemotherapy. Materials and Methods From 2004 to 2011, 138 patients with American Joint Committee on Cancer (AJCC) 2002 stage II nasopharyngeal carcinoma were treated with curative radiotherapy in 12 hospitals in South Korea. Treatment methods included radiotherapy alone in 34 patients, neoadjuvant chemotherapy followed by radiotherapy alone in seven, concurrent chemoradiotherapy in 80, and neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in 17. Adjuvant chemotherapy was used in 42 patients. Total radiation dose ranged from 64 Gy to 74.2 Gy (median, 70 Gy). Results Median follow-up was 48 months (range, 7 to 97 months) for all patients. At the last follow-up, 13 patients had died and 32 had experienced treatment failure; locoregional failure occurred in 14, distant failure in 16, and both in two. Five-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were 86.2%, 85.5%, 74.4%, and 88.2%, respectively. Multivariate analyses showed that the significant prognostic factors were concurrent chemotherapy and N stage for locoregional relapse-free survival, concurrent chemotherapy for progression-free survival, and age and N stage for overall survival. Neither neoadjuvant nor concurrent chemotherapy improved distant metastasis-free survival. Conclusion Concurrent chemotherapy significantly improved 5-year locoregional relapse-free survival and progression-free survival in stage II nasopharyngeal carcinoma. However, neoadjuvant chemotherapy failed to improve either.
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Affiliation(s)
- Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jung Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Su Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyoung Kang
- Department of Medical Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin-Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Loong HH, Chan AT. Controversies in the systemic treatment of Nasopharyngeal carcinoma. Oral Oncol 2014; 50:785-90. [DOI: 10.1016/j.oraloncology.2014.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/11/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
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Tham IWK, Lu JJ. Controversies and challenges in the current management of nasopharyngeal cancer. Expert Rev Anticancer Ther 2014; 10:1439-50. [DOI: 10.1586/era.10.97] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chang H, Gao J, Xu B, Guo S, Lu R, Li G, Huang S, Han F, Liu Z, Tao Y, Tu Z, Chen C, Li X, Xia Y. Haemoglobin, Neutrophil to Lymphocyte Ratio and Platelet Count Improve Prognosis Prediction of the TNM Staging System in Nasopharyngeal Carcinoma: Development and Validation in 3237 Patients from a Single Institution. Clin Oncol (R Coll Radiol) 2013; 25:639-46. [DOI: 10.1016/j.clon.2013.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/19/2013] [Accepted: 05/09/2013] [Indexed: 01/04/2023]
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Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K. The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. BIOMED RESEARCH INTERNATIONAL 2013; 2013:401261. [PMID: 24228247 PMCID: PMC3818806 DOI: 10.1155/2013/401261] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 12/16/2022]
Abstract
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.
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Affiliation(s)
- Vassilis Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Stella Thalassinou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kalliopi Platoni
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Anna Zygogianni
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - John Kouvaris
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Christos Antypas
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Efstathios Efstathopoulos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kelekis Nikolaos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
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Ji X, Xie C, Hu D, Fan X, Zhou Y, Zheng Y. Survival benefit of adding chemotherapy to intensity modulated radiation in patients with locoregionally advanced nasopharyngeal carcinoma. PLoS One 2013; 8:e56208. [PMID: 23441169 PMCID: PMC3575472 DOI: 10.1371/journal.pone.0056208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/07/2013] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the contribution of chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) and to identify the optimal combination treatment strategy. Patients and Methods Between 2006 and 2010, 276 patients with stage II-IVb NPC were treated by IMRT alone or IMRT plus chemotherapy. Cisplatin-based chemotherapy included neoadjuvant or concurrent, or neoadjuvant plus concurrent protocols. The IMRT alone and chemoradiotherapy groups were well-matched for prognostic factors, except N stage, with more advanced NPC in the chemoradiotherapy arm. Results With a mean follow-up of 33.8 months, the 3-year actuarial rates of overall survival (OS), metastasis-free survival (MFS), relapse-free survival (RFS), and disease-free survival (DFS) were 90.3%, 84.2%, 80.3%, and 69.2% for all of the patients, respectively. Compared with the IMRT alone arm, patients treated by concurrent chemoradiotherapy had a significantly better DFS (HR = 2.64; 95% CI, 1.12−6.22; P = 0.03), patients with neoadjuvant-concurrent chemoradiotherapy had a significant improvement in RFS and DFS (HR = 4.03; 95% CI, 1.35−12.05; P = 0.01 and HR = 2.43; 95% CI, 1.09−5.44; P = 0.03), neoadjuvant chemoradiotherapy provided no significant benefit in OS, MFS, RFS, and DFS. Stage group and alcohol consumption were prognostic factors for OS and N stage was a significant predictor for DFS. Conclusions Addition of concurrent or neoadjuvant-concurrent chemotherapy to IMRT is available to prolong RFS or DFS for locoregionally advanced NPC. Such work could be helpful to guide effective individualized therapy.
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Affiliation(s)
- Xuemei Ji
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
- * E-mail: (XJ); (CX)
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
- * E-mail: (XJ); (CX)
| | - Desheng Hu
- Department of Radiation Oncology, Tumor Hosptal of Hubei Province, Wuhan, China
| | - Xia Fan
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yajuan Zhou
- Department of Radiation Oncology, Tumor Hosptal of Hubei Province, Wuhan, China
| | - Yingjie Zheng
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Ho CY, Chan KT, Chu PY. Comparison of narrow-band imaging and conventional nasopharyngoscopy for the screening of unaffected members of families with nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2013; 270:2515-20. [DOI: 10.1007/s00405-013-2354-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 01/09/2013] [Indexed: 01/07/2023]
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Su SF, Han F, Zhao C, Huang Y, Chen CY, Xiao WW, Li JX, Lu TX. Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. CHINESE JOURNAL OF CANCER 2012; 30:565-73. [PMID: 21801605 PMCID: PMC4013407 DOI: 10.5732/cjc.010.10547] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed. Herein, we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome. We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy, and classified all cases into the following prognostic categories according to different TNM stages: early stage group (T1–2N0–1M0), advanced local disease group (T3–4N0–1M0), advanced nodal disease group (T1–2N2–3M0), and advanced locoregional disease group (T3–4N2–3M0). The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were 83.0%, 90.4%, and 84.0% respectively. The early disease group had the lowest treatment failure rate, with a 5-year OS of 95.6%. The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625, respectively). The advanced locoregional disease group had the highest incidence of relapse and death, with a 5-year DMFS and OS of 62.3% and 62.2%, respectively, and a hazard ratio for death of 10.402. Comparing with IMRT alone, IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC. Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages, and that IMRT alone for early stage NPC patients can produce satisfactory results. However, for advanced local, nodal, and locoregional disease groups, a combination of chemotherapy and radiotherapy is recommended.
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Affiliation(s)
- Sheng-Fa Su
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China
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Pan XB, Zhu XD. Role of chemotherapy in stage IIb nasopharyngeal carcinoma. CHINESE JOURNAL OF CANCER 2012; 31:573-8. [PMID: 22776232 PMCID: PMC3777455 DOI: 10.5732/cjc.011.10433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The efficacy of neoadjuvant chemotherapy and adjuvant chemotherapy on stage IIb nasopharyngeal carcinoma (NPC) remains unclear. Conventional two-dimensional radiotherapy combined with concurrent chemotherapy can improve the overall survival, progression-free survival, recurrence-free survival, and distant metastasis-free survival of patients with stage IIb NPC. Intensity-modulated radiotherapy without concurrent chemotherapy also provides good outcomes for patients with stage IIb NPC. This article summarizes the features of stage IIb NPC and reviews the role of chemotherapy in this subgroup of NPC.
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Affiliation(s)
- Xin-Bin Pan
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P. R. China
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Lin Q, Yang R, Sun L, Chen S, Wu H. Biological response of nasopharyngeal carcinoma to radiation therapy: a pilot study using serial 18F-FDG PET/CT scans. Cancer Invest 2012; 30:528-36. [PMID: 22668086 DOI: 10.3109/07357907.2012.691193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We used serial (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to evaluate tumors' maximum standardized uptake value (SUV(max)) before, during, and after radiotherapy to explore the biological behavior of and response to radiation therapy in various subtypes of nasopharyngeal carcinoma (NPC). Sixty-one patients with pathologically diagnosed NPC were prospectively enrolled into the study. WHO type II(B) disease had a higher initial SUV(max) and more significant biological response at the primary site as compared with type II(A) subtype. The two subtypes of WHO type II NPC may significantly differ in their biological behavior and response to radiotherapy.
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Affiliation(s)
- Qin Lin
- School of Life Sciences, Xiamen University, The First Affiliated Hospital of Xiamen University, China
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He X, Ye M, Guo X, Pan Z, Zhang Z, He S, Liu T. Treatment outcome of patients with stages I-II nasopharyngeal carcinoma after late course accelerated hyperfractionation radiotherapy alone. Oral Oncol 2012; 48:1058-1063. [PMID: 22658301 DOI: 10.1016/j.oraloncology.2012.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 02/18/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To follow up the efficacy and incidence of radiation-induced complications of late course accelerated fractionation (LCAF) radiotherapy in early-stage nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS From December 1995 to November 2002, 158 patients with stages I-II NPC were admitted for radiotherapy alone. For the first two-thirds of the treatment, 2 daily fractions of 1.2 Gy were given to the primary lesion, 5 days per week to a total dose of 48 Gy/40 fractions, over a period of 4 weeks. From the 5th week, an accelerated hyperfractionation schedule was carried out. Two daily fractions of 1.5 Gy were given, to a total dose of 30 Gy/20 fractions over 2 weeks. Thus the total dose was 78 Gy in 60 fractions in 6 weeks. RESULTS All patients completed the treatment. Acute mucositis: none in 3 patients, grade 1 in 32, grade 2 in 69, grade 3 in 51, and grade 4 in 3 patients. Five-year nasopharyngeal control and overall survival (OS) rate of T1 and T2 were 97.8%, 90.2% (p=0.380) and 88.6%, 81.4% (p=0.252), respectively. Five-year OS in N0 and N1 patients were 86.5% and 81.9% (p=0.033), respectively. Thirty-eight patients died, and the main cause of death was distant metastasis. Seventeen (11%) patients had radiation-induced cranial nerve palsy. CONCLUSION With LCAF, treatment-related toxicities were acceptable. Five-year nasopharyngeal control and OS in T2 stage were improved. Main cause of death was distant metastasis. Patients with N1 had a relatively lower survival rate, which suggested that chemotherapy might be indicated for those patients.
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Affiliation(s)
- Xiayun He
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Ming Ye
- Department of Radiation Oncology, Renji Hospital, Medical School of Shanghai Jiaotong University, Shanghai, PR China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
| | - Ziqiang Pan
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Shaoqin He
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Taifu Liu
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
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Liu WS, Wu MF, Tseng HC, Liu JT, Weng JH, Li YC, Lee JK. The Role of Pretreatment FDG-PET in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 2012; 82:561-6. [DOI: 10.1016/j.ijrobp.2010.11.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/02/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
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Tuan JKL, Ha TC, Ong WS, Siow TR, Tham IWK, Yap SP, Tan TWK, Chua ET, Fong KW, Wee JTS. Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma. Radiother Oncol 2012; 104:305-11. [PMID: 22280806 DOI: 10.1016/j.radonc.2011.12.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/16/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE We sought to evaluate the nature and frequency of late toxicities in a cohort of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy alone. METHODS AND MATERIALS Seven-hundred and ninety-six consecutive NPC patients treated using conventional radiotherapy at a single center from 1992 to 1995 were retrospectively analyzed. Patients with histology proven, completely staged, Stage I-IVB World Health Organization Type I-III NPC and completed radical radiotherapy were included. Patients with incomplete staging investigations, distant metastases at diagnosis, previous treatment, and incomplete radiotherapy were excluded. Radiotherapy-related complications were categorized using the RTOG Late Radiation Morbidity Scoring Criteria. RESULTS Median follow-up was 7.2 years. The 5-year overall survival and disease free survival were 69% and 56%, respectively, and the corresponding 10-year rates were 52% and 44%. Among 771 patients with at least 3 months of follow-up post treatment, 565 (73%) developed RT-related complications. Diagnosed neurological complications were cranial nerve palsies (n=70; 9%), temporal lobe necrosis (n=37; 5%), Lhermitte's syndrome (n=7; 1%), and brachial plexopathy (n=2; 0.3%). Non-neurological complications included xerostomia (n=353; 46%), neck fibrosis (n=169; 22%), hypo-pituitarism (n=48; 6%), hearing loss (n=120; 16%), dysphagia (n=116; 15%), otorrhea (n=101; 13%), tinnitus (n=94; 12%), permanent tube feeding (n=61; 8%), trismus (n=45; 6%), second malignancies within treatment field (n=17; 2%), and osteo-radionecrosis (n=13; 2%). CONCLUSIONS While radiotherapy is curative in NPC, many patients suffer significant late treatment morbidities with conventional radiotherapy techniques.
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Current World Literature. Curr Opin Oncol 2011; 23:303-10. [DOI: 10.1097/cco.0b013e328346cbfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ho CY, Lee YL, Chu PY. Use of narrow band imaging in evaluation of possible nasopharyngeal carcinoma. Am J Rhinol Allergy 2011; 25:107-11. [DOI: 10.2500/ajra.2011.25.3582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background This study was designed to evaluate the narrow band imaging (NBI) system for its ability to differentiate between malignant neoplasm and benign neoplasm by real-time image during nasopharyngoscopy, the quality of the visualization, and the limitation of the NBI in nasopharyngeal lesions. Methods Between June 2009 and May 2010, 63 patients who had a suspected nasopharyngeal tumor via nasopharyngoscopy at Taipei Veterans General Hospital, Taiwan, were included in this study. All of the patients received nasopharyngoscopy with conventional view and NBI view and nasopharyngeal biopsy. The patients were divided into two groups depending on the pathological results: nasopharyngeal carcinoma (NPC) and lymphoid hyperplasia/chronic inflammation (LH). Results Forty-one patients were in the NPC group and 22 patients were in the LH group. The pattern of the NBI view showed regular cobblestone in the LH group, except for one patient. The pattern of the NBI view showed an irregular engorged vascular pattern and/or microvascular proliferative pattern in 32 of 41 NPC patients (78.0%). The sensitivity, specificity, positive predictive value, and negative predictive value of NBI in nasopharynx (NP) were 78.0, 95.5, 97.0, and 70.0%, respectively, in NP neoplasm. Conclusion NBI could be helpful in differentiating benign and malignant neoplasm in the NP region. Using NBI in NP regions had some limitations, including bleeding and mucus coating.
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Affiliation(s)
- Ching-Yin Ho
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan and School of Medicine, National Yang Ming University, Taiwan
| | - Yi-Lun Lee
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan and School of Medicine, National Yang Ming University, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan and School of Medicine, National Yang Ming University, Taiwan
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Su SF, Han F, Zhao C, Chen CY, Xiao WW, Li JX, Lu TX. Long-term outcomes of early-stage nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy alone. Int J Radiat Oncol Biol Phys 2010; 82:327-33. [PMID: 21035959 DOI: 10.1016/j.ijrobp.2010.09.011] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/03/2010] [Accepted: 09/04/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Reports of intensity-modulated radiotherapy (IMRT) for early-stage nasopharyngeal carcinoma (NPC) have been limited. The present study evaluated the long-term survival outcomes and toxicity of early-stage NPC patients treated with IMRT alone. METHODS AND MATERIALS Between February 2001 and January 2008, 198 early-stage (T1-T2bN0-N1M0) NPC patients had undergone IMRT alone. The data from these patients were retrospectively analyzed. The patients were treated to 68 Gy at 2.27 Gy/fraction prescribed to the planning target volume of the primary nasopharygeal gross tumor volume. The Radiation Therapy Oncology Group scoring system was used to assess the toxicity. RESULTS At a median follow-up of 50.9 months (range, 12-104), the 5-year estimated disease-specific survival, local recurrence-free survival, and distant metastasis-free survival rate was 97.3%, 97.7%, and 97.8%, respectively. The 5-year local recurrence-free survival rate was 100% for those with Stage T1 and T2a and 94.2% for those with Stage T2b lesions (p = 0.252). The 5-year distant metastasis-free survival rate for Stage T1N0, T2N0, T1N1, and T2N1 patients was 100%, 98.8%, 100%, and 93.8%, respectively (p = .073). All local recurrence occurred in patients with T2b lesions. Five patients developed distant metastasis. Of these 5 patients, 4 had had Stage T2bN1 disease and 1 had had Stage T2bN0 disease with retropharyngeal lymph node involvement. The most common acute toxicities were mainly Grade 1 or 2. At 24 months after IMRT, no Grade 3 or 4 xerostomia had developed, and 62 (96.9%) of 64 evaluated patients were free of trismus; only 2 patients (3.1%) had Grade 1 trismus. Radiation encephalopathy and cranial nerve injury were not observed. CONCLUSIONS IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 yielded satisfactory survival outcomes with acceptable toxicity, and no differences were found in survival outcomes among these four subgroups. Patients with Stage T2b lesions might have relatively greater risk of local recurrence and those with T2bN1 disease mighth have a greater risk of distant metastasis.
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Affiliation(s)
- Sheng-Fa Su
- State Key Laboratory of Oncology in Southern China, Guangzhou, People's Republic of China
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