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Majidova N, Sarı M, Kahvecioglu FA, Ozcan E, Akdag MO, Dogan A, Yıldırım S, Sonusen SD, Yunusov E, Yasar A, Celebi A, Sever N, Kocaaslan E, Erel P, Agyol Y, Guren AK, Arıkan R, Isık S, Balvan O, Geredelı C, Uygun K, Hacibekiroglu I, Kostek O, Bayoglu IV. Clinicopathologic Features and Efficacy of Induction Chemotherapy in Nasopharyngeal Carcinoma: Real-World Experience. Oncol Res Treat 2024:1-7. [PMID: 38565096 DOI: 10.1159/000537988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Nasopharyngeal carcinoma (NPC) accounts for 0.01% of all carcinomas, and 70% of patients have locally advanced disease with a poor prognosis. The mainstay therapy is chemoradiotherapy (CRT), and concurrent administration of platinum-based agents and irradiation provides high local control rates. However, induction (neoadjuvant) chemotherapy (ICT) prior to CRT is recommended for large tumors with a high tumor burden at the category 1 level. For ICT, platinum-based doublet or triplet combination regimens are recommended. Selected patients with a high tumor burden at the time of diagnosis who did not receive ICT before CRT were given adjuvant (consolidation) therapy after CRT. This multicenter study aimed to share our experience in treatment of NPC and evaluate the factors associated with survival. METHODS The study included patients diagnosed with NPC who were followed and treated between 2008 and 2022. Hundred and forty-two patients from 6 centers were evaluated. The factors associated with disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS The median age of our patients was 51 years (IQR: 16-81 years), and the male:female ratio was 2.5:1. A majority of patients (71%) had stage 3-4 disease. They had locally advanced disease, and 48 patients (34%) received ICT. Twenty patients (14%) received adjuvant therapy. The median follow-up was 41 months (range, 2.7-175.1 months). The median DFS in NPC was 92.6 months (range, 71.9-113.3 months), with a 40th month DFS of 70.9%. The median OS was 113 months (range, 91-135 months), with a 40th month OS of 84.7%. Median DFS was 95.3 months (range, 64.2-126.4 months) in patients who received ICT before CRT, which was longer than in the CRT-only group (p = 0.6). DFS at the 40th month was 75.1% in patients treated with ICT compared to 65.1% in the CRT-only group. Median OS was 117 months (range, 92-142 months) in patients receiving ICT, which was longer than in the CRT-only group (p = 0.4). OS at the 40th month was 86.7% in patients receiving ICT but 83.6% in the CRT-only group. CONCLUSIONS Both the objective response rate and survival were longer in patients who radiologically responded to CRT following ICT. Nonresponse to ICT is a negative predictive indicator. The role of ICT in locally advanced NPC is increasing.
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Affiliation(s)
- Nargiz Majidova
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey,
| | - Murat Sarı
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Akdag Kahvecioglu
- Division of Medical Oncology, Department of Internal Medicine, Sakarya University School of Medicine, Adapazari, Turkey
| | - Erkan Ozcan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, Turkey
| | | | - Akif Dogan
- Division of Medical Oncology, Department of Internal Medicine, Istanbul Kartal Lutfi Kirdar Education and Training Hospital, Istanbul, Turkey
| | - Sedat Yıldırım
- Division of Medical Oncology, Department of Internal Medicine, Istanbul Kartal Lutfi Kirdar Education and Training Hospital, Istanbul, Turkey
| | - Sermin Dinc Sonusen
- Division of Medical Oncology, Department of Internal Medicine, Professor Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Emil Yunusov
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Alper Yasar
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdussamet Celebi
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Nadiye Sever
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Erkam Kocaaslan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Pınar Erel
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Yesım Agyol
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Alı Kaan Guren
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Rukıye Arıkan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Selver Isık
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlem Balvan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Caglayan Geredelı
- Division of Medical Oncology, Department of Internal Medicine, Professor Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Kazım Uygun
- Division of Medical Oncology, Department of Internal Medicine, Kocaeli University, İzmit, Turkey
| | - Ilhan Hacibekiroglu
- Division of Medical Oncology, Department of Internal Medicine, Sakarya University School of Medicine, Adapazari, Turkey
| | - Osman Kostek
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ibrahım Vedat Bayoglu
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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Yao JJ, Jin YN, Lin YJ, Zhang WJ, Marks T, Ryan I, Zhang HY, Xia LP. The feasibility of reduced-dose radiotherapy in childhood nasopharyngeal carcinoma with favorable response to neoadjuvant chemotherapy. Radiother Oncol 2023; 178:109414. [PMID: 36375563 DOI: 10.1016/j.radonc.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND To assess the feasibility of adjusting radiation dose (RD) in childhood NPC with favorable tumor response after neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS Using an NPC-specific database, children and adolescents (≤18 years) with locoregionally advanced NPC (CA-LANPC) were retrospectively analyzed. Enrolled patients were those who received favorable tumor response after 2-4 cycles of NAC followed by concurrent chemoradiotherapy. Survival outcomes and treatment-related toxicities were compared for the standard RD on primary tumors (PT-RDstandard, 66-72 Gy) and the reduced RD on primary tumors (PT-RDreduced, 60-65.9 Gy). RESULTS A total of 132 patients were included, and the median follow-up time was 75.2 months (IQR, 53.2-98.7 months) for the entire cohort. The PT-RDreduced group had a significantly decreased incidence of severe mucositis (51.3 % vs 32.1 %; P = 0.034) when compared to the PT-RDstandard group. The total incidence of severe sequela in the PT-RDstandard group were significantly higher than those in the PT-RDreduced group (31.8 % vs 13.7 %; P = 0.029). In the propensity-matched analysis, the PT-RDreduced group resulted in parallel 5-year survival with the PT-RDstandard group from the matched cohort (disease-free survival, 82.7 % vs 80.3 %, P = 0.841; overall survival, 91.7 % vs 91.3 %, P = 0.582; distant metastasis-free survival, 87.5 % vs 82.8 %, P = 0.573; and locoregional relapse-free survival, 95.6 % vs 97.3 %, P = 0.836). In multivariate analysis, the impact of PT-RDreduced on all survival end points remained insignificant. CONCLUSIONS Chemoradiotherapy with RD at levels of 60-65.9 Gy may be a reasonable strategy for CA-LANPC with favorable tumor response after NAC.
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Affiliation(s)
- Ji-Jin Yao
- VIP Region, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, China; The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China
| | - Ya-Nan Jin
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China
| | - Yu-Jing Lin
- Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Wang-Jian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Tia Marks
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer 12144, USA
| | - Ian Ryan
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer 12144, USA
| | - Hong-Yu Zhang
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China.
| | - Liang-Ping Xia
- VIP Region, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, China.
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Jin YN, Liu BQ, Peng KW, Ou XQ, Zeng WS, Zhang WJ, Marks T, Yao JJ, Xia LP. The prognostic value of adding systemic inflammation response index to Epstein-Barr virus DNA in childhood nasopharyngeal carcinoma: A real-world study. Head Neck 2022; 44:1404-1413. [PMID: 35373866 DOI: 10.1002/hed.27033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To assess the prognostic value of the systemic inflammation response index (SIRI) combined with plasma load of Epstein-Barr virus (EBV) DNA in children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CALANPC). METHODS A total of 205 consecutive patients with CALANPC were enrolled. We used recursive partitioning analysis (RPA) to classify patients into various risk groups, with a primary endpoint of overall survival (OS). RESULTS Elevated SIRI (≥1.53) and EBV DNA (≥4000 copy/ml) were significantly associated with inferior OS in CALANPC. RPA categorized patients into low- and high-risk groups based on prognostic factors. Survival curves showed excellent discrimination in OS (95.3% vs 77.6%; p < 0.001) between the low- and high-risk groups. A significant improvement was confirmed using the prognostic methods for conventional TNM staging systems (p < 0.05). CONCLUSIONS The combination of SIRI with EBV DNA provided a more detailed understanding of patient risks, and enhanced risk discrimination in CALANPC.
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Affiliation(s)
- Ya-Nan Jin
- VIP Region, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong Province, China
| | - Bao-Qiu Liu
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Kun-Wei Peng
- VIP Region, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Xue-Qing Ou
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong Province, China
| | - Wu-Shuang Zeng
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong Province, China
| | - Wang-Jian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tia Marks
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Ji-Jin Yao
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong Province, China
| | - Liang-Ping Xia
- VIP Region, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
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Kebudi R, Buyukkapu SB, Gorgun O, Ozkaya K, Meral R, Ayan I, Altun M. Nasopharyngeal carcinoma in children: Multimodal treatment and long-term outcome of 92 patients in a single center over a 28-year period. Pediatr Blood Cancer 2021; 68:e29372. [PMID: 34582092 DOI: 10.1002/pbc.29372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term outcome and late effects in pediatric patients with nasopharyngeal carcinoma (NPC) treated with neoadjuvant chemotherapy (NACT), followed by radiotherapy (RT). METHODS Ninety-two children (65 male, 27 female) diagnosed with NPC between 1989 and 2017 in the Istanbul University, Institute of Oncology were evaluated retrospectively. NACT consisted of three cycles of cisplatin-containing regimen every 3 weeks, followed by RT. RESULTS The median age was 13 years (5-18 years). Most had locoregionally advanced disease (stage III/IVA/IVB) and five had distant metastases at presentation. At a median follow-up of 108 months (3-332 months), 5- and 10-year overall survival rates and event-free survival rates were 87.5%, 79.7% and 82.1%, 78.9%, respectively. Three patients with distant metastasis are long-term survivors. Thirteen patients relapsed at a median of 8 months (2-23 months). Hypothyroidism (36%) and xerostomia (25%) were the most frequent long-term treatment-related toxicities. Nine second malignancies developed in eight patients, eight in the irradiated field at a median of 14 years (range 5-26 years), five of whom are long-term survivors after curative surgery. CONCLUSIONS Three courses of cisplatin-containing NACT, followed by RT lead to high survival and locoregional control rate in advanced stage NPC in children. Patients with distant metastasis should also be treated with curative intent by systemic chemotherapy and locoregional radiotherapy. Patients should be followed closely for recurrences and long-term morbidities including second malignancies, which may be treated with curative surgeries if diagnosed early.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Sema Bay Buyukkapu
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Omer Gorgun
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Kübra Ozkaya
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Rasim Meral
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Inci Ayan
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Musa Altun
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.,Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Supplemental folic acid and/or multivitamins in pregnancy is associated with a decreased risk of childhood and adolescent nasopharyngeal carcinoma. J Dev Orig Health Dis 2021; 13:550-555. [PMID: 34779376 DOI: 10.1017/s2040174421000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to evaluate the association between prenatal and neonatal period exposures and the risk of childhood and adolescent nasopharyngeal carcinoma (NPC). From January 2009 to January 2016, a total of 46 patients with childhood and adolescent NPC (i.e., less than 18 years of age) who were treated at Sun Yat-sen University Cancer Center were screened as cases, and a total of 45 cancer-free patients who were treated at Sun Yat-sen University Zhongshan Ophthalmic Center were selected as controls. The association between maternal exposures during pregnancy and obstetric variables and the risk of childhood and adolescent NPC was evaluated using logistic regression analysis. Univariate analysis revealed that compared to children and adolescents without a family history of cancer, those with a family history of cancer had a significantly higher risk of childhood and adolescent NPC [odds ratios (OR) = 3.15, 95% confidence interval (CI) = 1.02-9.75, P = 0.046], and the maternal use of folic acid and/or multivitamins during pregnancy was associated with a reduced risk of childhood and adolescent NPC in the offspring (OR = 0.07, 95% CI = 0.02-0.25, P < 0.001). After multivariate analysis, only the maternal use of folic acid and/or multivitamins during pregnancy remained statistically significant. These findings suggest that maternal consumption of folic acid and/or multivitamins during pregnancy is associated with a decreased risk of childhood and adolescent NPC in the offspring.
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Does three cycles of neoadjuvant chemotherapy prior to concurrent chemoradiotherapy provide benefits for all childhood patients with locoregionally advanced nasopharyngeal carcinoma? J Cancer Res Clin Oncol 2021; 148:2569-2579. [PMID: 34618220 DOI: 10.1007/s00432-021-03817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/24/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Adding neoadjuvant chemotherapy (NAC) to concurrent chemoradiotherapy (CCRT) is the main strategy in treatment of children and adolescents with locoregionally advanced nasopharyngeal carcinoma (CA-LANPC). Yet, an optimal number of NAC cycles remains unknown. We aimed to optimize the NAC cycle and potentially contribute to clinical decision making for the individual treatment of CA-LANPC. PATIENTS AND METHODS Utilizing an NPC-specific database through an acknowledged big-data information system at our center, we identified 143 CA-LANPC treated with NAC followed by CCRT between September 2007 through April 2018. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict disease-free survival (DFS). The clinical benefits of NAC cycles (two cycles vs three cycles) were assessed in each risk group. RESULTS Independent factors derived from multivariable analysis to predict DFS were T stage (T1-3 vs T4) and plasma Epstein-Barr virus (EBV) DNA (< 4000 vs ≥ 4000 copies/mL) for risk stratification. Consequently, 87 (61%) participants were classified as low-risk group (T1-3 with low or high EBV DNA, and T4 with low EBV DNA) and the other 56 patients (39%) were classified as a high-risk group (T4 with high EBV DNA) through RPA, and corresponding 5-year DFS rates of 91.9% and 71.2%, respectively (p = 0.001). Among the high-risk group, patients receiving three cycles of NAC had statistically significant improvement in 5-year DFS over those who received two cycles of NAC (86.7% vs 59.1%; p = 0.020), while the survival benefit of three cycles NAC for low-risk groups were not observed (94.7% vs 89.7%; p = 0.652). CONCLUSIONS We found three cycles of NAC with CCRT was a positive prognostic indicator for improved DFS for the high-risk group among CA-LANPC. However, whether low-risk patients could benefit from three cycles NAC needs further study.
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Uezono H, Indelicato DJ, Rotondo RL, Sandler ES, Katzenstein HM, Dagan R, Mendenhall WM, Mailhot Vega R, Brennan BM, Bradley JA. Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma. Pediatr Blood Cancer 2019; 66:e27990. [PMID: 31524334 DOI: 10.1002/pbc.27990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE In children treated for nasopharyngeal carcinoma, proton therapy and postchemotherapy target volumes can reduce the radiation dose to developing tissue in the brain and the skull base region. We analyzed outcomes in children with nasopharyngeal carcinoma treated with induction chemotherapy followed by moderate-dose proton therapy. METHODS/MATERIALS Seventeen patients with nonmetastatic nonkeratinizing undifferentiated/poorly differentiated nasopharyngeal carcinoma underwent double-scattered proton therapy between 2011 and 2017. Median age was 15.3 years (range, 7-21). The American Joint Committee on Cancer T and N stage distribution included the following: T1, one patient; T2, five patients; T3, two patients; and T4, nine patients; and N1, six patients; N2, nine patients; and N3, two patients. Median radiation dose to the primary target volume and enlarged lymph nodes was 61.2 Gy (range, 59.4-61.2). Uninvolved cervical nodes received 45 Gy (range, 45-46.8). All radiation was delivered at 1.8 Gy/fraction daily using sequential plans. In 11 patients, photon-based intensity-modulated radiotherapy was used for elective neck irradiation to optimize dose homogeneity and improve target conformity. All patients received induction chemotherapy; all but one received concurrent chemotherapy. Five received adjuvant beta-interferon therapy. RESULTS Median follow-up was 3.0 years (range, 1.6-7.9). No patients were lost to follow-up. Overall survival, progression-free survival, and local control rates were 100%. Fifteen patients developed mucositis requiring enteral feeding (n = 14) or total parenteral nutrition (n = 1) during radiotherapy. Serious late side effects included cataract (n = 1), esophageal stenosis requiring dilation (n = 1), sensorineural hearing loss requiring aids (n = 1), and hormone deficiency (n = 5, including three with isolated hypothyroidism). CONCLUSION Following induction chemotherapy, moderate-dose proton therapy can potentially reduce toxicity in the brain and skull base region without compromising disease control. However, further follow-up is needed to fully characterize and evaluate any reduction in long-term complications.
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Affiliation(s)
- Haruka Uezono
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Eric S Sandler
- Department of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida
| | - Howard M Katzenstein
- Department of Pediatric Oncology, Nemours Children's Specialty Clinic, Jacksonville, Florida
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Raymond Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Bernadette M Brennan
- Department of Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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Rodriguez-Galindo C, Krailo MD, Krasin MJ, Huang L, McCarville MB, Hicks J, Pashankar F, Pappo AS. Treatment of Childhood Nasopharyngeal Carcinoma With Induction Chemotherapy and Concurrent Chemoradiotherapy: Results of the Children's Oncology Group ARAR0331 Study. J Clin Oncol 2019; 37:3369-3376. [PMID: 31553639 DOI: 10.1200/jco.19.01276] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The treatment of childhood nasopharyngeal carcinoma has been adapted from adult regimens; pediatric-specific studies are limited. The ARAR0331 study sought to evaluate the impact of induction chemotherapy (IC) and concurrent chemoradiotherapy (CCR). PATIENTS AND METHODS Patients with American Joint Committee on Cancer stages IIb to IV were scheduled to receive three cycles of IC with cisplatin and fluorouracil, followed by CCR with three cycles of cisplatin. Patients with complete or partial response to IC received 61.2 Gy to the nasopharynx and neck, and patients with stable disease received 71.2 Gy. RESULTS Between February 2006 and January 2012, 111 patients (75 male) were enrolled. Median age was 15 years, and 46.8% of the patients were African American. After a feasibility analysis, the study was amended to reduce cisplatin to two cycles during CCR. The 5-year event-free survival (EFS) and overall survival estimates were 84.3% and 89.2%, respectively. The 5-year EFS for stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two CCR cycles of cisplatin had improved 5-year postinduction EFS (90.7% v 81.2%, P = .14). CONCLUSION Patients in ARAR0331 were characterized by advanced disease and by a high proportion of black children and adolescents. Treatment with IC and CRT resulted in excellent outcomes. A radiation dose reduction is possible for patients responding to IC. Although the outcomes are comparable, we observed a trend toward decreased EFS for patients assigned to receive fewer doses of cisplatin during CCR.
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Affiliation(s)
| | - Mark D Krailo
- Children's Oncology Group, Monrovia, CA.,University of Southern California, Los Angeles, CA
| | | | - Li Huang
- Children's Oncology Group, Monrovia, CA
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Lu S, Wei J, Sun F, Xiao W, Cai R, Zhen Z, Zhu J, Wang J, Huang J, Lu L, Sun X, Gao Y. Late Sequelae of Childhood and Adolescent Nasopharyngeal Carcinoma Survivors After Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:45-51. [DOI: 10.1016/j.ijrobp.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Li Y, Tang LQ, Liu LT, Guo SS, Liang YJ, Sun XS, Tang QN, Bei JX, Tan J, Chen S, Ma J, Zhao C, Chen QY, Mai HQ. Induction Chemotherapy Plus Concurrent Chemoradiotherapy Versus Concurrent Chemoradiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma in Children and Adolescents: A Matched Cohort Analysis. Cancer Res Treat 2018; 50:1304-1315. [PMID: 29334605 PMCID: PMC6192939 DOI: 10.4143/crt.2017.463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/03/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the long-term clinical outcome and toxicity of induction chemotherapy (IC) followed by concomitant chemoradiotherapy (CCRT) compared with CCRT alone for the treatment of children and adolescent locoregionally advanced nasopharyngeal carcinoma (LACANPC). MATERIALS AND METHODS A total of 194 locoregionally advanced nasopharyngeal carcinoma patients youngerthan 21 years who received CCRT with or without IC before were included in the study population. Overall survival (OS) rate, progression-free survival (PFS) rate, locoregional recurrence-free survival (LRFS) rate, and distant metastasis-free survival (DMFS) rate were assessed by the Kaplan-Meier method and a log-rank test. Treatment toxicities were clarified and compared between two groups. RESULTS One hundred and thiry of 194 patients received IC+CCRT. Patients who were younger and with more advanced TNM stage were more likely to receive IC+CCRT and intensive modulated radiotherapy. The addition of IC before CCRT failed to improve survival significantly. The matched analysis identified 43 well-balanced patients in both two groups. With a median follow-up of 51.5 months, no differences were found between the IC+CCRT group and the CCRT group in 5-year OS (83.7% vs. 74.6%, p=0.153), PFS (79.2% vs. 73.4%, p=0.355), LRFS (97.7% vs. 88.2%, p=0.083), and DMFS (81.6% vs. 81.6%, p=0.860). N3 was an independent prognostic factor predicting poorer OS, PFS, and DMFS. The addition of IC was associated with increased rates of grade 3 to 4 neutropenia. CONCLUSION This study failed to demonstrate that adding IC before CCRT could provide a significant additional survival benefit for LACANPC patients. Further investigations are warranted.
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Affiliation(s)
- Yang 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 Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lin-Quan Tang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li-Ting Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shan-Shan Guo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu-Jing Liang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xue-Song Sun
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qing-Nan Tang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jin-Xin Bei
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing Tan
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shuai Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun Ma
- 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, Sun Yat-Sen University Cancer Center, 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
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiu-Yan Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Qiang Mai
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
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11
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Challapalli SD, Simpson MC, Adjei Boakye E, Pannu JS, Costa DJ, Osazuwa-Peters N. Head and Neck Squamous Cell Carcinoma in Adolescents and Young Adults: Survivorship Patterns and Disparities. J Adolesc Young Adult Oncol 2018; 7:472-479. [DOI: 10.1089/jayao.2018.0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Matthew C. Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric Adjei Boakye
- Saint Louis University Center for Outcomes Research, St. Louis, Missouri
| | - Jay S. Pannu
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Dary J. Costa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Otolaryngology, Cardinal Glennon Children's Medical Center, St. Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Saint Louis University Cancer Center, St. Louis, Missouri
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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12
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Aliyu UM, Folasire AM, Ntekim AI. Treatment outcome of patients with nasopharyngeal carcinoma in Nigeria: An institutional experience. PRECISION RADIATION ONCOLOGY 2018. [DOI: 10.1002/pro6.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - Atara Isaiah Ntekim
- College of Medicine; University of Ibadan; Ibadan Nigeria
- University College Hospital; Ibadan Nigeria
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13
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Yan HL, Li L, Li SJ, Zhang HS, Xu W. miR-346 promotes migration and invasion of nasopharyngeal carcinoma cells via targeting BRMS1. J Biochem Mol Toxicol 2016; 30:602-607. [PMID: 27501413 DOI: 10.1002/jbt.21827] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/06/2016] [Indexed: 01/21/2023]
Abstract
The aim of this study is to determine the expression and roles of miR-346 in nasopharyngeal carcinoma (NPC). We showed that miR-346 was upregulated in NPC tissues compared with adjacent non-tumorous nasopharyngeal tissues. Inhibition of miR-346 significantly attenuated the migration and invasion of NPC cells. Luciferase reporter assay showed that miR-346 targeted the 3'-untranslated region (3'-UTR) of breast cancer metastasis suppressor 1 (BRMS1). Overexpression of miR-346 suppressed the endogenous expression of BRMS1 in NPC cells. There was a significant negative correlation between miR-346 and BRMS1 protein expression in NPC tissues (r = -0.372, P = 0.008). Rescue experiments demonstrated that overexpression of BRMS1 lacking the 3'-UTR impaired the invasiveness of NPC cells transfected with miR-346 mimic. Taken together, miR-346 shows the ability to promote the migration and invasion of nasopharyngeal cancer cells via targeting BRMS1 and represents a potential therapeutic target for NPC.
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Affiliation(s)
- Hong-Ling Yan
- Department of Otorhinolaryngology, Tangshan Maternity and Child Health Care Hospital, Tangshan, People's Republic of China
| | - Li Li
- Department of Radiotherapy, Shanghai Armed Police Hospital, Shanghai, People's Republic of China
| | - Shu-Juan Li
- Department of Otorhinolaryngology, Tangshan Maternity and Child Health Care Hospital, Tangshan, People's Republic of China
| | - Hai-Sheng Zhang
- Department of Otorhinolaryngology, Tangshan Maternity and Child Health Care Hospital, Tangshan, People's Republic of China
| | - Wei Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University of Medicine, Shanghai, People's Republic of China
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