Concurrent Chemoradiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma: Treatment Outcomes and Prognostic Factors

Effect of radiotherapy interruption on nasopharyngeal cancer

Nasopharyngeal carcinoma (NPC) is a malignant tumor originating from the epithelial cells of the nasopharynx with a unique geographic distribution, and is particularly prevalent in East and Southeast Asia. Due to its anatomical location, the surgery is difficult to access and the high sensitivity of nasopharyngeal cancer to radiotherapy (RT) makes it the main treatment modality. Radical radiotherapy is the first-line treatment for early-stage nasopharyngeal carcinoma and the cornerstone of multidisciplinary treatment for patients with locally advanced nasopharyngeal carcinoma. Nevertheless, radiotherapy interruption is inevitable as a consequence of unavoidable factors such as public holidays, machine malfunction, patient compliance, and adverse response to treatment, which in turn leads to a reduction in bioactivity and causes sublethal loss of tumor cells to repair. Unirradiated tumor cells are more likely to repopulate at or near their original fastest growth rate during this interval. If no measures are taken after the radiotherapy interruption, such as increasing the dose of radiotherapy and systemic therapy, the tumor is most likely to go uncontrolled and then progress. This review describes the effects of radiotherapy interruption on nasopharyngeal carcinoma, the mechanism of the effect, and explores the measures that can be taken in response to such interruption.

Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT

Background

Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined.

Methods

During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, D_max(the maximum dose), D_0.1c (maximum average dose delivered to a 0.1-cc volume), D_1cc, D_2cc, D_3cc, D_5cc, D_10cc and D_mean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis.

Results

Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of D_max was the largest (0.987). Moreover, logistic stepwise regression indicated that D_max was the most important dose factor. The RIBN incidence at 5% over 5 years (TD_5/5) and 50% incidence over 5 years (TD_50/5) was 69.59 Gy and76.45 Gy, respectively.

Conclusions

Brainstem necrosis is associated with high dose irritation. D_max is the most significant predictive dosimetric factor for RIBN. D_max of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was D_max < 69.59 Gy.

Effect of high-quality nursing intervention on psychological emotion, life quality and nursing satisfaction of patients with nasopharyngeal carcinoma undergoing radiotherapy

OBJECTIVE

This study was designed to investigate the effect of high-quality nursing (HQN) intervention on psychological emotion, quality of life (QOL) and nursing satisfaction of patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy.

METHODS

Fifty-eight NPC patients receiving radiotherapy in our hospital between August 2017 and February 2019 were selected and divided into two groups according to different nursing intervention models. Among them, the control group (CG; 28 cases) was given routine nursing intervention, while the research group (RG; 30 cases) was treated with HQN intervention. The efficacy and the incidence of adverse reactions of the two groups were evaluated. Health knowledge awareness rate, psychological mood, QOL, sleep quality and nursing satisfaction were compared between CG and RG.

RESULTS

RG presented significantly higher efficacy and notably lower incidence of adverse reactions than CG after 3 months of nursing intervention. Patients in RG acquired evidently higher knowledge awareness rate regarding radiotherapy, dietary, adverse reaction prevention, self-care and functional exercise than those in RG (P < 0.05). In comparison with CG, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) as well as Pittsburgh Sleep Quality Index (PSQI) in RG were evidently lower, while the Short-Form 36 Item Health Survey (SF-36) scores and nursing satisfaction were statistically higher.

CONCLUSIONS

HQN intervention is high-performing in NPC patients undergoing radiotherapy, which can effectively improve the curative effect, reduce the incidence of adverse reactions, enhance patients' health knowledge awareness rate while relieving their bad emotions and improving their QOL, sleep quality and nursing satisfaction.

Survival outcome and prognostic factors of patients with nasopharyngeal cancer in Yogyakarta, Indonesia: A hospital-based retrospective study

Purpose

This study aimed to determine the survival outcome and prognostic factors of patients with nasopharyngeal cancer accessing treatment in Yogyakarta, Indonesia.

Methods

Data on 759 patients with NPC diagnosed from 2007 to 2016 at Dr Sardjito General Hospital were included. Potential prognostic variables included sociodemographic, clinicopathology and treatment parameters. Multivariable analyses were implemented using semi-parametric Cox proportional hazards modelling and fully parametric survival analysis.

Results

The median time of observation was 14.39 months. In the whole cohort the median observed survival was 31.08 months. In the univariable analysis, age, education status, insurance type, BMI, ECOG index, stage and treatment strategy had an impact on overall survival (OS) (p values <0.01). Semi-parametric multivariable analyses with stage stratification showed that education status, ECOG index, and treatment modality were independent prognostic factors for OS (p values <0.05). In the fully parametric models age, education status, ECOG index, stage, and treatment modality were independent prognostic factors for OS (p values <0.05). For both multivariable analyses, all treatment strategies were associated with a reduced hazard (semi-parametric models, p values <0.05) and a better OS (parametric models, p values <0.05) compared with no treatment. Furthermore, compared with radiation alone or chemotherapy alone, a combination of chemotherapy and radiation either in a form of concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiation, or induction chemotherapy followed by CCRT demonstrated a reduced hazard (hazard ratio/HR 0.226, 95% confidence interval/CI 0.089–0.363, and HR 0.390, 95%CI 0.260–0.519) and a better OS (time ratio/TR 3.108, 95%CI 1.274–4.942 and TR 2.531, 95%CI 1.829–3.233) (p values < 0.01).

Conclusions

Median OS for the cohort was low compared to those reported in both endemic and non-endemic regions. By combining the findings of multivariable analyses, we showed that age, education status, ECOG index, stage and first treatment modality were independent predictors for the OS.

LINC00667 Sponges miR-4319 to Promote the Development of Nasopharyngeal Carcinoma by Increasing FOXQ1 Expression

Accumulating evidence has indicated that lncRNAs regulate various biological and pathological processes in diverse malignant tumors. The roles of LINC00667 in cancer development have been explored in glioma, hepatocellular carcinoma and non-small cell lung cancer, but not in nasopharyngeal carcinoma (NPC). In the present study, we characterize the role and molecular mechanism of LINC00667 in NPC progression. It was found that LINC00667 was overexpressed in NPC cells compared to normal cells. Silencing LINC00667 suppressed the proliferation, migration, invasion and epithelial mesenchymal transition (EMT) in NPC cells. In addition, bioinformatics analysis revealed that LINC00667 acted as a ceRNA to absorb miR-4319. Further investigations illustrated that miR-4319 had low expression in NPC cells and functioned as a tumor suppressor in the progression of NPC. Mechanistic study identified forkhead box Q1 (FOXQ1) as a functional target of miR-4319. The effect of LINC00667 in NPC development was mediated by the miR-4319/FOXQ1 axis. Analysis on tumorxenograft mouse model demonstrated that knockdown of LINC00667 repressed NPC tumor growth in vivo and confirmed the in vitro results. Our present study suggested that LINC00667 promoted the malignant phenotypes of NPC cells by competitively binding to miR-4319 to up-regulate FOXQ1 expression. Our results reveled that LINC00667 could be a diagnostic and therapeutic target for NPC patients.

Long Noncoding RNA UCA1 Accelerates Nasopharyngeal Carcinoma Cell Progression By Modulating miR-124-3p/ITGB1 Axis

Background

Nasopharyngeal carcinoma (NPC) is a common malignant cancer that is distributed particularly in Southeastern Asia. Previous studies have manifested that long noncoding RNA urothelial carcinoma associated 1 (UCA1) was involved in NPC tumorigenesis and metastasis. However, the biological mechanism of UCA1 for NPC cell progression requires further investigation.

Methods

The expression levels of UCA1, miR-124-3p, integrin beta-1 (ITGB1) were detected by qRT-PCR. Protein expression of ITGB1 was determined by Western blot assay. Cell proliferation, migration and invasion were evaluated by CCK8 and transwell assay, respectively. The interaction between miR-124-3p and UCA1 or ITGB1 was determined by luciferase reporter system, RIP and RNA pull-down assay. Mice model was established by subcutaneously injecting SUNE1 cells stably transfected with sh-UCA1 and sh-NC.

Results

The expression of UCA1 was up-regulated in NPC tissues and cells. However, UCA1 knockdown hindered NPC cell growth, migration and invasion. In addition, the interaction between miR-124-3p and UCA1 or ITGB1 was confirmed by luciferase reporter system, RIP and RNA pull-down assay. Besides, miR-124-3p inhibitor abrogated UCA1 silencing-mediated suppression on cell progression in NPC. Moreover, UCA1 accelerated NPC cell progression through modulating ITGB1 via sponging miR-124-3p. In vivo experiments revealed the interference of UCA1-inhibited tumor growth by regulating miR-124-3p/ITGB1 axis.

Conclusion

UCA1 acts as an oncogene to promote NPC cell proliferation by up-regulating ITGB1 through suppressing miR-124-3p in vitro and in vivo, providing a potential target for NPC diagnosis and treatment.

[Long non-coding RNA XIST modulates cisplatin resistance by altering PDCD4 and Fas-Lexpressions in human nasopharyngeal carcinoma HNE1 cells in vitro]

OBJECTIVE

To explore the role of long non-coding RNA (lncRNA) X inactive specific transcript (XIST) in modulating cisplatin (DDP) resistance of human nasopharyngeal carcinoma cells and investigate the possible mechanism.

METHODS

Realtime PCR was performed to detect the expression of XIST in cisplatin-resistant human nasopharyngeal carcinoma cell line HNE1/DDP. The effects of up-regulation and down-regulation of XIST on DDP resistance, proliferation and apoptosis of HNE1/ DDP cells were assessed using MTT assay, EdU assay and flow cytometry. Western blotting was used to detect the changes in the expressions of programmed cell death 4 (PDCD4) and Fas ligand (Fas-L) proteins in the cells in response to up-regulation or down-regulation of XIST.

RESULTS

The expression of XIST was significantly up-regulated in HNE1/DDP cells in comparison with HNE1 cells (0.57±0.06 vs 0.1±0.02, P &lt; 0.05). Down-regulation of XIST significantly decreased while up-regulation of XIST obviously increased DDP resistance of HNE1/DDP cells (P &lt; 0.05). Down-regulation of XIST significantly reduced the proliferation (6.17 ± 1.93 vs 16.59 ± 4.86, P &lt; 0.05) and enhanced apoptosis [(18.04 ± 4.72)% vs (4.22 ± 1.65)%, P &lt; 0.05], while upregulating XIST enhanced the proliferation (25.40±7.21 vs 13.16±3.95, P &lt; 0.05) and inhibited apoptosis [(2.82±0.88)% vs (6.46± 1.75)%, P &lt; 0.05] in HNE1/DDP cells. Down-regulation of XIST significantly increased the protein expressions of PDCD4 and Fas-L (P &lt; 0.05) in HNE1/DDP cells, and up-regulation of XIST resulted in reverse changes in PDCD4 and Fas-L expressions (P &lt; 0.05).

CONCLUSIONS

XIST is up-regulated in HNE1/DDP cells, and down-regulation and up-regulation of XIST expression reduce and increase DDP resistance of the cells, respectively, possibly as a result of changes in the expressions of PDCD4 and Fas-L.

NACT+IMRT versus NACT+IMRT+CCRT in locoregionally advanced NPC patients: a retrospective study

Purpose

The outcomes and safety profiles of neoadjuvant chemotherapy (NACT) + intensity modulated radiotherapy (IMRT) or NACT + IMRT + concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) patients were retrospectively analyzed.

Patients and methods

Between 2010 and 2014, 125 patients with stage III-IVb NPC, who were treated with IMRT (36, 28.8%) or IMRT + CCRT (89, 71.2%) following NACT, participated in the research. There were grade 3-4 toxicities during NACT or radiotherapy (RT) in NACT + IMRT group and NACT + IMRT + CCRT group.

Results

MRI within 3 months demonstrated that no patient suffered with progressive disease, 116 patients (92.8%) achieved a response rate (RR) with the complete response (CR) rate of 70.4% (88/125) and partial response (PR) rate of 22.4% (28/125), and nine patients (7.2%) showed stable disease (SD) at the primary site and metastatic nodes. Compared with NACT + IMRT group, patients in NACT + IMRT + CCRT group did not show significantly better RR (93.3% vs 91.7%, P=1.00), CR rate (71.9% vs 66.7%, P=0.67), or PR rate (21.4% vs 25%, P=0.81). There was no significant difference in overall survival (OS, P=0.114), local relapse-free survival (LRFS, P=0.124), distant metastasis-free survival (DMFS, P=0.668) or progression-free survival (PFS, P=0.475) between NACT + IMRT group and NACT + IMRT + CCRT group. T classification (P=0.042) and N classification (P=0.021) were independent prognostic factors for DMFS.

Conclusion

To sum up, no significant difference was observed in combined RR, CR rate, LRFS, DMFS, PFS, or OS between the two groups.