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Wang D, Liao M, Wu J, Luo W, Qi S, Liu B, Li J. Salvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta-analysis. Head Neck 2023; 45:503-520. [PMID: 36420965 DOI: 10.1002/hed.27253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2-, 3-, and 5-year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5-year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2-, 3-, and 5-year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment-related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes to re-irradiation, while offering a better safety profile for selective patients with resectable IrNPC.
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Affiliation(s)
- Dong Wang
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
| | - Mange Liao
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
| | - Jian Wu
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
| | - Wenlong Luo
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siguo Qi
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
| | - Bo Liu
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
| | - Jiarong Li
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Dazhou, Dazhou, Sichuan, China
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2
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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3
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Jicman Stan D, Niculet E, Lungu M, Onisor C, Rebegea L, Vesa D, Bezman L, Bujoreanu FC, Sarbu MI, Mihailov R, Fotea S, Tatu AL. Nasopharyngeal carcinoma: A new synthesis of literature data (Review). Exp Ther Med 2022; 23:136. [PMID: 35069817 PMCID: PMC8756428 DOI: 10.3892/etm.2021.11059] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is an epithelial tumor, which develops most frequently from the lateral pharyngeal recess and holds some complex epidemiological characteristics. Its unusual race and geographic distribution suggests that not only the environmental factors are a contributing factor to the development of this rare cancer type, but also the genetic traits play an important role, along with nitrosamine-containing food consumption and Epstein-Barr virus infection. The signs and symptoms which a patient can present and suffer from are various and include nasal, otic, neurological as well as general ones; the way this tumor manifests being dependent on the stage of the tumor. The therapeutic management applicable in NPC needs to be established according to the case of the patient and include radiotherapy, chemotherapy, surgery, immune therapy, targeted therapy or combined treatment. The main objective of the treatment is local and regional tumor control; relapse is an important factor for future development of distant metastases. New therapeutic concepts are always sought of, current research focusing on precision medicine, meaning systemic treatment with a personalized radiotherapy approach according to the characteristics of the tumor.
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Affiliation(s)
- Daniela Jicman Stan
- Department of Otorhinolaryngology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Biomedical Doctoral School, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galati, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galati, Romania.,Department of Pathology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Mihaela Lungu
- Department of Neurology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Cristian Onisor
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galati, Romania
| | - Laura Rebegea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Doinita Vesa
- Department of Otorhinolaryngology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Laura Bezman
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galati, Romania.,Department of Ophthalmology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania
| | - Florin Ciprian Bujoreanu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 'Dunarea de Jos' University, 800010 Galati, Romania.,Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Mihaela Ionela Sarbu
- Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Raul Mihailov
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Silvia Fotea
- Department of Neurology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Department of Pediatrics, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galati, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 'Dunarea de Jos' University, 800010 Galati, Romania.,Department of Neurology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Department of Ophthalmology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM, 'Dunarea de Jos' University of Galati, 800010 Galati, Romania
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4
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Newton E, Valenzuela D, Foley J, Thamboo A, Prisman E. Outcomes for the treatment of locoregional recurrent nasopharyngeal cancer: A systematic review and pooled analysis. Head Neck 2021; 43:3979-3995. [PMID: 34403174 DOI: 10.1002/hed.26836] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 07/06/2021] [Accepted: 07/29/2021] [Indexed: 01/13/2023] Open
Abstract
Despite advances in the treatment of primary nasopharyngeal carcinoma, locoregional recurrence (lrNPC) occurs at 10%-50% at 5 years. This review aims to evaluate salvage treatment for locally recurrent nasopharyngeal cancer. A literature search for all original articles published on the treatment of lrNPC from January 1990 to January 2021 was conducted. Pooled analysis was performed using a random effects model and assessed statistical heterogeneity of the combined results with I2 index. Overall, 66 studies were included for analysis. A total of 5286 patients treated with intensity-modulated radiation therapy (39%), conformal radiotherapy (31%), open nasopharyngectomy (12%), endoscopic nasopharyngectomy (10%), stereotactic radiosurgery (4%), and brachytherapy (4%) were included. Surgical therapy has similar overall survival outcomes to re-irradiation but with decreased treatment-related morbidity and mortality. Both surgical and re-irradiation for lrNPC have similar long-term survival. Surgical approaches to lrNPC may offer similar survival while avoiding treatment-associated morbidity and mortality.
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Affiliation(s)
- Ethan Newton
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Valenzuela
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua Foley
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Ng WT, Soong YL, Ahn YC, AlHussain H, Choi HCW, Corry J, Grégoire V, Harrington KJ, Hu CS, Jensen K, Kwong DL, Langendijk JA, Le QT, Lee NY, Lin JC, Lu TX, Mendenhall WM, O'Sullivan B, Ozyar E, Pan JJ, Peters LJ, Poh SS, Rosenthal DI, Sanguineti G, Tao Y, Wee JT, Yom SS, Chua MLK, Lee AWM. International Recommendations on Reirradiation by Intensity Modulated Radiation Therapy for Locally Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:682-695. [PMID: 33571626 DOI: 10.1016/j.ijrobp.2021.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Reirradiation for locally recurrent nasopharyngeal carcinoma (NPC) is challenging because prior radiation dose delivered in the first course is often close to the tolerance limit of surrounding normal structures. A delicate balance between achieving local salvage and minimizing treatment toxicities is needed. However, high-level evidence is lacking because available reports are mostly retrospective studies on small series of patients. Pragmatic consensus guidelines, based on an extensive literature search and the pooling of opinions by leading specialists, will provide a useful reference to assist decision-making for these difficult decisions. METHODS AND MATERIALS A thorough review of available literature on recurrent NPC was conducted. A set of questions and preliminary draft guideline was circulated to a panel of international specialists with extensive experience in this field for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the whole panel for review and reconsideration. The current guideline was based on majority voting after repeated iteration for final agreement. RESULTS The initial round of questions showed variations in clinical practice even among the specialists, reflecting the lack of high-quality supporting data and the difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of reirradiation (including patient selection, targets contouring, dose prescription, and constraints). CONCLUSION This paper provides useful reference on radical salvage treatment strategies for recurrent NPC and optimization of reirradiation through review of published evidence and consensus building. However, the final decision by the attending clinician must include full consideration of an individual patient's condition, understanding of the delicate balance between risk and benefits, and acceptance of risk of complications.
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Affiliation(s)
- Wai Tong Ng
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hussain AlHussain
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Vincent Grégoire
- Center for Molecular Imaging, Oncology, and Radiotherapy, Université Catholique de Louvain, Brussels, Belgium, and Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Kevin J Harrington
- Royal Marsden/Institute of Cancer Research National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | - Chao Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Dora L Kwong
- Department of Clinical Oncology, University of Hong Kong and Queen Mary Hospital, Hong Kong
| | - Johannes A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, NRG Oncology and HNCIG, Stanford, California
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Jin Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Tai Xiang Lu
- Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Jian Ji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lester J Peters
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sharon S Poh
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Joseph T Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, Hong Kong, China.
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6
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Tan LP, Tan GW, Sivanesan VM, Goh SL, Ng XJ, Lim CS, Kim WR, Mohidin TBBM, Mohd Dali NS, Ong SH, Wong CY, Sawali H, Yap YY, Hassan F, Pua KC, Koay CE, Ng CC, Khoo ASB. Systematic comparison of plasma EBV DNA, anti-EBV antibodies and miRNA levels for early detection and prognosis of nasopharyngeal carcinoma. Int J Cancer 2019; 146:2336-2347. [PMID: 31469434 PMCID: PMC7065012 DOI: 10.1002/ijc.32656] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/17/2019] [Accepted: 08/15/2019] [Indexed: 12/31/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is originated from the epithelial cells of nasopharynx, Epstein–Barr virus (EBV)‐associated and has the highest incidence and mortality rates in Southeast Asia. Late presentation is a common issue and early detection could be the key to reduce the disease burden. Sensitivity of plasma EBV DNA, an established NPC biomarker, for Stage I NPC is controversial. Most newly reported NPC biomarkers have neither been externally validated nor compared to the established ones. This causes difficulty in planning for cost‐effective early detection strategies. Our study systematically evaluated six established and four new biomarkers in NPC cases, population controls and hospital controls. We showed that BamHI‐W 76 bp remains the most sensitive plasma biomarker, with 96.7% (29/30), 96.7% (58/60) and 97.4% (226/232) sensitivity to detect Stage I, early stage and all NPC, respectively. Its specificity was 94.2% (113/120) against population controls and 90.4% (113/125) against hospital controls. Diagnostic accuracy of BamHI‐W 121 bp and ebv‐miR‐BART7‐3p were validated. Hsa‐miR‐29a‐3p and hsa‐miR‐103a‐3p were not, possibly due to lower number of advanced stage NPC cases included in this subset. Decision tree modeling suggested that combination of BamHI‐W 76 bp and VCA IgA or EA IgG may increase the specificity or sensitivity to detect NPC. EBNA1 99 bp could identify NPC patients with poor prognosis in early and advanced stage NPC. Our findings provided evidence for improvement in NPC screening strategies, covering considerations of opportunistic screening, combining biomarkers to increase sensitivity or specificity and testing biomarkers from single sampled specimen to avoid logistic problems of resampling. What's new? Plasma Epstein–Barr virus (EBV) DNA is an established nasopharyngeal carcinoma (NPC) biomarker, but not all cases are associated with EBV and its sensitivity for stage I NPC remains controversial. Meanwhile, most newly‐reported NPC biomarkers have neither been externally validated nor compared to established biomarkers. This study systematically evaluates six established and four new biomarkers in NPC cases, population controls, and hospital controls. The findings provide evidence to policymakers for improvement in NPC screening and monitoring strategies, covering considerations of opportunistic screening, combining biomarkers to increase sensitivity/specificity, and testing multiple biomarkers on single specimens to avoid the logistic problems of resampling.
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Affiliation(s)
- Lu Ping Tan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Selangor, Malaysia
| | - Geok Wee Tan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Mohan Sivanesan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siang Ling Goh
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia
| | - Xun Jin Ng
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Chun Shen Lim
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia.,Department of Biochemistry, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Wee Ric Kim
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Nor Soleha Mohd Dali
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siew Hoon Ong
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Chun Ying Wong
- Department of Otorhinolaryngology, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - Halimuddin Sawali
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Yoke Yeow Yap
- Department of Otorhinolaryngology, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Surgery, Clinical Campus Faculty of Medicine and Health Sciences, University Putra Malaysia at Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Faridah Hassan
- Department of Otorhinolaryngology, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
| | - Kin Choo Pua
- Department of Otorhinolaryngology, Pulau Pinang Hospital, Ministry of Health Malaysia, Georgetown, Pulau Pinang, Malaysia
| | - Cheng Eng Koay
- Gleneagles Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.,Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Ching Ching Ng
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia
| | - Alan Soo-Beng Khoo
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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7
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Lin Y, Ouyang Y, Lu Z, Liu Y, Chen K, Cao X. Long-Term Outcomes of Three-Dimensional High-Dose-Rate Brachytherapy for Locally Recurrent Early T-Stage Nasopharyngeal Carcinoma. Front Oncol 2019; 9:278. [PMID: 31134143 PMCID: PMC6524703 DOI: 10.3389/fonc.2019.00278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Brachytherapy (BT) is one of the techniques available for retreatment of patients with locally recurrent nasopharyng eal carcinoma (rNPC). In this study, we evaluated the treatment outcome and late toxicities of three-dimensional high-dose-rate brachytherapy (3D-HDR-BT) for patients with locally rNPC. Materials and Methods: This is a retrospective study involving 36 patients with histologically confirmed rNPC from 2004 to 2011. Of the 36 patients, 17 underwent combined-modality treatment (CMT) consisting of external beam radiotherapy (EBRT) followed by 3D-HDR-BT, while the other 19 underwent 3D-HDR-BT alone. The median dose of EBRT for the CMT group was 60 (range, 50-66) Gy, with an additional median dose of BT of 16 (range, 9-20) Gy. The median dose for the 3D-HDR-BT group was 32 (range, 20-36) Gy. The measured treatment outcomes were the 5- and 10-year locoregional recurrence-free survival (LRFS), disease-free survival (DFS), overall survival (OS), and late toxicities. Results: The median age at recurrence was 44.5 years. The median follow-up period was 70 (range, 6-142) months. The 5-year LRFS, DFS, and OS for the entire patient group were 75.4, 55.6, and 74.3%, respectively, while the 10-year LRFS, DFS, and OS for the entire patient group were 75.4, 44.2, and 53.7%, respectively. The 10-year LRFS in the CMT group was higher than that in the 3D-HDR-BT-alone group (93.8 vs. 58.8%, HR: 7.595, 95%CI: 1.233-61.826, p = 0.025). No grade 4 late radiotherapy-induced toxicities were observed. Conclusions: 3D-HDR-BT achieves favorable clinical outcomes with mild late toxicity in patients with locally rNPC.
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Affiliation(s)
- Yanzhu Lin
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yi Ouyang
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghong Liu
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kai Chen
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinping Cao
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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8
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Agas RAF, Yu KKL, Sogono PG, Co LBA, Jacinto JCKM, Bacorro WR, Mejia MBA. Reirradiation for Recurrent Nasopharyngeal Carcinomas: Experience From an Academic Tertiary Center in a Low- to Middle-Income Country. J Glob Oncol 2019; 5:1-14. [PMID: 30735433 PMCID: PMC6426519 DOI: 10.1200/jgo.18.00191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The objectives of this study were to report the oncologic outcomes and the treatment-related toxicities after reirradiation (re-RT) for recurrent nasopharyngeal carcinoma (rNPC) at our institution and to apply a recently published prognostic model for survival in rNPC in our cohort. PATIENTS AND METHODS Thirty-two patients with rNPC treated at the authors' institution with re-RT were retrospectively reviewed. Treatment modalities for re-RT were intensity-modulated radiotherapy (n = 14), three-dimensional conformal radiotherapy (n = 9), single-fraction stereotactic radiosurgery (n = 6), fractionated stereotactic radiotherapy (n = 2), and high dose rate intracavitary brachytherapy (n = 1). Twenty-seven patients received re-RT with curative intent, whereas five patients were treated palliatively. RESULTS Median follow-up time was 15.5 months (range, 1 to 123 months) for the entire cohort and 20 months (range, 3 to 123 months) for patients treated with curative intent. For the entire cohort, median locoregional recurrence-free survival (LRRFS) was 14 months, with actuarial 1- and 2-year LRRFS estimates of 67.5% and 44.0%, respectively. Median overall survival (OS) time was 38 months, with actuarial 1- and 2-year estimates of 74.2% and 57.2%, respectively. For patients treated with curative intent, median LRRFS was not reached. Actuarial 1- and 2-year LRRFS estimates were 68.2% and 54.5%, respectively. Median OS time after curative intent re-RT was 42 months, with actuarial 1- and 2-year estimates of 75.4% and 63.8%, respectively. One- and 2-year OS estimates based on risk stratification were 68.6% for high risk compared with 80.8% for low risk and 34.3% for high risk compared with 70.7% for low risk, respectively (P = .223). Three patients (9.4%) developed symptomatic temporal lobe necrosis. There was no reported grade 5 treatment-related toxicity. CONCLUSION Results of the study suggest that re-RT is an effective and safe salvage treatment strategy for rNPC. Re-RT to a maximum equivalent dose in 2-Gy fractions of 60 Gy may yield good LRRFS and translate to prolonged OS.
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Affiliation(s)
- Ryan Anthony F Agas
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Kelvin Ken L Yu
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Paolo G Sogono
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Lester Bryan A Co
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Warren R Bacorro
- Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
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Bacorro WR, Agas RAF, Cabrera SMR, Bojador MR, Sogono PG, Mejia MBA, Sy Ortin TT. A novel applicator design for intracavitary brachytherapy of the nasopharynx: Simulated reconstruction, image-guided adaptive brachytherapy planning, and dosimetry. Brachytherapy 2018; 17:709-717. [DOI: 10.1016/j.brachy.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
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10
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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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11
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Yan H, Mo Z, Xiang Z, Rong D, Zhang Y, Chen G, Zhong Z, Zhang F, Gao F. CT-guided 125I brachytherapy for locally recurrent nasopharyngeal carcinoma. J Cancer 2017; 8:2104-2113. [PMID: 28819412 PMCID: PMC5559973 DOI: 10.7150/jca.19078] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose: The study evaluated the feasibility, clinical effectiveness, and quality of life of computed tomography (CT)-guided 125I brachytherapy for locally recurrent nasopharyngeal carcinoma (NPC). Methods: We recruited 81 patients diagnosed with locally recurrent NPC after previous radiotherapy with or without chemotherapy. Thirty-nine patients received 125I brachytherapy (group A) and 42 received re-irradiation (IMRT, group B). The evaluated outcomes were local control, complications, and quality of life. Cox proportional hazards regression analysis was used to compare local tumor progression-free survival (LTPFS) and overall survival (OS) in the two treatment groups. Results: The median follow-up was 30 months (range, 5-68 months), median LTPFS was 21 in group A and 17 months in group B. The 1-, 2-, and 3-year OS in group A were 84.6%, 51.3%, 30.7%, and 85.7%, 50.0%, and 32.6% in group B. In group A, 10/39 patients (25.6%) experienced at least one ≥grade III complication; no grade V complications occurred. In group B, 28/42 (66.7%) experienced at least one ≥grade III complication and 6/42 (14.3%) died of severe grade V complications. No significant between-group difference existed in the Quality of Life score on the EORTC QLQ-H&N35 questionnaire before treatment. In group A, quality of life was significantly improved after treatment; but did not improve, or even deteriorated in group B. Conclusions: 125I brachytherapy was a feasible, safe, and effective treatment for locally recurrent NPC. 125I brachytherapy significantly reduced complications caused by re-irradiation and improved patients' quality of life.
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Affiliation(s)
- Huzheng Yan
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Zhiqiang Mo
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Zhanwang Xiang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Dailin Rong
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Yanlin Zhang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Guanyu Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Zhihui Zhong
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Fujun Zhang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
| | - Fei Gao
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. ADD: 651 Dongfeng Road, East, Guangzhou, China
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Lee VHF, Kwong DLW, Leung TW, Ng SCY, Lam KO, Tong CC, Sze CK. Hyperfractionation compared to standard fractionation in intensity-modulated radiation therapy for patients with locally advanced recurrent nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2016; 274:1067-1078. [DOI: 10.1007/s00405-016-4339-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/05/2016] [Indexed: 12/01/2022]
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13
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Saba NF, Salama JK, Beitler JJ, Busse PM, Cooper JS, Jones CU, Koyfman S, Quon H, Ridge JA, Siddiqui F, Worden F, Yao M, Yom SS. ACR Appropriateness criteria® for nasopharyngeal carcinoma. Head Neck 2016; 38:979-86. [PMID: 27131050 DOI: 10.1002/hed.24423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) presents mostly with locally advanced disease and is treated with multimodal therapy; however, consensus is lacking for different clinical scenarios. METHODS The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. RESULTS The ACR Expert Panel on Radiation Oncology - Head and Neck Cancer developed consensus recommendations for guiding management of nasopharyngeal carcinoma. CONCLUSION Multidisciplinary evaluation is essential to guiding the optimal use of surgery, radiation, and systemic therapy in this disease. © 2015 Wiley Periodicals, Inc. Head Neck 38: 979-986, 2016.
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Affiliation(s)
- Nabil F Saba
- Emory University, Atlanta, Georgia, American Society of Clinical Oncology
| | | | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Harry Quon
- Johns Hopkins University, Baltimore, Maryland
| | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, American College of Surgeons
| | | | - Francis Worden
- University of Michigan, Ann Arbor, Michigan, American Society of Clinical Oncology
| | - Min Yao
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Sue S Yom
- University of California San Francisco, San Francisco, California
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Stoker SD, Indrasari SR, Herdini C, Hariwiyanto B, Karakullukcu B, Dhamiyati W, Widayati K, Romdhoni AC, Fles R, Haryana SM, Wildeman MAM, Tan IB. Photodynamic therapy as salvage therapy for patients with nasopharyngeal carcinoma experiencing local failures following definitive radiotherapy. Photodiagnosis Photodyn Ther 2015; 12:519-25. [PMID: 25917042 DOI: 10.1016/j.pdpdt.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treating local failures of nasopharyngeal carcinoma (NPC) is a challenge. This study evaluates photodynamic therapy (PDT) in the treatment of residual and recurrent NPC. METHOD In this phase II study, patients with local recurrent or residual NPC after curative intent (chemo-) radiation could be included. Exclusion criterion was a tumour depth more than 10mm. Foscan® 0.15mg/kg was administered intravenously. After 96h, the illumination was performed under local anaesthesia with a nasopharyngeal light applicator. Tumour response was measured 10 weeks after illumination by endoscopy, biopsy and CT-scan. Kaplan-Meier method was used for survival analysis. RESULTS Twenty-one patients were included. Fourteen patients were treated for residual disease (67%), and two for recurrent (10%). For five patients this distinction could not be made, due to uncertainty about complete response after initial treatment. The median follow-up time was 32 months. Twenty patients (95%) had a complete response 10 weeks post-treatment. Two patients had recurrent local disease at 5 and 7 months post-PDT. They received another course of PDT, one with success. The 2-year local control rate was 75%, progression free survival was 49% and overall survival was 65%. Nine patients (43%) had no evidence of disease and were in a good clinical condition (ECOG Performance Scale 0) at the end of the study period. No serious adverse events were observed. CONCLUSION This study showed that PDT is effective in treating local failures of NPC with a depth of less than 10mm. The treatment was easy to perform under local anaesthesia. Especially in regions were other modalities like radiation and surgery are limited PDT can be a good alternative treatment.
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Affiliation(s)
- S D Stoker
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S R Indrasari
- Department of Otorhinolaryngology, Dr. Sardjito General Hospital/Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - C Herdini
- Department of Otorhinolaryngology, Dr. Sardjito General Hospital/Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - B Hariwiyanto
- Department of Otorhinolaryngology, Dr. Sardjito General Hospital/Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - B Karakullukcu
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W Dhamiyati
- Department of Radiotherapy, Faculty of Medicine/Dr. Sardjito Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - K Widayati
- Department of Internal Medicine, Faculty of Medicine/Dr. Sardjito Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - A C Romdhoni
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - R Fles
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S M Haryana
- Department of Bio-Molecular, Faculty of Medicine/Dr. Sardjito Hospital, Gadjah Mada University, Yogyakarta, Indonesia
| | - M A M Wildeman
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - I B Tan
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Dr. Sardjito General Hospital/Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; Department of Maxillofacial Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
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15
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Li MY, Liu JQ, Chen DP, Qi B, Liang YY, Yin WJ. Glycididazole sodium combined with radiochemotherapy for locally advanced nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2015; 15:2641-6. [PMID: 24761877 DOI: 10.7314/apjcp.2014.15.6.2641] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate efficacy and side effects of glycididazole sodium (CMNa) combined with chemotherapy (cisplatin plus 5-FU/folic acid, PLF) and radiotherapy in treating patients with locally advanced nasopharyngeal carcinoma. MATERIALS AND METHODS Patients with III~IV stage nasopharyngeal carcinoma (NPC),were randomly divided into treatment group (46 patients) and control group (45 patients). Both groups received radiotherapy concomitant with PLF chemotherapy. The treatment group at the same time was given CMNa (800 mg/m2 before radiotherapy), by l h intravenous drip, three times a week. RESULTS When the dose of radiation was over 60 Gy, complete response rates of nasopharyngeal tumor and lymph node metastases in treatment group were significantly higher than in the control group (93.5% vs 77.8%; 89.1% vs 93.5%, p<0.05). Three months after radiotherapy, complete response rate of nasopharynx cancer and lymph node metastases in treatment group was both 97.8%, again higher than in the control group (84.4% and 82.2%) (p<0.05). In the treatment group, 1, 3, 5 year disease-free survival rates were 95.7%, 86.7% and 54.5%; and in control group, the corresponding disease-free survival rates were 93.3%, 66.2% and 38.6%, respectively, the difference being statistically significant (log-rank =5.887, p=0.015). One, 3, 5 year overall survival rates in two groups of patients were 97.8%, 93.5%, 70.4% and 95.5%, 88.07%, 48.4%, respectively, again with a statistically significant difference (log-rank=6.470, p=0.011). Acute toxicity and long-term radiotherapy related toxicity in the two groups did not differ (p>0.05). CONCLUSIONS Glycididazole sodium could improve curative effects without increasing adverse reactions when treating patients with locally advanced nasopharyngeal carcinoma.
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Affiliation(s)
- Ming-Yi Li
- The 4th Ward of Radiotherapy Department, Affiliated Cancer Hospital of Gangzhou Medical University, Guangzhou, China E-mail :
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Dizman A, Coskun-Breuneval M, Altinisik-Inan G, Olcay GK, Cetindag MF, Guney Y. Reirradiation with robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2015; 15:3561-6. [PMID: 24870757 DOI: 10.7314/apjcp.2014.15.8.3561] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT). MATERIALS AND METHODS Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife® FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6). RESULTS The median follow-up for all patients was 19.5 months (IQR: 12.2. -29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection. CONCLUSIONS The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.
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Affiliation(s)
- Aysen Dizman
- Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey E-mail :
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Qiu S, Lu J, Zheng W, Xu L, Lin S, Huang C, Xu Y, Huang L, Pan J. Advantages of intensity modulated radiotherapy in recurrent T1-2 nasopharyngeal carcinoma: a retrospective study. BMC Cancer 2014; 14:797. [PMID: 25366703 PMCID: PMC4233080 DOI: 10.1186/1471-2407-14-797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent T1-2 Nasopharyngeal Carcinoma (rT1-2) may be salvaged by 3D – CRT (3D-Conformal Radiotherapy), IMRT (Intensity Modulated Radiotherapy), Brachytherapy (BT), BT with external radiotherapy. The purpose of this study is to address the efficacy and toxicity profile of aforementioned four modalities for rT1-2 NPC. Methods 168 patients, median age 48 years (range 16–75 years) proven rT1-2 NPC were diagnosed and treated with four different irradiation modalities (3D-CRT, IMRT, BT, BT with external radiotherapy). Median time to recurrence was 30 months (range 1–180 months). The median follow-up time was 28 months (range, 4–135 months). Results 161 patients completed a median dose of 6445 cGy (ranging 30 to 87 Gy). Seven patients prematurely terminated their treatment due to acute side-effects and received 30–49 Gy. The 1- and 3-year local regional recurrent free survival (LRRFS), distant free survival (DFS), and overall survival (OS) rates were 82.03% vs. 82.03% vs. 82.58%, 51.33% vs. 51.33% vs. 53.41, respectively. Gender and recurrence T-classification were the two significant adverse prognostic factors for LRRFS, DFS, and OS rates. Grade 3 or 4 toxicities were tolerable. Conclusion 3D-CRT, IMRT, BT, BT with external radiotherapy are feasible and efficacious for rT1-2 NPC. In toxicity 3D-CRT/IMRT group is lower than BT group. IMRT is superior for rT1-2 NPC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
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