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Yongfeng P, Chuner J, Lei W, Fengqin Y, Zhimin Y, Zhenfu F, Haitao J, Yangming J, Fangzheng W. The Usefulness of Pretreatment MR-Based Radiomics on Early Response of Neoadjuvant Chemotherapy in Patients With Locally Advanced Nasopharyngeal Carcinoma. Oncol Res 2020; 28:605-613. [PMID: 33523792 PMCID: PMC7962941 DOI: 10.3727/096504020x16022401878096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to explore the predictive role of pretreatment MRI-based radiomics on early response of neoadjuvant chemotherapy (NAC) in locoregionally advanced nasopharyngeal carcinoma (NPC) patients. Between January 2016 and December 2016, a total of 108 newly diagnosed NPC patients who were hospitalized in the Cancer Hospital of the University of Chinese Academy of Sciences were reviewed. All patients had complete data of enhanced MR of nasopharynx before treatment, and then received two to three cycles of TP-based NAC. After 2 cycles of NAC, enhanced MR of nasopharynx was conducted again. Compared with the enhanced MR images before treatment, the response after NAC was evaluated. According to the evaluation criteria of RECIST1.1, 108 cases were divided into two groups: 52 cases for the NAC-sensitive group and 56 cases for the NAC-resistance group. ITK-SNAP software was used to manually sketch and segment the region of interest (ROI) of nasopharyngeal tumor on the MR enhanced T1WI sequence image. The parameters were analyzed and extracted by using AI Kit software. ANOVA/MW test, correlation analysis, and LASSO were used to select texture features. We used multivariate logistic regressions to select texture features and establish a predictive model. The ROC curve was used to evaluate the efficiency of the predictive model. A total of 396 texture features were obtained by using feature calculation. After all features were screened, we selected two features including ClusterShade_angle135_offset4 and Correlation_AllDirection_offshe1_SD. Based on these two features, we established a predictive model by using multivariate logistic regression. The AUC of the two features used alone (0.804, 95% CI=0.6020.932; 0.762, 95% CI=0.5560.905) was smaller than the combination of these two features (0.905, 95% CI=0.7240.984, p=0.0005). Moreover, the sensitivity values of the two features used alone and the combined use were 92.9%, 51.7%, and 85.7%, respectively, while the specificity values were 66.7%, 91.7%, and 83.3%, respectively, in the early response of NAC for NPC. The predictive model based on MRI-enhanced sequence imaging could distinguish the sensitivity and resistance to NAC and provide new biomarkers for the early prediction of the curative effect in NPC patients.
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Affiliation(s)
- Piao Yongfeng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Jiang Chuner
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Wang Lei
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Yan Fengqin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Ye Zhimin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Fu Zhenfu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Jiang Haitao
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CASBeijingP.R. China
| | - Wang Fangzheng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang CancerHospital),ZhejiangP.R. China
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Wang F, Chuner J, Lei W, Fengqin Y, Zhimin Y, Quanquan S, Tongxin L, Zhenfu F, Yangming J. Optimal induction chemotherapeutic regimen followed by concurrent chemotherapy plus intensity-modulated radiotherapy as first-line therapy for locoregionally advanced nasopharyngeal carcinoma. Medicine (Baltimore) 2020; 99:e22283. [PMID: 32991429 PMCID: PMC7523833 DOI: 10.1097/md.0000000000022283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
For patients with locoregionally advanced nasopharyngeal carcinoma (NPC), induction chemotherapy (IC) regimens based on TPF (docetaxel, cisplatin, and 5-fluorouracil), TP (docetaxel and cisplatin), and GP (gemcitabine and cisplatin) have shown excellent survival outcomes as the first-line therapy; however, no trials comparing the efficacy and safety of TPF, TP, and GP have been reported. We report 2 phase II trials comparing the treatment outcomes and side effects of 3 different IC regimens followed by concurrent chemoradiotherapy in locoregionally advanced patients with NPC.A total of 206 locoregionally advanced patients with NPC treated with a combination treatment from January 2012 to January 2014 were enrolled in the 2 studies. The patients received TPF-, TP-, and GP-based IC regimens every 3 weeks, followed by intensity-modulated radiotherapy and concurrent therapy with cisplatin every 3 weeks.After a median follow-up duration of 47 months (10-60 months), the 3-year local recurrence-free survival, regional recurrence-free survival, distant metastases-free survival, progression-free survival, and overall survival rates were 96.4%, 100%, 87.7%, 86%, and 94.7% in the TPF arm; 91.7%, 95.9%, 91.9%, 85.2%, and 92% in the TP arm; 98.6%, 100%, 89.0%, 87.6%, and 89.2% in the GP arm. The survival differences among the 3 arms were not statistically significant (P > .05). The multivariate analysis demonstrated that the IC regimen was not an independent prognostic factor for any survival outcomes. The patients in the TP arm experienced significantly lower grade 3/4 toxicities than the patients in the other 2 arms.TP-based IC regimen has similar efficacy compared with TPF- and GP-based IC regimens; however, TP-based IC regimen has a lower toxicity profile.
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Affiliation(s)
- Fangzheng Wang
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Jiang Chuner
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou
| | - Wang Lei
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Yan Fengqin
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Ye Zhimin
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Sun Quanquan
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Liu Tongxin
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Fu Zhenfu
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences
- Zhejiang Key Laboratory of Radiation Oncology
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, People's Republic of China
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Fangzheng W, Chuner J, Haiyan Q, Quanquan S, Zhimin Y, Tongxin L, Jiping L, Peng W, Kaiyuan S, Zhenfu F, Yangming J. Survival without concurrent chemotherapy for locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy plus intensity-modulated radiotherapy: Single-center experience from an endemic area. Medicine (Baltimore) 2019; 98:e18484. [PMID: 31861031 PMCID: PMC6940191 DOI: 10.1097/md.0000000000018484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Although induction chemotherapy (IC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) is the new standard treatment option in locoregionally advanced nasopharyngeal carcinoma (NPC), many patients fail to receive CC. The aim of this study was to investigate long-term survival outcomes and toxicities in these patients who are treated with IC before IMRT without CC.We retrospectively reviewed 332 untreated, newly diagnosed locoregionally advanced NPC patients who received IC before IMRT alone at our institution from May 2008 through April 2014. The IC was administered every 3 weeks for 1 to 4 cycles. Acute and late radiation-related toxicities were graded according to the acute and late radiation morbidity scoring criteria of the radiation therapy oncology group. The accumulated survival was calculated according to the Kaplan-Meier method. The log-rank test was used to compare the difference in survival.With a median follow-up duration of 65 months (range: 8-110 months), the 5-year estimated locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates were 93.4%, 91.7%, 85.8%, and 82.5%, respectively. Older age and advanced T stage were adverse prognostic factors for overall survival, and the absence of comorbidity was a favorable prognostic factor for PFS. However, acceptable acute complications were observed in these patients.IC combined with IMRT alone provides promising long-term survival outcomes with manageable toxicities. Therefore, the omission of CC from the standard treatment did not affect survival outcomes.
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Affiliation(s)
- Wang Fangzheng
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Key Laboratory of Radiation Oncology of Zhejiang Province
| | - Jiang Chuner
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Breast Tumor Surgery, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang, Hangzhou
| | - Qin Haiyan
- Department of Radiation Oncology, People's Hospital of Kecheng, Zhejiang, Quzhou
| | - Sun Quanquan
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Key Laboratory of Radiation Oncology of Zhejiang Province
| | - Ye Zhimin
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Key Laboratory of Radiation Oncology of Zhejiang Province
| | - Liu Tongxin
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Key Laboratory of Radiation Oncology of Zhejiang Province
| | - Liu Jiping
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Physics
| | - Wu Peng
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Pathology
| | - Shi Kaiyuan
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang, Hangzhou
| | - Fu Zhenfu
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences
- Department of Radiation Oncology, Zhejiang Cancer Hospital
- Key Laboratory of Radiation Oncology of Zhejiang Province
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, People's Republic of China
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Fangzheng W, Chuner J, Quanquan S, Zhimin Y, Tongxin L, Jiping L, Sakamoto M, Peng W, Kaiyuan S, Weifeng Q, Zhenfu F, Yangming J. Addition of chemotherapy to intensity-modulated radiotherapy does not improve survival in stage II nasopharyngeal carcinoma patients. J Cancer 2018; 9:2030-2037. [PMID: 29896288 PMCID: PMC5995949 DOI: 10.7150/jca.25042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/28/2018] [Indexed: 01/16/2023] Open
Abstract
In this study, we examined whether combining neoadjuvant chemotherapy (NAC) and/or concurrent chemotherapy (CC) with intensity-modulated radiotherapy (IMRT) improved survival in patients with stage II nasopharyngeal carcinoma (NPC). Two hundred forty-two stage II NPC patients were enrolled between May 2008 and April 2014 and received radical IMRT with simultaneous integrated boost technique using 6 MV photons; some patient groups also received chemotherapy every 3 weeks for 2-3 cycles. The median follow-up duration was 69 months for all patients. At the last follow-up, 18 patients had experienced treatment failure; locoregional relapse among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT occurred in 3, 3, 4 and 5, respectively; distant metastases in 0, 0, 2 and 1, respectively, and there was a statistically significant difference among four groups (P=0.019). The 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates for all patients were 94.7%, 98.7%, 92.9%, and 93.4%, respectively. Five-year LRRFS, DMFS, PFS, and OS were similar among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT treatment groups. Univariate and multivariate analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received IMRT plus chemotherapy experienced more acute adverse events than those who received IMRT alone. Thus, the addition of NAC and/or CC to IMRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than IMRT alone in patients with stage II NPC.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Jiang Chuner
- Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Liu Jiping
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Masoto Sakamoto
- Department of Radiology, Fukui Red Cross Hospital, Fukui Japan
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Shi Kaiyuan
- Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Qin Weifeng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, 100101, People's Republic of, China
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Fangzheng W, Quanquan S, Chuner J, Zhimin Y, Shuangyan Y, Huanhuan Y, Jianfang S, Sakamoto M, Weifeng Q, Zhenfu F, Yangming J, Yuezhen W. Optimization of the margin expanded from the clinical to the planned target volume during intensity-modulated radiotherapy for nasopharyngeal carcinoma. Oncotarget 2017; 8:110201-110208. [PMID: 29299141 PMCID: PMC5746376 DOI: 10.18632/oncotarget.22518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/03/2017] [Indexed: 12/25/2022] Open
Abstract
During the radiotherapy process, the emergence of set-up errors is nearly inevitable. Because set-up errors were not detected and corrected daily, planned target volumes were formed by expanding the clinical target volume according to each unit's experience. We optimized the margins of clinical and planned target volumes during administration of intensity-modulated radiotherapy for nasopharyngeal carcinoma. A total of 72 patients newly diagnosed with non-metastatic nasopharyngeal carcinoma and treated with Tomotherapy were prospectively enrolled in the study. For each patient, one megavoltage computed tomography scan was obtained after conventional positioning, online correction, and daily tomotherapy delivery. The interfraction set-up errors were determined using a planning CT based on the registered scan. The mean interfraction errors were -2.437±2.0529 mm, 0.0652±2.3844 mm, 0.318±1.8314 mm, and 0.197±1.8721° for the medial-lateral, superior-inferior, and anterior-posterior directions, and the direction of rotation, respectively. The total MPTV in the three directions was 7.53 mm, 1.83 mm, and 2.08 mm, respectively. The 3-mm margins in the superior-inferior and anterior-posterior directions uniformly expanded from the clinical target volume should be sufficient, and the marging in the medial-lateral direction was up to 7.5 mm. These results suggest that personalized MPTV may be adopted for intensity-modulated radiotherapy planning.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Jiang Chuner
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Yang Shuangyan
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yu Huanhuan
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Shi Jianfang
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Masoto Sakamoto
- Department of Radiology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Qin Weifeng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing 100101, China
| | - Wang Yuezhen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
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Fangzheng W, Chuner J, Quanquan S, Zhimin Y, Tongxin L, Jiping L, Sakamoto M, Peng W, Kaiyuan S, Weifeng Q, Zhenfu F, Yangming J. Addition of 5-fluorouracil to docetaxel/cisplatin does not improve survival in locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:115469-115479. [PMID: 29383174 PMCID: PMC5777786 DOI: 10.18632/oncotarget.23300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/04/2017] [Indexed: 12/25/2022] Open
Abstract
Addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) is a potentially effective approach for treating locoregionally advanced nasopharyngeal carcinoma (NPC). In this study, we compared the efficacy and toxicity of IC regimens consisting of docetaxel plus cisplatin with (TPF) or without (TP) 5-fluorouracil followed by CCRT in these patients. Clinical data from 245 propensity score-matched pairs of newly diagnosed non-metastatic NPC patients who received either TPF or TP IC before CCRT were retrospectively reviewed. After a median follow-up of 60 months, 5-year locoregional relapse-free, distant metastasis-free, progression-free, and overall survival rates were 95.6%, 94.7%, 90.4%, and 92.9% in TPF arm patients and 96.7%, 94.2%, 91.7%, and 91.0% in TP arm patients, respectively. There were thus no differences in survival between the two arms. Multivariate analysis revealed that IC regimen was not an independent prognostic factor for any of the survival outcomes. However, patients who received TP experienced lower incidences of grade 3/4 toxicities than those who received TPF. These results indicate that omission of 5-fluorouracil from TPF-based IC did not affect survival outcomes, but was associated with reduced toxicity, in patients with locoregionally advanced NPC.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Jiang Chuner
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Liu Jiping
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Masoto Sakamoto
- Department of Radiology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Shi Kaiyuan
- Department of Ultrasonography, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Qin Weifeng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China.,Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, People's Republic of China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing 100101, People's Republic of China
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Fangzheng W, Chuner J, Zhimin Y, Quanquan S, Tongxin L, Min X, Peng W, Bin L, Sakamoto M, Yuezhen W, Fengqin Y, Zhenfu F, Yangming J. Association of the neoadjuvant chemotherapy cycle with survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma: a propensity-matched analysis. Oncotarget 2017; 8:94117-94128. [PMID: 29212214 PMCID: PMC5706860 DOI: 10.18632/oncotarget.21587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/21/2017] [Indexed: 01/07/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) is widely used to treat locoregionally advanced nasopharyngeal carcinoma (NPC). To determine the optimal number of NAC cycles, we assessed the effect of NAC cycle on survival outcomes of locoregionally advanced NPC patients receiving NAC before concurrent chemotherapy and intensity-modulated radiotherapy. Clinical data from 1,188 non-metastatic NPC patients were retrospectively reviewed. All received ≥2 cycles of NAC added to concurrent chemoradiotherapy. Propensity score matching (PSM) was used to identify paired patients according to various covariates. In total, 297 pairs were selected. After a median follow-up time of 57 months (range: 7 to 104 months), the 5-year locoregional relapse-free survival, distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival rates in patients treated with 2 cycles vs. 3 to 4 cycles of NAC were 91.3% vs. 87.2% (P=0.149), 93.3% vs. 88.5% (P=0.043), 88.7% vs. 81.7% (P=0.037), and 94.0% vs. 92.6% (P=0.266), respectively. On multivariate analysis, 2 cycles of NAC were associated with improved DMFS (hazard ratio, 0.499; P=0.038) and PFS (hazard ratio, 0.585; P=0.049). NAC cycle was an independent prognosticator of DMFS and PFS in univariate and multivariate analyses. Thus, 2 cycles of NAC appear sufficient, as additional cycles were not associated with added survival benefit for locoregionally advanced NPC.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China.,Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui 918-8501, Japan
| | - Jiang Chuner
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Xu Min
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China
| | - Long Bin
- Department of Nuclear Medicine, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China
| | - Masoto Sakamoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui 918-8501, Japan
| | - Wang Yuezhen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Yan Fengqin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou 310022, People's Republic of China
| | - Jiang Yangming
- Department of Didital Earth, Institute of Remote Sensing and Didital Earth, CAS, Beijing 100101, People's Republic of China
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8
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Fangzheng W, Chuner J, Lei W, Fengqin Y, Zhimin Y, Quanquan S, Tongxin L, Min X, Peng W, Bin L, Aizawa R, Sakamoto M, Zhenfu F. Addition of 5-fluorouracil to first-line induction chemotherapy with docetaxel and cisplatin before concurrent chemoradiotherapy does not improve survival in locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:91150-91161. [PMID: 29207632 PMCID: PMC5710912 DOI: 10.18632/oncotarget.20017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022] Open
Abstract
Although a multicenter, randomized study indicated that induction chemotherapy (IC) with docetaxel/cisplatin/fluorouracil (TPF) before concurrent chemoradiotherapy (CCRT) improves survival outcomes, it remains unclear whether TPF is the best IC regimen for treating locoregionally advanced nasopharyngeal carcinoma (NPC). Our aim was to compare the efficacy and toxicities of TPF vs. docetaxel/cisplatin (TP) IC followed by CCRT in patients with locoregionally advanced NPC. One hundred thirty-two patients with locoregionally advanced NPC received 21-day cycles of IC with either TPF or TP. Both were followed by intensity-modulated radiotherapy concurrent with the cisplatin treatment every 3 weeks. Three-year rates of locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were respectively 96.4%, 87.7%, 86.0%, and 94.7% for patients in the TPF arm patients and 90.3%, 91.9%, 85.2%, and 92.0% for patients in the TP arm. There were no differences in survival between the two arms. Multivariate analysis revealed the IC regimen was not an independent prognostic factor for any survival outcome. However, patients in the TP arm experienced fewer grade 3/4 toxicities. In sum, IC with docetaxel and cisplatin is associated with similar efficacy and less toxicity than the TPF regimen. Addition of fluorouracil to docetaxel plus cisplatin IC is therefore not recommended for patients with locoregionally advanced NPC.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China.,Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan
| | - Jiang Chuner
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Wang Lei
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Yan Fengqin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Xu Min
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Long Bin
- Department of Nuclear Medicine, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Rihito Aizawa
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 606-8507, Kyoto, Japan
| | - Masoto Sakamoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
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9
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Fangzheng W, Quanquan S, Chuner J, Lei W, Fengqin Y, Zhimin Y, Tongxin L, Min X, Peng W, Haitao J, Aizawa R, Sakamoto M, Yuezhen W, Zhenfu F. Gemcitabine/cisplatin induction chemotherapy before concurrent chemotherapy and intensity-modulated radiotherapy improves outcomes for locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:96798-96808. [PMID: 29228572 PMCID: PMC5722524 DOI: 10.18632/oncotarget.18245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022] Open
Abstract
Addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CC) is an encouraging first-line treatment strategy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We evaluated the clinical efficacy and toxicity of addition of gemcitabine plus cisplatin (GP) IC to intensity-modulated radiotherapy (IMRT) and CC for patients with locoregionally advanced NPC. At a median follow-up duration of 48 months (10-59 months), 4-year local relapse-free survival (LRFS) was 86.9%, regional relapse-free survival (RRFS) was 90.6%, distant metastasis-free survival (DMFS) was 79.8%, progression-free survival (PFS) was 77.0%, and overall survival (OS) was 81.9%. Univariate analysis revealed that T stage, N stage, clinical stage, and CC correlated with OS, while N stage and clinical stage correlated with PFS. In multivariate analysis, T4 was a prognostic indicator of poor OS and PFS, and N3 was a prognostic indicator of poor OS. Having received ≥ 2 cycles of IC was prognostic of better RRFS. During IC, grade 3-4 thrombocytopenia occurred in 10 patients, and grade 3-4 leukocytopenia was observed in 16 patients. Two patients developed mild liver dysfunction. These findings indicate that GP-based IC followed by CC has promising efficacy with acceptable toxicities.
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Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China.,Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501, Japan
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Jiang Chuner
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Wang Lei
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Yan Fengqin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Liu Tongxin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Xu Min
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Wu Peng
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Jiang Haitao
- Department of Radiology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Rihito Aizawa
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Masoto Sakamoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501, Japan
| | - Wang Yuezhen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
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