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Comparison of concurrent chemoradiotherapy versus neoadjuvant chemotherapy followed by radiation in patients with advanced nasopharyngeal carcinoma in endemic area: experience of 128 consecutive cases with 5 year follow-up.

Wu SY, Wu YH, Yang MW, Hsueh WT, Hsiao JR, Tsai ST, Chang KY, Chang JS, Yen CJ - BMC Cancer (2014)

Bottom Line: Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046).For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability.Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan. yencj@mail.ncku.edu.tw.

ABSTRACT

Background: Combined radiotherapy and chemotherapy is considered the standard of care for locally advanced nasopharyngeal carcinoma (LA-NPC) in Epstein-Barr virus infection endemic area. This study compared the long-term outcomes between LA-NPC patients treated with neoadjuvant chemotherapy followed by radiotherapy (NACT) and those treated with concurrent chemoradiotherapy (CCRT).

Methods: From 2003 to 2007, a total of 128 histopathologically proven LA-NPC patients receiving either NACT or CCRT were consecutively enrolled at the National Cheng Kung University Hospital in Taiwan. NACT consisted of 3-week cycles of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL) or weekly alternated cisplatin on day 1 and fluorouracil and leucovorin on day 8 (P-FL). CCRT comprised 3-week cycles of cisplatin (Cis 100) or 4-week cycles of cisplatin and fluorouracil (PF4). The first failure site, disease free survival (DFS), overall survival (OS), and other prognostic factors were analyzed.

Results: Thirty-eight patients (30%) received NACT. Median follow-up duration was 53 months. More patients with advanced nodal disease (N2-N3) (86.8% vs 67.8%, p =0.029) and advanced clinical stage (stage IVA-IVB) enrolled in the NACT group (55.2% vs 26.7%, p =0.002). For NACT, both MEPFL and P-FL had similar 5-year DFS and OS (52.9% vs 50%, p =0.860 and 73.5% vs 62.5%, p =0.342, respectively). For CCRT, both PF4 and Cis 100 had similar 5-year DFS and OS (62.8% vs 69.6%, p =0.49 and 72.9% vs 73.9%, p =0.72, respectively). Compared to CCRT, NACT had similar 5-year DFS and OS (51.5% vs 65.1%, p =0.28 and 71.7% vs 74.3%, p =0.91, respectively). Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046).

Conclusions: For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability. Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.

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Kaplan-Meier curves of time to locoregional failure and time to distant failure. Kaplan-Meier curves of time to locoregional failure (A) and time to distant failure (B) for patients in NACT group (red) in comparison with CCRT group (black). Patients without recurrence or death in first 2 years were further analyzed and time to locoregional failure (C) and time to distant failure (D) curve as illustrated.
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Fig2: Kaplan-Meier curves of time to locoregional failure and time to distant failure. Kaplan-Meier curves of time to locoregional failure (A) and time to distant failure (B) for patients in NACT group (red) in comparison with CCRT group (black). Patients without recurrence or death in first 2 years were further analyzed and time to locoregional failure (C) and time to distant failure (D) curve as illustrated.

Mentions: The 5-year TTLF rate was 85.2% for CCRT and 74.5% for NACT (p =0.20) and the 5-year TTDF rate was 83.1% for CCRT and 76.4% for NACT (p =0.56). The Kaplan-Meier curve did not separate till 2 years in TTLF analysis (Figure 2A) but not in TTDF analysis (Figure 2B). When we re-analyzed patients who remained disease-free in first 2 years, patients who received NACT had a higher risk for developing locoregional failure (HR =6.31, 95% CI: 1.22 to 32.59, p =0.03) but not distant failure (HR =1.87, 95% CI: 0.50 to 6.96, p =0.35). No other clinical parameters, such as gender, histology classification, clinical T stage, clinical nodal stage and clinical stage had a significant influence on late locoregional failure or distant failure (Table 6).Figure 2


Comparison of concurrent chemoradiotherapy versus neoadjuvant chemotherapy followed by radiation in patients with advanced nasopharyngeal carcinoma in endemic area: experience of 128 consecutive cases with 5 year follow-up.

Wu SY, Wu YH, Yang MW, Hsueh WT, Hsiao JR, Tsai ST, Chang KY, Chang JS, Yen CJ - BMC Cancer (2014)

Kaplan-Meier curves of time to locoregional failure and time to distant failure. Kaplan-Meier curves of time to locoregional failure (A) and time to distant failure (B) for patients in NACT group (red) in comparison with CCRT group (black). Patients without recurrence or death in first 2 years were further analyzed and time to locoregional failure (C) and time to distant failure (D) curve as illustrated.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4228264&req=5

Fig2: Kaplan-Meier curves of time to locoregional failure and time to distant failure. Kaplan-Meier curves of time to locoregional failure (A) and time to distant failure (B) for patients in NACT group (red) in comparison with CCRT group (black). Patients without recurrence or death in first 2 years were further analyzed and time to locoregional failure (C) and time to distant failure (D) curve as illustrated.
Mentions: The 5-year TTLF rate was 85.2% for CCRT and 74.5% for NACT (p =0.20) and the 5-year TTDF rate was 83.1% for CCRT and 76.4% for NACT (p =0.56). The Kaplan-Meier curve did not separate till 2 years in TTLF analysis (Figure 2A) but not in TTDF analysis (Figure 2B). When we re-analyzed patients who remained disease-free in first 2 years, patients who received NACT had a higher risk for developing locoregional failure (HR =6.31, 95% CI: 1.22 to 32.59, p =0.03) but not distant failure (HR =1.87, 95% CI: 0.50 to 6.96, p =0.35). No other clinical parameters, such as gender, histology classification, clinical T stage, clinical nodal stage and clinical stage had a significant influence on late locoregional failure or distant failure (Table 6).Figure 2

Bottom Line: Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046).For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability.Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan. yencj@mail.ncku.edu.tw.

ABSTRACT

Background: Combined radiotherapy and chemotherapy is considered the standard of care for locally advanced nasopharyngeal carcinoma (LA-NPC) in Epstein-Barr virus infection endemic area. This study compared the long-term outcomes between LA-NPC patients treated with neoadjuvant chemotherapy followed by radiotherapy (NACT) and those treated with concurrent chemoradiotherapy (CCRT).

Methods: From 2003 to 2007, a total of 128 histopathologically proven LA-NPC patients receiving either NACT or CCRT were consecutively enrolled at the National Cheng Kung University Hospital in Taiwan. NACT consisted of 3-week cycles of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL) or weekly alternated cisplatin on day 1 and fluorouracil and leucovorin on day 8 (P-FL). CCRT comprised 3-week cycles of cisplatin (Cis 100) or 4-week cycles of cisplatin and fluorouracil (PF4). The first failure site, disease free survival (DFS), overall survival (OS), and other prognostic factors were analyzed.

Results: Thirty-eight patients (30%) received NACT. Median follow-up duration was 53 months. More patients with advanced nodal disease (N2-N3) (86.8% vs 67.8%, p =0.029) and advanced clinical stage (stage IVA-IVB) enrolled in the NACT group (55.2% vs 26.7%, p =0.002). For NACT, both MEPFL and P-FL had similar 5-year DFS and OS (52.9% vs 50%, p =0.860 and 73.5% vs 62.5%, p =0.342, respectively). For CCRT, both PF4 and Cis 100 had similar 5-year DFS and OS (62.8% vs 69.6%, p =0.49 and 72.9% vs 73.9%, p =0.72, respectively). Compared to CCRT, NACT had similar 5-year DFS and OS (51.5% vs 65.1%, p =0.28 and 71.7% vs 74.3%, p =0.91, respectively). Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046).

Conclusions: For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability. Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.

Show MeSH
Related in: MedlinePlus