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Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy.

Wee CW, Keam B, Heo DS, Sung MW, Won TB, Wu HG - Radiat Oncol J (2015)

Bottom Line: Weekly cisplatin was used as concurrent chemotherapy.Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity.However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated.

Materials and methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy.

Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier plots of overall survival (A) and disease-free survival (B) comparing patients treated by concurrent chemoradiation (CCRT) with or without neoadjuvant chemotherapy (NCT).
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Figure 2: Kaplan-Meier plots of overall survival (A) and disease-free survival (B) comparing patients treated by concurrent chemoradiation (CCRT) with or without neoadjuvant chemotherapy (NCT).

Mentions: To validate the role of NCT in addition to CCRT, we performed a subgroup analysis with 71 patients. We compared 41 patients treated with NCT followed by CCRT and 30 patients treated with CCRT alone. The median follow-up for survivors was 63.4 months (range, 6.0 to 123.7 months) for patients treated with NCT followed by CCRT and 38.6 months (range, 6.3 to 102.9 months) for patients treated with CCRT alone. Overall, NCT did not improve outcomes for any clinical endpoint (Fig. 2). Moreover, although not statistically significant, CCRT alone resulted in better outcomes for every endpoints at five years. However, the N stage (p = 0.007) and AJCC stage (p = 0.035) were more advanced in the NCT plus CCRT group, and both remained significant prognostic factors for DMFS and DFS in a univariate analysis of the 71 patients in the subgroup analysis. Therefore, to adjust for the N stage and AJCC stage in DMFS and DFS, we performed further analysis with a Cox proportional hazard model with two variables simultaneously: N stage with NCT use and AJCC stage with NCT use (results not shown). For DMFS, the N stage remained significant (p = 0.017), while NCT did not affect outcomes (p = 0.790). Similarly, N stage (p = 0.006) and AJCC stage (p = 0.026) both remained significant for DFS, while NCT did not affect results (p = 0.742 and p = 0.461, respectively). However, the significance of AJCC stage on DMFS was diminished (p = 0.952) with the use of NCT. The use of NCT prior to CCRT led to increased risk of severe hematologic toxicity during the treatment course (25.4% vs. 7.0%; p = 0.015). The details of patient characteristics and survival outcomes of the subgroup analysis are shown on Tables 5 and 6, respectively.


Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy.

Wee CW, Keam B, Heo DS, Sung MW, Won TB, Wu HG - Radiat Oncol J (2015)

Kaplan-Meier plots of overall survival (A) and disease-free survival (B) comparing patients treated by concurrent chemoradiation (CCRT) with or without neoadjuvant chemotherapy (NCT).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493434&req=5

Figure 2: Kaplan-Meier plots of overall survival (A) and disease-free survival (B) comparing patients treated by concurrent chemoradiation (CCRT) with or without neoadjuvant chemotherapy (NCT).
Mentions: To validate the role of NCT in addition to CCRT, we performed a subgroup analysis with 71 patients. We compared 41 patients treated with NCT followed by CCRT and 30 patients treated with CCRT alone. The median follow-up for survivors was 63.4 months (range, 6.0 to 123.7 months) for patients treated with NCT followed by CCRT and 38.6 months (range, 6.3 to 102.9 months) for patients treated with CCRT alone. Overall, NCT did not improve outcomes for any clinical endpoint (Fig. 2). Moreover, although not statistically significant, CCRT alone resulted in better outcomes for every endpoints at five years. However, the N stage (p = 0.007) and AJCC stage (p = 0.035) were more advanced in the NCT plus CCRT group, and both remained significant prognostic factors for DMFS and DFS in a univariate analysis of the 71 patients in the subgroup analysis. Therefore, to adjust for the N stage and AJCC stage in DMFS and DFS, we performed further analysis with a Cox proportional hazard model with two variables simultaneously: N stage with NCT use and AJCC stage with NCT use (results not shown). For DMFS, the N stage remained significant (p = 0.017), while NCT did not affect outcomes (p = 0.790). Similarly, N stage (p = 0.006) and AJCC stage (p = 0.026) both remained significant for DFS, while NCT did not affect results (p = 0.742 and p = 0.461, respectively). However, the significance of AJCC stage on DMFS was diminished (p = 0.952) with the use of NCT. The use of NCT prior to CCRT led to increased risk of severe hematologic toxicity during the treatment course (25.4% vs. 7.0%; p = 0.015). The details of patient characteristics and survival outcomes of the subgroup analysis are shown on Tables 5 and 6, respectively.

Bottom Line: Weekly cisplatin was used as concurrent chemotherapy.Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity.However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated.

Materials and methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy.

Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

No MeSH data available.


Related in: MedlinePlus