Induction or adjuvant chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in paediatric nasopharyngeal carcinoma in the IMRT era: A recursive partitioning risk stratification analysis based on EBV DNA

2021 ◽  
Vol 159 ◽  
pp. 133-143
Author(s):  
Yu-Jing Liang ◽  
Dong-Xiang Wen ◽  
Mei-Juan Luo ◽  
Lin-Quan Tang ◽  
Shan-Shan Guo ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Nasopharyngeal Carcinoma ◽  
Risk Stratification ◽  
Concurrent Chemoradiotherapy ◽  
Recursive Partitioning ◽  
Ebv Dna

scholarly journals Radiosensitivity-Related Genes and Clinical Characteristics of Nasopharyngeal Carcinoma

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Yongmei Dai ◽  
Yue Zhang ◽  
Mi Yang ◽  
Liang Zhou ◽  
Hua Pan ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Molecular Mechanisms ◽  
Concurrent Chemoradiotherapy ◽  
Peripheral Blood Leukocyte ◽  
Analysis Method ◽  
Diagnostic Endoscopy ◽  
Ebv Dna ◽  
Blood Leukocyte ◽  
Medical University ◽  
In Silico Analyses

Background and Purpose. Radioresistance is one of the main obstacles limiting the therapeutic efficacy of chemoradiotherapy (CRT) and favorable patient prognoses, and the molecular mechanisms underlying this type of resistance remain unclear. The purpose of this study was to identify characteristic genes involved in chemoradiotherapy resistance in nasopharyngeal carcinoma (NPC). Materials and Methods. Clinicopathological data of 185 patients with NPC treated at Nanfang Hospital of Southern Medical University between January 2013 and December 2014 were retrospectively analyzed. SPSS statistical software was used to analyze the clinicopathological data related to radiotherapy efficacy. Three patients who achieved complete remission and three with disease progression after CRT were selected. Differentially expressed genes (DEGs) were screened via mRNA microarray analysis of primary diagnostic endoscopy specimens. Results. The peripheral blood leukocyte count, platelet count, and EBV-DNA copy number in NPC patients who were resistant to radiotherapy were higher than those in NPC patients who were sensitive to radiotherapy. The RobustRankAggreg (RRA) analysis method identified 392 DEGs, and the 66 most closely related genes among the DEGs were identified from the PPI network. Conclusion. The results of this study indicate that screening for DEGs and pathways in NPC using integrated in silico analyses can help identify a series of genetic and clinical signatures for NPC patients treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy.

scholarly journals Impact of cumulative cisplatin dose in childhood nasopharyngeal carcinoma based on neoadjuvant chemotherapy response in the intensity-modulated radiotherapy era: a real-world study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ya-Nan Jin ◽  
Meng-Yun Qiang ◽  
Meng-Meng Liu ◽  
Zhi-Bin Cheng ◽  
Wang-Jian Zhang ◽  
...  
Keyword(s):  
High Risk ◽  
Nasopharyngeal Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Risk Group ◽  
Disease Free Survival ◽  
High Risk Group ◽  
Low Risk ◽  
Chemotherapy Response ◽  
Ebv Dna

Abstract Background We aimed to comprehensively investigate the optimal cumulative cisplatin dose during concurrent chemoradiotherapy (CC-CCD) for locoregionally advanced nasopharyngeal carcinoma (CA-LANPC) with different tumor responses after neoadjuvant chemotherapy (NAC). Methods Patients with CA-LANPC who underwent NAC followed by cisplatin-based concurrent chemoradiotherapy were retrospectively analyzed. Evaluation of tumor response in patients was conducted by Response Evaluation Criteria for Solid Tumor (RECIST) 1.1 after two to four cycles NAC. Multivariate Cox proportional hazards models were used for prognosis. Recursive partitioning analysis (RPA) was conducted to classify participates and predict disease-free survival (DFS). Results One hundred and thirty-two patients with favorable response after NAC were included. The median CC-CCD was 163 mg/m2 (IQR, 145–194 mg/m2), and 160 mg/m2 was selected as the cutoff point to group patients into low and high CC-CCD groups (< 160 vs. ≥ 160 mg/m2). There was significant improvement in 5-year DFS (91.2% vs. 72.6%; P = 0.003) for patients receiving high CC-CCD compared to those receiving low CC-CCD. Multivariate analysis revealed that CC-CCD, T stage, and Epstein–Barr virus (EBV) DNA were independent prognostic factors for DFS (P < 0.05 for all). Patients were further categorized into two prognostic groups by RPA: the low-risk group (T1-3 disease with regardless of EBV DNA, and T4 disease with EBV DNA < 4000 copy/mL), and the high-risk group (T4 disease with EBV DNA ≥ 4000 copy/mL). Significant 5-year DFS improvement was observed for the high-risk group (P = 0.004) with high CC-CCD. However, DFS improvement was relatively insignificant in the low-risk group (P = 0.073). Conclusions CC-CCD was a positive prognostic factor for responders after NAC in CA-LANPC. Furthermore, CC-CCD ≥ 160 mg/m2 could significantly improve DFS in the high-risk group with CA-LANPC, but the benefit of high CC-CCD in the low-risk group needs further study.

scholarly journals Selection and Validation of Chemotherapy Beneficiaries among Elderly Nasopharyngeal Carcinoma (NPC) Patients Treated with Intensity-Modulated Radiation Therapy (IMRT): A Large Real-World Study

2021 ◽  
Author(s):  
Yan-Ling Wu ◽  
Kai-Bin Yang ◽  
Ying Huang ◽  
Jing-Rong Shi ◽  
Qing-shui He ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Real World ◽  
Poor Prognosis ◽  
Recursive Partitioning ◽  
Intensity Modulated Radiation Therapy ◽  
Risk Groups ◽  
Good Prognosis ◽  
Prognosis Group ◽  
Ebv Dna ◽  
Good Prognosis Group

Abstract Purpose: Using real-world evidence, this study aimed to identify elderly nasopharyngeal carcinoma (NPC) patients who would benefit from chemotherapy.Methods and Materials: 1,714 elderly NPC patients between April 2007 and December 2017 were identified. Recursive partitioning analysis (RPA) was used to generate risk-stratified outcomes. Prognostic factors were performed for individual comparisons of different risk groups to assess chemotherapy benefits.Results: The median follow-up was 59.3 (0.39-170.09) months. Epstein Barr virus (EBV) DNA and T stage were included in the RPA-generated risk stratification, categorizing patients into a good-prognosis group (EBV DNA ≤ 4,000 copies/mL & T1-2), and a poor-prognosis group (EBV DNA ≤ 4,000 copies/mL & T3-4 and EBV DNA > 4,000 copies/mL & any T). Over survival (OS) was significantly higher in the good-prognosis group compared with the training set (HR = 0.309, 95% CI = 0.184-0.517; P < 0.001), and validated in the testing set (HR = 0.276, 95% CI = 0.113-0.670; P = 0.002). In the poor-prognosis group, a significantly improved OS for chemoradiotherapy (CRT) compared with RT alone was observed (HR = 0.70, 95% CI = 0.55-0.88; P = 0.003). Patients who received induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT) and CCRT had a significantly improved OS compared with RT alone (IC+CCRT vs. RT alone: P = 0.002; CCRT vs. RT alone: P = 0.008) but not in the IC+RT group (P = 0.306). The 5-year OS for CRT vs. RT-alone with ACE-27 scores of 0, 1 and 2 were 76.0% vs. 70.0% (P = 0.014), 80.5% vs. 68.2% (P = 0.150) and 58.5% vs. 62.2% (P = 0.490), respectively; for those aged 60-64, 65-70 and ≥70 years old they were 80.9% vs. 75.9% (P = 0.068), 73.3% vs. 63.4% (P = 0.270) and 64.8% vs. 67.1% (P = 0.820), respectively.Conclusions: For elderly NPC patients a simple screening cutoff for chemotherapy beneficiaries might be EBV DNA＜4000 copies/ml & T3-4 and EBV DNA ≥4000 copies/ml & any T, but not for those >70 years old and with an ACE-27 score > 1. IC+CCRT and CCRT were effective forms of chemotherapy.

scholarly journals Establishment and Validation of Nomogram Based on Combination of Pretreatment C-Reactive Protein/Albumin Ratio–EBV DNA Grade in Nasopharyngeal Carcinoma Patients Who Received Concurrent Chemoradiotherapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhang-Zan Huang ◽  
Wen Wen ◽  
Xin Hua ◽  
Chen-Ge Song ◽  
Xi-Wen Bi ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Cross Validation ◽  
Concurrent Chemoradiotherapy ◽  
Multivariate Analyses ◽  
C Reactive Protein ◽  
Training Set ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Ebv Dna ◽  
Fold Cross Validation

BackgroundA higher ratio of pretreatment C-reactive protein/albumin ratio (CAR) is associated with poor prognosis in nasopharyngeal carcinoma (NPC), and Epstein–Barr virus (EBV) DNA level is known to not only participate in the occurrence of nasopharyngeal carcinoma but also affect the development and prognosis of the disease. Herein, we proposed that a combination of both these markers could improve the predictive prognostic ability.MethodsIn all, 842 NPC patients who received concurrent chemoradiotherapy (CCRT) were entered in this study. We collected all patients’ blood samples and EBV DNA copy numbers within one week before any treatment. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off. We employed the Kaplan–Meier method for survival analyses and the univariate and multivariate analyses (Cox proportional hazards regression model) for statistical analysis. A nomogram was constructed based on multivariate analyses results of the validation set. The model was internally validated using 1000 bootstrap samples to avoid overfitting. Another validation of 10-fold cross-validation was also applied. Calibration curves and concordance index (C-index) were calculated to determine predictive and discriminatory capacity.ResultsIn the whole cohort, we observed that higher CAR, EBV DNA level, and CAR-EBV DNA (C-E) grade were associated with shorter overall survival (OS) and distant metastasis-free survival (DMFS) (all P&lt;0.05). In univariate and multivariate analyses, C-E grade was an independent prognostic factor (all P&lt;0.05). In the training set, we gained the similar results with the whole set. According to multivariate analyses of the training set, we constructed a nomogram. The results of bootstrap samples and 10-fold cross-validation showed favorable predictive efficacy. And calibration curves of the model provided credibility to its predictive capability.ConclusionC-E grade was confirmed as an independent prognostic predictor in patients with NPC who received CCRT. Higher level of pretreatment C-E grade could signify a higher risk of metastasis and shorter OS. The prognostic nomogram based on C-E grade was dependable in nasopharyngeal carcinoma patients.

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