Premilinary survival results and potential beneficiaries for locally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6030-6030
Author(s):  
Mei Feng ◽  
Jinyi Lang ◽  
Lu Li ◽  
Yecai Huang ◽  
Peng Xu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Nasopharyngeal Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Stage Iii ◽  
Significant Difference

6030 Background: Neoadjuvant is a promising chemotherapy modality for recurrent nasopharyngeal carcinoma (NPC). However, there is still controversy for locally advanced NPC. We study the survival results of locally advanced NPC treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy (NACT) retrospectively, and to explore the potential beneficiaries. Methods: 147 stage III-IVa+b NPC treated with IMRT were included and divided into two groups. NACT group (76) received 2-3 cycles of neoadjuvant chemotherapy with TP or TPF, and then 2-3 cycles of platinum-based chemoradiotherapy (CCRT). CCRT group (71) received 3 cycles of platinum-based chemoradiotherapy. TNM stage, age and whole blood count before treatment were all collected. The stratified analysis was used for distinguishing the potential beneficiaries. Results: median follow-up time was 30 months. For all patients, the 3-year LRRFS, DMFS and OS in NACT and CCRT were 94.5%, 96.8%; 85.8%, 82.8% and 81.6%, 83.4% respectively ( p> 0.05). For stage III patients, the 3-year LRRFS, DMFS and OS were 95.2%, 97.3%; 91.4%, 84.6% and 86.3%, 82.1% respectively ( p= 0.38, p= 0.15, p= 0.58). Though there was no statistical significance, DMFS in NACT was better than it in CCRT. However, for stage IV, the survival rate had no significant difference. The incidence of grade 3-4 bone marrow suppression was higher in NACT ( p= 0.007), and the other toxicities were similar. Univariate analysis showed the percentages of neutrophil and neutrophil-to-lymphocyte ratio (NLR) were significantly correlated with OS ( p= 0.031, p= 0.049). N and clinical stage were the adverse prognostic factors for OS ( p= 0.025, p= 0.007) and DMFS ( p= 0.018, p= 0.001). Clinical stage was the prognostic factors for OS and DMFS in multivariate analyses ( p= 0.019, p= 0.01). Conclusions: NACT had a comparable survival results and tolerable toxicity with CCRT for locally advanced NPC. Stage III might be the potential beneficiaries from NACT, especially for DMFS. Percentages of neutrophil and NLR might be the new adverse prognostic factor for OS. Clinical stage was still the prognostic factor for OS and DMFS.

Analysis of prognostic factors after 16 years of follow-up in a randomized phase II trial of neoadjuvant FAC compared with CMF in stage III breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 11118-11118
Author(s):  
Julieta Leone ◽  
Jose Pablo Leone ◽  
Carlos Teodoro Vallejo ◽  
Juan Eduardo Perez ◽  
Alberto Omar Romero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Stage Iii Breast Cancer

11118 Background: Neoadjuvant chemotherapy is a standard treatment in stage III breast cancer. Prognostic factors can help to identify patients (pts) with high risk of recurrence. The aim of this study was to assess several prognostic factors after a long follow-up, in stage III breast cancer pts, treated with neoadjuvant chemotherapy. Methods: We evaluated 126 pts with stage III breast cancer that participated in a phase-II randomized trial of neoadjuvant 5-fluorouracil, doxorubicin and cyclophosphamide (FAC every 21 days) compared with cyclophosphamide, methotrexate and 5-fluorouracil (CMF days 1 and 8 every 28). Chemotherapy was administered for three cycles prior to definitive surgery and radiotherapy, and then for six cycles as adjuvant. Response was assessed by WHO criteria. Results: The median age was 52 years (range 24-75). Median follow-up was 4.5 years (range 0.2-16.4), disease free survival (DFS) 4.8 years and overall survival (OS) 6.4 years. Results of the phase-II study showed no difference in efficacy between groups. Univariate analysis showed that the number of pathologically involved lymph nodes (pLN), pathologic response and estrogen and progesterone receptor status correlated with DFS and OS. Number of pLN was the only prognostic factor with statistical significance in Cox regression test for both, DFS and OS (P=0.0004 and P=0.0006, respectively). In a subgroup analysis of pts with pLN, we found no difference in survival when we compared FAC with CMF. Conclusions: The prolonged follow-up of this study provides a unique opportunity to evaluate factors that predict long-term outcomes. After 16 years of follow-up, the number of pLN remains the most powerful predictor of survival. The subset of pts with pLN had similar survival regardless of the regimen used. Clinical trial information: NCT00002696.

Correlation between change of FA score and postoperative recurrence in esophageal cancer patients who received neoadjuvant treatment.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 41-41
Author(s):  
Satoru Matsuda ◽  
Hiroya Takeuchi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
Tsunehiro Takahashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Neoadjuvant Treatment ◽  
Postoperative Recurrence ◽  
Transthoracic Esophagectomy ◽  
Clinicopathological Factors ◽  
Significant Difference

41 Background: We previously reported that fibrinogen and albumin score (FA score), which was consisted of plasma fibrinogen level (FNG) and serum albumin level (Alb), was shown to predict postoperative survival in esophageal cancer patients who underwent transthoracic esophagectomy. In this study, in patients who received neoadjuvant chemotherapy (NAC), change of FA score during NAC was reviewed and the correlation with recurrence free survival (RFS) was investigated. Methods: We retrospectively reviewed 125 patients who received neoadjuvant chemotherapy and underwent transthoracic esophagectomy in our institution between 2001 and 2012. FNG and Alb before (preTx) and after (preope) NAC were confirmed in 92 patients. Based on our previous reports, patients with elevated fibrinogen ( > 350 mg/dL) and decreased albumin ( < 3.8 g/dl) levels were allocated a FA score of 2, those with only one of these abnormalities were allocated a FA score of 1, and those with neither of these abnormalities were allocated a FA score of 0. Regarding change of FA score, based on the preTx and preope FA score, we classified into decrease group and increase (no change or increase) group. Patient characteristics, clinicopathological factors, preTx FA score, and preope FA score were reviewed, and correlation with RFS was investigated. Results: The number of preTx and preope FA score 0/1/2 was 39/41/12, 36/37/19. Regarding change of FA score, FA score decreased in 70 patients (76%), increased in 22 (24%). There was no significant difference in patient background and clinicopathological factors between groups. In survival univariate analysis, change of FA score (Increase group, HR 2.023, p = 0.025) were significantly correlated with RFS. In multivariate analysis, using preTx clinical stage as a covariate, FA score was shown to be an independent predict factor (Increase group, HR 2.076, p = 0.023) for RFS significantly. Conclusions: Change of FA score between before and after NAC was shown to be a predictive factor of RFS in esophageal cancer patients who received NAC. Both fibrinogen and albumin are popular indicators routinely measured in daily clinical practice, FA score may be highly validate and feasible.

A potential survival impact of blood immune cells in patients with locoregionally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18027-e18027
Author(s):  
Li Yang ◽  
Zhiyuan Xu ◽  
Victor Ho-Fun Lee ◽  
Anne W. M. Lee
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Immune Cells ◽  
Concurrent Chemoradiotherapy ◽  
Univariate Analysis ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Stage Iii ◽  
Target Volumes ◽  
Complete Blood Counts

e18027 Background: To exam the changes of blood immune cells during concurrent chemoradiotherapy (CCRT) and explore their effects on survival in patients with locoregionally advanced nasopharyngeal carcinoma. Methods: Study population included stage III-IVA (TNM-8th edition) locoregionally advanced nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy followed by CCRT from January 2015 to October 2019. Patients received induction PX (cisplatin: 80mg/m2 on day 1 + capecitabine: 1000mg/m2 twice daily from day 1 to 14 every 3 weeks for 3 cycles) followed by CCRT (cisplatin: 100mg/m2 every 3 weeks for a total of 2-3 cycles or 40mg/m2 weekly for a total of 6 weeks concurrent with intensity-modulated radiation therapy [IMRT]). IMRT with doses of 70Gy, 63Gy and 56Gy were delivered to 3 levels of planning target volumes (PTV) (high, intermediate and low risk) respectively and simultaneously in 35 fractions/7 weeks. All had complete blood counts with differentials at baseline and before each chemotherapy. The primary endpoint was progression-free survival (PFS). “Immune cells” of our interest included lymphocytes, neutrophils and platelets. Results: A total of 139 patients were eligible and recruited. The median follow-up was 34 months (range 4-72). All immune cells decreased significantly during CCRT; the rate of grade 3/4 lymphopenia, neutropenia and thrombocytopenia during CCRT were 96.4%, 25.2% and 9.4%, respectively. The median (interquartile range, IQR) time to nadir from the start of CCRT were 40 (32-44), 26 (20-42) and 30 (15-39) days for lymphocytes, neutrophils and platelets, respectively. The median PFS was not reached and estimated 2-year PFS was 90.2%. Patients with lymphocyte nadir ≤ 0.2×109/L had better PFS compared with those with lymphocyte nadir > 0.2×109/L（2-yr PFS 95.5% vs. 87.5%, P=0.048). Patients with platelet nadir < 100×109/L had better PFS compared with those with platelet nadir ≥ 100×109/L(2-yr PFS 96.9% vs. 84.2%, P=0.011). Neutrophil nadir was not associated with PFS in univariate analysis. Multivariate analysis including prognostic variables in univariate analysis showed that platelet nadir (< 100 × 109/L vs ≥ 100 × 109/L, hazard ratio [HR] 0.279, 95% confidence interval [CI] 0.091-0.857, P=0.026), stage (III vs IVA, HR 0.321, 95% CI 0.115-0.901, P=0.031) and cumulative concurrent cisplatin dose (< 180mg/m2 vs ≥ 180mg/m2, HR 3.422, 95% CI 1.366-8.577, P=0.009) were prognostic of PFS by adjusting lymphocyte nadir and baseline hemoglobin. Conclusions: Blood immune cells decreased during CCRT and thrombocytopenia was prognostic of PFS in patients with LANPC. Longer follow-up is warranted to identify prognostic factors of overall survival.

Predictors of treatment interruption/dose reduction of neoadjuvant chemotherapy for rectal cancer: A multicenter study.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 580-580 ◽  
Author(s):  
Soundouss Raissouni ◽  
Dawn Elizabeth Armstrong ◽  
Julie A. Price Hiller ◽  
Jamison Mercer ◽  
Erin Diana Powell ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Dose Reduction ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Curative Intent ◽  
Cancer Centre

580 Background: Neoadjuvant chemoradiation (CRT) is the standard of care for patients with locally advanced rectal cancer. Many patients require dose reduction or chemotherapy interruption due to significant toxicities. To assess the predictors of neoadjuvant chemotherapy treatment (tx) adjustments, we performed a retrospective study in four Canadian provinces. Methods: Cancer Registries identified consecutive patients with clinical stage I-III rectal cancer from the Tom Baker Cancer Center, Cross Cancer Institute, BC Cancer Agency, Ottawa Hospital Cancer Centre and the Dr. H. Bliss Murphy Cancer Centre who received CRT and had curative intent surgery (Sx) from 2005 to 2012. Patient, tumor and tx characteristics were correlated with treatment completion. Results: Of the 891 patients included, 886 patients had tx dose adjustments data available. 738 (83.2%) completed the planned neoadjuvant chemotherapy, while 148 (16.7%) failed to complete planned chemotherapy. Patients who required tx interruption/cessation or dose reduction were more likely to be female, elderly, had higher ECOG PS and were treated with fluorouracil (FU) chemotherapy in univariate analysis (see Table). On multivariable analysis, female gender (OR 1.807, 95% CI 1.02-3.2, p=0.042) and tx with FU (vs capecitabine) (OR 2.7, 95% CI 1.52-4.77, p=0.0007) were associated with dose reduction and tx interruption/cessation. Conclusions: Gender and type of chemotherapy are predictors of neoadjuvant chemotherapy interruption or dose reduction in rectal cancer. Careful monitoring of these patients is warranted during neoadjuvant CRT. [Table: see text]

Neoadjuvant treatment with chemotherapy or chemoradiation in stage III non-small cell lung cancer: Analysis of the National Cancer Database.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7046-7046
Author(s):  
Sindhu Janarthanam Malapati ◽  
Sunny R K Singh ◽  
Rohit Kumar ◽  
Tarik H. Hadid
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Tumor Resection ◽  
Postoperative Mortality ◽  
Stage Iii ◽  
Rank Test ◽  
R0 Resection ◽  
Significant Difference ◽  
Stage Iii Nsclc

7046 Background: Use of neoadjuvant chemotherapy (Neo-chemo) improves survival in locally advanced NSCLC. However, data regarding the benefit of adding radiation (Neo-CRT) is limited. Meta-analyses suggest that the use of Neo-CRT could lead to significant tumor downstaging but with increase in therapy-related mortality. Methods: Patients with resected stage III NSCLC were identified from the NCDB between 2010 and 2015. Patients were divided into two groups based on the type of neoadjuvant therapy received (Neo-chemo vs. Neo-CRT). Surgical and survival outcomes were compared. Kaplan-Meier method and log-rank test were used for survival analysis. Results: Of the 136,942 patients with stage III NSCLC, 15,804 patients had definitive surgery. Mean age was higher for those who received Neo-chemo (63.8 vs. 61.8 years, p<0.0001). Median overall survival (OS) for Neo-CRT was 49.8 months and for Neo-chemo was 53.6 months. After adjusting for treatment facility, age, gender, race, comorbidity index, insurance status, T and N stage, there was a 12% reduction in mortality with use of Neo-chemo compared to Neo-CRT (p=0.03, 95% confidence interval 0.78-0.98). 3 years OS for Neo-CRT and Neo-chemo was 51.1 and 54.3%, respectively. The 30-day operative mortality rate was slightly higher in the Neo-chemo group (4.6 vs. 3.2%, p=0.004) but 90-day mortality rates were similar (7.41% vs. 6.83%, p=0.37). Length of hospital stay for primary tumor resection was shorter for the Neo-chemo group (5 vs. 6 days, p<0.0001); however, there was no significant difference in 30-day readmission rates between the two groups (91.53% vs. 94.01%, p=0.09). Conclusions: In this study, neoadjuvant chemotherapy resulted in 12% lower mortality compared to neoadjuvant chemoradiation despite the notable increase in the rate of complete pathologic tumor and nodal response achieved with the addition of neoadjuvant radiation. There was no difference in R0 resection rates, postoperative mortality or readmissions between the two groups. [Table: see text]

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