scholarly journals A Ten-year Experience of the Multidisciplinary Management of the Regional Failure of Nasopharyngeal Carcinoma in the Era of IMRT

2020 ◽  
Author(s):  
xiyin Guan ◽  
Xing Xing ◽  
Xiaoshen Wang ◽  
Xiayun He ◽  
Hongmei Ying ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Neck Dissection ◽  
Multidisciplinary Treatment ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Prior Treatment ◽  
Treatment Modalities ◽  
Cervical Lymph Nodes ◽  
Regional Failure

Abstract Objective: To evaluate clinical outcomes of cervical node recurrence/residual tumor of nasopharyngeal carcinoma (NPC) with treatment decisions made by a multidisciplinary treatment (MDT) team. Methods: Between March 2010 and July 2019, patients who had previously undergone definitive intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and presented with residual or recurrent cervical lymph nodes were enrolled in our study. Clinical features and treatment modalities were retrospectively reviewed, and survival outcomes were analyzed. Results: A total of 183 patients were enrolled in the study, among whom 139 underwent neck dissection, and the remaining 44 were either considered not eligible for surgery or refused surgery. For the two groups of patients, the 3-year overall survival (OS) was 73.4% vs 36.8% (p=0.000), and the progression-free survival (PFS) was 57.1% vs 32.3% (p=0.004), respectively. Patients who underwent neck dissection had a significantly better clinical outcome and shorter latency between the prior treatment and detection of neck recurrence/residual tumor than those who did not. Conclusion: For regional failure cases that have no contradictions for surgery and are predicted to benefit from surgery by the MDT team, neck dissection could be the best choice. It is important for an experienced MDT team to choose the optimum treatment modalities for patients for the cervical failure of NPC. Regular follow-up after prior treatment contributes to the early detection of regional failure and provides a chance for surgery.

scholarly journals Irradiation-Induced Nasopharyngeal Necrosis in Newly Diagnosed Nasopharyngeal Carcinoma Treated by Intensity-Modulated Radiation Therapy: Clinical Characteristics and the Influence of Treatment Strategies

2021 ◽  
Author(s):  
Yi Xu ◽  
Yang Liu ◽  
Zekun Wang ◽  
Jingbo Wang ◽  
Jianghu Zhang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Clinical Characteristics ◽  
Propensity Scores ◽  
Treatment Strategies ◽  
Multivariate Logistic Regression Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Intensity Modulated ◽  
The Impact ◽  
Accumulated Dose

Abstract Purpose: To define the clinical characteristics of irradiation-induced nasopharyngeal necrosis (INN) after intensity-modulated radiotherapy (IMRT) and identify the influence of treatment strategies on INN in primary nasopharyngeal carcinoma (NPC) patients.Patients and methods: From 2008 to 2019, NPC patients pathologically diagnosed with INN after primary IMRT were reviewed. Those patients were matched with propensity scores for patients without INN in our center. The impact of treatment strategies on INN occurrence was assessed using univariate and multivariate logistic regression analysis. Results: The incidence rate of INN was 1.9% among the primary NPC population, and 53 patients with INN were enrolled. Headache and foul odor were the main symptoms, and 71.7% of cases had pseudomembrane during or at the end of radiotherapy. All patients were in early or middle stage INN, and no one presented with skull-based osteoradionecrosis. Then 212 non-INN patients were included based on propensity scores match. Overall survival (p=0.248) and progression-free survival (p=0.266) curves were similar between the INN and non-INN groups. Treatment strategies including combining chemotherapy or molecular targeted therapy with radiotherapy were not associated with INN occurrence, while boost dose (OR 7.360; 95% CI 2.301-23.547; P = 0.001) was a predictor factor for it. However, the optimal threshold for an accumulated dose to predict INN's occurrence was failed to determine.Conclusion: In the IMRT era, the severity of INN in primary NPC patients is lessened. This study showed that treatment strategies contributed little to develop INN, while the accumulated dose of radiation may relate to its occurrence.

scholarly journals A Long Survival of III-IVb Stage Nasopharyngeal Carcinoma Treated with IMRT with or without Nimotuzumab: a Propensity Score-matched Analysis

2019 ◽  
Author(s):  
Wang Zhi-Qiang ◽  
Mei Qi ◽  
Li Ji-Bin ◽  
You Rui ◽  
Liu You-Ping ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Propensity Score ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Chinese Patients ◽  
Term Survival ◽  
Free Survival ◽  
Distant Failure ◽  
Group A ◽  
Group B

Abstract Backgrounds: To assess the efficacy of Nimotuzumab in combination with first-line treatment of chemoradiotherapy of Chinese patients with primary III-IVb stage nasopharyngeal carcinoma. Methods: Patients with primary locoregionally advanced nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy (IMRT) and concurrent Cisplatin-based chemotherapy between January, 2008 and December, 2013 at a single institution were retrospectively reviewed. Group A received at least 6 doses of Nimotuzumab; Group B did not received Nimotuzumab. A propensity score matching method was used to match patients from each group in a 1:3 ratio. Results: In total, 730 eligible patients were propensity-matched, with 184 patients in Group A and 546 in Group B. There were no significant differences in patient and tumor characteristics between Group A and Group B. At a median follow-up of 74.78 months (range 3.53–117.83 months), locoregional recurrence, distant failure and death were observed in 10.68%, 11.10% and 16.03% of all patients, respectively. Estimated 5-year locoregional relapse–free survival, distant metastasis–free survival, progression-free survival and overall survival in the Group A versus Group B were: 85.34% versus 89.79% (P=0.156), 93.09% versus 85.61% (P = 0.012), 79.96% versus 77.99% (P = 0.117) and 88.91% versus 78.30% (P=0.006), respectively. Conclusions: This nimotuzumab-containing regimen resulted in a better long-term survival in III-IVb stage NPC patients, and warrants further prospective evaluation.

scholarly journals EP-1135 Effect of Primary Treatment on Neck Dissection Choice in Nasopharyngeal Carcinoma Regional Failure

2019 ◽  
Vol 133 ◽  
pp. S630-S631
Author(s):  
R. Sim ◽  
S. Mueller ◽  
G. Iyer ◽  
N.C. Tan ◽  
K.C. Soo ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Neck Dissection ◽  
Primary Treatment ◽  
Regional Failure

scholarly journals Efficacy of intensity-modulated radiotherapy with concurrent carboplatin in nasopharyngeal carcinoma

2015 ◽  
Vol 49 (2) ◽  
pp. 155-162 ◽  
Author(s):  
Anussara Songthong ◽  
Chakkapong Chakkabat ◽  
Danita Kannarunimit ◽  
Chawalit Lertbutsayanukul
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Radiation Treatment ◽  
Evaluation Criteria ◽  
Tumour Response ◽  
Intensity Modulated Radiotherapy ◽  
Treatment Compliance ◽  
Progression Free Survival ◽  
Intensity Modulated ◽  
Kaplan Meier ◽  
Carboplatin Auc

Abstract Background. The aim of the prospective phase II study was to evaluate the efficacy and toxicities of concurrent carboplatin with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC). Patients and methods. Between October 2005 and November 2011, 73 stage II‒IVB NPC patients received IMRT 70 Gy concurrently with three cycles of carboplatin (AUC 5) every three weeks, followed by three cycles of adjuvant carboplatin (AUC 5) and 5-FU (1,000 mg/m2/day for four days) every four weeks. All patients were evaluated for tumour response using response evaluation criteria in solid tumour (RECIST) criteria, survival analysis using Kaplan-Meier methods, and toxicities according to common terminology criteria for adverse events (CTCAE) version 4.0. Results. At three months after chemoradiation, 82.2% and 17.8% of patients achieved complete and partial response, respectively. With a median follow-up of 48.1 months (1.3‒97.8 months), 9.6% and 17.8% had local recurrence and distant metastasis, respectively. The median survival was not reached. A three-year overall survival was 83.6% and a progression-free survival was 65.3%. Regarding treatment compliance, 97.2%, 68.5% and 69.8% completed radiation treatment, concurrent carboplatin and adjuvant chemotherapy, respectively. Grade 3‒4 acute toxicities were oral mucositis (16.4%), dysphagia (16.4%), xerostomia (15.1%) and haematotoxicity (6.8%). Conclusions. Carboplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. This should be considered as an alternative treatment for NPC patients.

Toripalimab plus intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma: An open-label single-arm, phase II trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6023-6023
Author(s):  
Mingyuan Chen ◽  
Yijun Hua ◽  
Rui You ◽  
Zhi-Qiang Wang ◽  
Peiyu Huang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Intensity Modulated ◽  
Local Surgery ◽  
Recurrent Nasopharyngeal Carcinoma ◽  
Grade 3

6023 Background: Toripalimab is a humanized immunoglobulin G4 monoclonal antibody against programmed death 1 (PD-1). We aimed to investigate the efficacy and safety of toripalimab in combination with intensity-modulated radiotherapy (IMRT) for recurrent nasopharyngeal carcinoma (rNPC). Methods: We conducted a single-arm, phase II trial with rNPC patients who had biopsy-proven disease and were unsuitable for local surgery. Eligible patients received IMRT in combination with toripalimab administered via intravenous infusion of 240 mg once every 3 weeks for a maximum of seven cycles. The primary endpoint was the objective response rate (ORR). The secondary endpoints included safety profiles, progression-free survival (PFS). Results: Between May 2019 and January 2020, a total of 25 rNPC patients were enrolled (18 men [72.0%] and 7 women [28.0%]; median [IQR] age, 49.0 [43.5-52.5] years). With a median (IQR) follow-up duration of 14.6 months (13.1-16.2) months, 19 patients (79.2%) achieved an overall response, and disease control was achieved in 23 (95.8%) patients at 3 months post radiotherapy. The 12-month progression-free survival was 91.8% (95% CI 91.7% - 91.9%). The incidences of acute (grade ≥3) blood triglyceride elevation, creatine phosphokinase elevation, skin reaction, and mucositis were 1 (4.0%), 1 (4.0%), 2 (8.0%), and 1 (4.0%), respectively. The incidences of late severe (grade ≥3) nasopharyngeal wall necrosis, nasal bleeding, and trismus were 28.0%, 12.0%, and 4.0%, respectively. Conclusions: Toripalimab combined with IMRT was tolerable and showed promising antitumor activity in rNPC patients. Clinical trial information: NCT03854838.

Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection

2018 ◽  
Vol 129 (2) ◽  
pp. 387-395 ◽  
Author(s):  
You-Ping Liu ◽  
Hao Li ◽  
Rui You ◽  
Ji-Bin Li ◽  
Xue-Kui Liu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Neck Dissection ◽  
Regional Failure

scholarly journals Development and Validation of a Prognostic Nomogram Based on Residual Tumor in Patients With Nondisseminated Nasopharyngeal Carcinoma

2020 ◽  
Vol 19 ◽  
pp. 153303382095703
Author(s):  
Ping-Yan Liao ◽  
Zhong-Yi Dong ◽  
Chan-Tao Huang ◽  
Xin-Ran Tang ◽  
Guan-Dong Liu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Clinical Decision Making ◽  
Predictive Accuracy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Related Factors ◽  
Discriminative Ability ◽  
Predictive Values ◽  
Free Survival

Objectives: To investigate the prognostic value of residual tumor based on Magnetic resonance imaging(MRI) and establish an effective prognostic nomogram model referring to clinical,pathological and other related factors for predicting prognosis in nasopharyngeal carcinoma. Methods: Overall, 538 patients with non-metastatic, histologically-confirmed nasopharyngeal carcinoma were retrospectively examined. Data from 397 patients were used for the construction and validation of a nomogram based on the presence of residual tumor. A concordance index (C-index) was employed to assess the predictive accuracy and discriminative ability of the nomogram. Results: The 3-year survival rates in the non-residual and residual tumor cohorts were as follows: progression-free survival, 73.4% vs. 61.0%, P = 0.009; locoregional recurrence-free survival, 81.9% vs. 72.0%, P = 0.02; and distant metastasis-free survival, 80.7% vs. 73.5%, P = 0.11. Nine significant factors were included in the nomogram model. The calibration curve for the probability of progression-free survival showed that the nomogram-based predictive values had good concordance with the actual observations. Conclusion: The results showed that the patients in the residual tumor cohorts had a worse prognosis.The proposed nomogram may predict the prognosis and guide clinical decision-making concerning local residual tumors in nasopharyngeal carcinoma patients. Patients with a high risk of progression require more timely and aggressive treatment.

Management of Parotid Metastatic Cutaneous Squamous Cell Carcinoma: Regional Recurrence Rates and Survival

2018 ◽  
Vol 159 (2) ◽  
pp. 293-299 ◽  
Author(s):  
Nir Hirshoren ◽  
Olivia Ruskin ◽  
Lachlan J. McDowell ◽  
Matthew Magarey ◽  
Stephen Kleid ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Adjuvant Radiotherapy ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Regional Recurrence ◽  
Treatment Modalities ◽  
Cancer Center ◽  
Cervical Lymph Nodes

Objectives Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyzing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting A tertiary referral cancer center in Australia. Subjects and Methods The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or without neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results Of 78 patients, 65 underwent superficial parotidectomy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissections. Involved preauricular, facial, external jugular, and occipital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival—50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)—and improved 2-year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion This study supports surgery plus adjuvant radiotherapy as a standard of care for metastatic cSCC. The low incidence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required.

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