scholarly journals Prognostic value of plasma EBV DNA for nasopharyngeal cancer patients during treatment with intensity-modulated radiation therapy and concurrent chemotherapy

2018 ◽  
Vol 52 (2) ◽  
pp. 195-203 ◽  
Author(s):  
Chawalit Lertbutsayanukul ◽  
Danita Kannarunimit ◽  
Anussara Prayongrat ◽  
Chakkapong Chakkabat ◽  
Sarin Kitpanit ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Value ◽  
Radiation Treatment ◽  
Nasopharyngeal Cancer ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
Ebv Dna

Abstract Background Plasma EBV DNA concentrations at the time of diagnosis (pre-EBV) and post treatment (post-EBV) have significant value for predicting the clinical outcome of nasopharyngeal cancer (NPC) patients. However, the prognostic value of the EBV concentration during radiation therapy (mid-EBV) has not been vigorously studied. Patients and methods This was a post hoc analysis of 105 detectable pre-EBV NPC patients from a phase II/III study comparing sequential (SEQ) versus simultaneous integrated boost (SIB) intensity-modulated radiation therapy (IMRT). Plasma EBV DNA concentrations were measured by PCR before commencement of IMRT, at the 5th week of radiation therapy and 3 months after the completion of IMRT. The objective was to identify the prognostic value of mid-EBV to predict overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). Results A median pre-EBV was 6880 copies/ml. Mid-EBV and post-EBV were detectable in 14.3% and 6.7% of the patients, respectively. The median follow-up time was 45.3 months. The 3-year OS, PFS and DMFS rates were 86.0% vs. 66.7% (p = 0.043), 81.5% vs. 52.5% (p = 0.006), 86.1% vs. 76.6% (p = 0.150), respectively, for those with undetectable mid-EBV vs. persistently detectable mid-EBV. However, in the multivariate analysis, only persistently detectable post-EBV was significantly associated with a worse OS (hazard ratio (HR) = 6.881, 95% confident interval (CI) 1.699-27.867, p = 0.007), PFS (HR = 5.117, 95% CI 1.562–16.768, p = 0.007) and DMFS (HR = 129.071, 95%CI 19.031–875.364, p < 0.001). Conclusions Detectable post-EBV was the most powerful adverse prognostic factor for OS, PFS and DMFS; however, detectable mid-EBV was associated with worse OS, PFS especially Local-PFS (LPFS) and may facilitate adaptive treatment during the radiation treatment period.

scholarly journals Prognostic value of hypertension in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy

2020 ◽  
Author(s):  
yin wen jing ◽  
liu jin quan ◽  
chen dong ping ◽  
qi bin ◽  
wang meng yao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Distant Metastasis ◽  
Prognostic Value ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Untreated Hypertension

Abstract Purpose To investigate the prognostic value of hypertension in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: A total of 1057 patients with nonmetastatic, histologically proven NPC who were treated with IMRT were retrospectively reviewed. Associations between hypertension and overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were estimated by Cox regression. Results Among 1057 patients, 94 (8.9%) had hypertension. Compared to normotensive patients, the hypertensive patients were generally older, had higher body fat, were more likely to be alcohol consumers, were more often in the early stage and usually received radiotherapy alone. Compared to normotension, hypertension was significantly associated with worse OS (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.41–3.42; P = 0.000), LRRFS (HR, 2.13; 95% CI, 1.12–4.03; P = 0.021) and DMFS (HR, 1.82; 95% CI, 1.09–3.05; P = 0.023) after adjusting for covariates. Moreover, the association with OS remained unchanged regardless of smoking, body mass index (BMI), N stage and chemotherapy, whereas it was limited in the subgroup of patients who were older than 50 years, male, not alcohol consumers, in advanced T stage and in advanced clinical stage. Compared with treated hypertension, untreated hypertension was associated with increased risks for death (P = 0.221; HR, 1.88; 95% CI, 0.69–5.15), locoregional recurrence (P = 0.073; HR, 3.29; 95% CI, 0.89–12.09) and distant metastasis (P = 0.640; HR, 1.30; 95% CI, 0.44–3.83). The patients with more severe levels of hypertension had worse survival and locoregional control, although there was no statistically significant difference (P > 0.05). Conclusions Hypertension is an independent adverse prognostic factor in NPC patients treated with IMRT. The NPC patients with untreated hypertension had similar survival as those with treated hypertension. The severity of hypertension did not influence the prognosis.

scholarly journals Influence of Pelvic Intensity-Modulated Radiation Therapy With Concurrent Cisplatin-Based Chemotherapy of Cervical Cancer on the Vaginal Microbiome

2021 ◽  
Vol 11 ◽  
Author(s):  
Li Jiang ◽  
Bo Li ◽  
Yong Zhang ◽  
Shanshan Ma ◽  
Chang Liu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Treatment Time ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Composition Analysis ◽  
Vaginal Microbiome ◽  
Microbial Composition ◽  
Intensity Modulated

Pelvic intensity-modulated radiation therapy (IMRT) combined with concurrent chemotherapy is an effective treatment for cervical cancer; however, radiation resistance impairs its clinical benefit. The vaginal microbiome plays an important but poorly understood role in cancer radiochemotherapy. In this study, we investigated the effects of treatment on the overall composition and alteration of the vaginal microbiome in patients receiving pelvic IMRT with concurrent cisplatin-based chemotherapy. We collected samples from twenty patients with cervical cancer and six healthy controls and performed 16S rRNA sequencing. Vaginal microbial composition analysis revealed significant differences between the two groups, but no significant differences between radiation treatment time points. However, the relative abundances of Gammaproteobacteria, Gemmatimonadetes, Gemmatimonadales, Pseudomonadales, Gemmatimonadaceae, Rikenellaceae, Acinetobacter, Desulfovibrio, Prevotella 9, Rikenellaceae RC9 gut group, Turicibacter, and the metagenome increased with time. The results encourage further study into the effects of the vaginal microbiome on cervical cancer treatment strategies, especially radiochemotherapy. Better understanding of these effects could inform new therapeutic approaches to enhance the efficacy of radiochemotherapy.

scholarly journals Optimal plasma pretreatment EBV DNA cut-off point for nasopharyngeal cancer patients treated with intensity modulated radiation therapy

2018 ◽  
Vol 48 (5) ◽  
pp. 467-475 ◽  
Author(s):  
Chawalit Lertbutsayanukul ◽  
Danita Kannarunimit ◽  
Buntipa Netsawang ◽  
Sarin Kitpanit ◽  
Chakkapong Chakkabat ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cancer Patients ◽  
Nasopharyngeal Cancer ◽  
Intensity Modulated Radiation Therapy ◽  
Intensity Modulated ◽  
Plasma Pretreatment ◽  
Ebv Dna

Concurrent Chemotherapy and Intensity-Modulated Radiation Therapy for Anal Canal Cancer Patients: A Multicenter Experience

2007 ◽  
Vol 25 (29) ◽  
pp. 4581-4586 ◽  
Author(s):  
Joseph K. Salama ◽  
Loren K. Mell ◽  
David A. Schomas ◽  
Robert C. Miller ◽  
Kiran Devisetty ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Anal Canal ◽  
Cancer Patients ◽  
Intensity Modulated Radiation Therapy ◽  
Complete Response ◽  
Concurrent Chemotherapy ◽  
Hiv Positive ◽  
Anal Canal Cancer ◽  
Intensity Modulated ◽  
Dermatologic Toxicity

PurposeTo report a multicenter experience treating anal canal cancer patients with concurrent chemotherapy and intensity-modulated radiation therapy (IMRT).Patients and MethodsFrom October 2000 to June 2006, 53 patients were treated with concurrent chemotherapy and IMRT for anal squamous cell carcinoma at three tertiary-care academic medical centers. Sixty-two percent were T1-2, and 67% were N0; eight patients were HIV positive. Forty-eight patients received fluorouracil (FU)/mitomycin, one received FU/cisplatin, and four received FU alone. All patients underwent computed tomography–based treatment planning with pelvic regions and inguinal nodes receiving a median of 45 Gy. Primary sites and involved nodes were boosted to a median dose of 51.5 Gy. All acute toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. All late toxicity was scored using Radiation Therapy Oncology Group criteria.ResultsMedian follow-up was 14.5 months (range, 5.2 to 102.8 months). Acute grade 3+ toxicity included 15.1% GI and 37.7% dermatologic toxicity; all acute grade 4 toxicities were hematologic; and acute grade 4 leukopenia and neutropenia occurred in 30.2% and 34.0% of patients, respectively. Treatment breaks occurred in 41.5% of patients, lasting a median of 4 days. Forty-nine patients (92.5%) had a complete response, one patient had a partial response, and three had stable disease. All HIV-positive patients achieved a complete response. Eighteen-month colostomy-free survival, overall survival, freedom from local failure, and freedom from distant failure were 83.7%, 93.4%, 83.9%, and 92.9%, respectively.ConclusionPreliminary outcomes suggest that concurrent chemotherapy and IMRT for anal canal cancers is effective and tolerated favorably compared with historical standards.

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