Induction Chemotherapy Combined With Intensity-Modulated Radiotherapy for 129 Nasopharyngeal Carcinoma Patients With Synchronous Metastases: A Retrospective Study

ObjectiveTo analyze the therapeutic effect and prognostic factors of nasopharyngeal carcinoma (NPC) patients with distant metastases at initial diagnosis receiving induction chemotherapy with intensity-modulated radiotherapy (IMRT).MethodsA total of 129 patients who underwent platinum-based induction chemotherapy followed by definitive IMRT with or without concurrent or adjuvant chemotherapy for newly diagnosed distant metastatic NPC in our center between March 2008 and November 2018 were retrospectively analyzed. 41 patients underwent local therapy for metastatic sites. Kaplan-Meier method was used to estimate survival rates, Log-rank test and Cox proportional hazards model were used to figure out independent prognostic factors of overall survival (OS).ResultsA total of 66 patients had been dead (median follow-up time, 51.5 months). The median overall survival (OS) time was 54.2 months (range, 7-136 months), and the 1-year, 2-year, 3-year, 5-year overall survival rates were 88.0%,71.0%,58.0%, and 47.0%. Multivariate analysis found that the factors correlated with poor overall survival were pre-treatment serum lactate dehydrogenase (SLDH) >180U/L, chemotherapy cycles<4, and M1 stage subdivision (M1b, single hepatic metastasis and/or multiple metastases excluding the liver; and M1c, multiple hepatic metastases). The 5-year OS rates for M1a, M1b and M1c were 62.6%,40.4% and 0%, respectively.ConclusionPlatinum-containing induction chemotherapy combined with IMRT seemed to be advantageous to prolong survival for some NPC patients with synchronous metastases at initial diagnosis. The independent factors to prognosticate OS were pre-treatment SLDH, number of chemotherapy cycles, and M1 subcategories. Prospective clinical trials are needed to confirm the result.

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Prognostic analysis of 152 patients with distant metastasis after intensity-modulated radiotherapy for nasopharyngeal carcinoma

10.21203/rs.3.rs-15984/v1 ◽

2020 ◽

Author(s):

Hua Yang ◽

Rui Ma ◽

Yan Zhou ◽

Yutian Yin ◽

Lina Zhao ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Metastasis ◽

Adjuvant Chemotherapy ◽

Nasopharyngeal Carcinoma ◽

Distant Metastasis ◽

Survival Rates ◽

Intensity Modulated Radiotherapy ◽

Palliative Radiotherapy ◽

Intensity Modulated ◽

Organ Metastasis

Abstract Purpose The objectives of this study were to analyze the prognostic factors of patients with distant metastasis after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) and to provide a reference for the clinical treatment of these patients. Methods A retrospective analysis was conducted among 152 patients with distant metastasis after IMRT for NPC from January 2006 to December 2017 (median follow-up, 43 months). The survival rates were calculated and compared using the Kaplan-Meier method and log-rank tests, respectively. The Cox risk ratio model was used for univariateand multivariate analyses. Results Among all patients, the median interval from treatment completion to distant metastasis was 11.3 months. The median post-metastasis survival was 14 months, and the 1-, 2-, and 3-year survival rates were 60.4%, 40.2%, and 27.6%, respectively. Upon univariate analysis, overall survival was found to be related to the N stage and induction chemotherapy at initial diagnosis, time from initial radiotherapy completion to distant metastasis, liver metastasis, and chemotherapy and palliative radiotherapy after metastasis. Liver metastasis, multi-organ metastasis, chemotherapy after metastasis, and the time from radiotherapy completion to distant metastasis were independent prognostic factors for patient survival in the Cox regression analysis. Conclusions The prognosis of patients with distant metastasis after IMRT for NPC was related to the time from radiotherapy completion to distant metastasis, regardless of liver or multiple organ metastasis and adjuvant chemotherapy after metastasis. Adequate adjuvant chemotherapy and local palliative radiotherapy could potentially prolong the survival of patients with distant metastasis of NPC.

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Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era

Frontiers in Oncology ◽

10.3389/fonc.2020.625184 ◽

2021 ◽

Vol 10 ◽

Author(s):

Run-Da Huang ◽

Zhuang Sun ◽

Xiao-Hui Wang ◽

Yun-Ming Tian ◽

Ying-Lin Peng ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Nasopharyngeal Carcinoma ◽

Intensity Modulated Radiotherapy ◽

Individual Treatment ◽

Intensity Modulated ◽

Recurrent Nasopharyngeal Carcinoma ◽

Locally Recurrent ◽

The Impact ◽

Severe Grade

PurposeTo assess the impact of comorbidity on treatment outcomes in patients with locally recurrent nasopharyngeal carcinoma (lrNPC) using intensity-modulated radiotherapy (IMRT) and to develop a nomogram that combines prognostic factors to predict clinical outcome and guide individual treatment.MethodsThis was a retrospective analysis of patients with lrNPC who were reirradiated with IMRT between 2003 and 2014. Comorbidity was evaluated by Adult Comorbidity Evaluation-27 grading (ACE-27). The significant prognostic factors (P < 0.05) by multivariate analysis using the Cox regression model were adopted into the nomogram model. Harrell concordance index (C-index) calibration curves were applied to assess this model.ResultsBetween 2003 and 2014, 469 lrNPC patients treated in our institution were enrolled. Significant comorbidity (moderate or severe grade) was present in 17.1% of patients by ACE-27. Patients with no or mild comorbidity had a 5-year overall survival (OS) rate of 36.2 versus 20.0% among those with comorbidity of moderate or severe grade (P < 0.0001). The chemotherapy used was not significantly different in patients with lrNPC (P > 0.05). For the rT3–4 patients, the 5-year OS rate in the chemotherapy + radiation therapy (RT) group was 30.0 versus 16.7% for RT only (P = 0.005). The rT3–4 patients with no or mild comorbidity were associated with a higher 5-year OS rate in the chemotherapy + RT group than in the RT only group (32.1 and 17.1%, respectively; P=0.003). However, for the rT3–4 patients with a comorbidity (moderate or severe grade), the 5-year OS rate in the chemotherapy + RT group vs. RT alone was not significantly different (15.7 vs. 15.0%, respectively; p > 0.05). Eight independent prognostic factors identified from multivariable analysis were fitted into a nomogram, including comorbidity. The C-index of the nomogram was 0.715. The area under curves (AUCs) for the prediction of 1-, 3-, and 5-year overall survival were 0.770, 0.764, and 0.780, respectively.ConclusionComorbidity is among eight important prognostic factors for patients undergoing reirradiation. We developed a nomogram for lrNPC patients to predict the probability of death after reirradiation and guide individualized management.

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Retrospective Analysis of Induction Chemotherapy Plus Concurrent Chemoradiotherapy under Intensity-Modulated Radiotherapy Mode for Locally Advanced Nasopharyngeal Carcinoma

10.21203/rs.3.rs-631636/v1 ◽

2021 ◽

Author(s):

Kai Liao ◽

Hao-Yun Tao ◽

Ze-Jiang Zhan ◽

Wen-Ze Qiu ◽

Rong-Hui Zheng

Keyword(s):

Survival Rate ◽

Nasopharyngeal Carcinoma ◽

Induction Chemotherapy ◽

Concurrent Chemoradiotherapy ◽

Locally Advanced ◽

Survival Rates ◽

Intensity Modulated Radiotherapy ◽

Concurrent Chemotherapy ◽

Therapeutic Effects ◽

Intensity Modulated

Abstract Background: Nasopharyngeal carcinoma (NPC) originates from the mucous epithelium of the nasopharynx. Although induction chemotherapy plus concurrent chemoradiotherapy is the major therapeutic protocol used for locally advanced NPC without metastasis, more researches are needed to evaluate the curative effects.Aims: We aim to identify the therapeutic effects and prognosis after induction chemotherapy plus concurrent chemoradiotherapy in the treatment of locally advancedNPC under the intensity modulated radiotherapy mode.Methods: The patients (N= 544) with locally advanced NPC (III and IVa) after intensity modulated radiotherapy with induction chemotherapy and concurrent chemoradiotherapy were included in this study. We analyzed the characteristics of patients including gender, age, smoking status, tumor-node staging system, clinical stage, pathological type, the therapy protocol of induction chemotherapy and concurrent chemoradiotherapy, and chemotherapy prescription.Results: We have found the 5-year survival rates of OS, PFS, LRRFS, and DMFS were 85.21%, 78.51%, 90.71%, and 85.21% in follow-up and these data indicated that our therapeutic procedure provided beneficial effects on survival rates. Following, the chemotherapy drug base on DOC provided more beneficial effect of survival rate compared with TXT but there was no significant difference between chemotherapy drug base on DDP and NDP treated with NPC patients. The therapeutic effects of induction chemotherapy revealed no difference between TPF and TP. In addition, there was also no significant change between concurrent chemotherapy with TP dual drugs or platinum single drug. Moreover, the survival rate showed no difference between platinum accumulation dose ofmore and less than 150mg/m2for concurrent chemotherapy.Conclusion: Our results indicate that induction chemotherapy plus concurrent chemoradiotherapy under intensity modulated radiotherapy which is the standard therapeutic method for locally advanced NPC provides beneficial therapeutic effects, and it is worthy of further study.

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