scholarly journals Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhouying Peng ◽  
Yumin Wang ◽  
Yaxuan Wang ◽  
Ruohao Fan ◽  
Kelei Gao ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Meta Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Intensity Modulated ◽  
T Stage ◽  
Recurrent Nasopharyngeal Carcinoma ◽  
Disease Free

BackgroundThis meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC).MethodsRelevant studies were retrieved in six databases from 02/28,2011 to 02/28,2021. The 2-year, 3-year, 5-year overall survival (OS) rates and 2-year disease-free survival (DFS) rates were calculated to compare the survival outcomes of the two treatments of IMRT and ES. Combined odds ratios (ORs) and 95% confidence interval (C Is) were measured as effect size on the association between high T-stage and 5-year OS rates.ResultsA total of 23 publications involving 2,578 patients with recurrent NPC were included in this study. Of these, 1611 patients with recurrent rT3-4 NPC were treated with ES and IMRT in 358 and 1,253 patients, respectively. The combined 2-year OS and 5-year OS rates for the two treatments were summarized separately, and the 2-year OS and 5-year OS rate for ES were 64% and 52%, respectively. The 2-year OS and 5-year OS rate for IMRT were 65% and 31%, respectively. The combined 2-year DFS rates of IMRT and ES were 60% and 50%, respectively. Combined ORs and 95% confidence intervals for 5-year survival suggest that ES may improve survival in recurrent NPC with rT3-4. In terms of complications, ES in the treatment of high T-stage recurrent NPC is potentially associated with fewer complications.ConclusionsThe results of our study suggest that ES for rT3-4 may be a better treatment than IMRT, but the conclusion still needs to be sought by designing more studies.

Overall and disease-free survival outcomes of patients receiving intensity-modulated radiation therapy (IMRT) with PET-CT-based planning for cancers of the head and neck

2015 ◽  
pp. 1-11
Author(s):  
Benjamin L. Franc ◽  
Christi DeLemos ◽  
Christopher Jones
Keyword(s):  
Overall Survival ◽  
Metastatic Disease ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Distant Metastatic Disease ◽  
Intensity Modulated ◽  
Pet Ct ◽  
Disease Free

AbstractIntroductionCombined modality treatment regimens have provided modest gains in locoregional control rates of cancers of the head and neck (HNC), and intensity-modulated radiation therapy (IMRT) has gained widespread use. The methodology for determining contours of the gross tumour volume (GTV) in the radiation treatment plan is often based on combined anatomic and metabolic data from positron emission tomography–computed tomography (PET-CT). This study aimed to retrospectively evaluate the overall survival and disease-free survival outcomes of patients with HNC who received definitive IMRT with or without chemotherapy, planned with PET-CT.Materials and MethodsA total of 1,200 patients underwent treatment for HNC during the study period, from 1 January 2002 to 31 December 2010. Of those, 261 cases had evaluable data that met the inclusion criteria for the study. The incidence and timing of locoregional recurrence, distant metastatic disease, new primary malignancies and death were evaluated retrospectively. Overall and disease-free survival (survival to time of first recurrence) were determined by the life table method. Incidence of distance metastatic disease and additional cancers were also studied.ResultsMedian follow-up from treatment initiation was 26·4 months (range 1·2–84·7 months). Overall survival and disease-free survival rates were 0·883 and 0·791, respectively, at 1 year; 0·793 and 0·688, respectively, at 2 years; and 0·732 and 0·619, respectively, at 3 years. The cumulative risk of recurrence was 22·6% at 3 years following definitive IMRT and the median time to recurrence was 345 days. There was an overall low incidence of distant metastatic disease (3·07%) and additional cancers (8·05%).ConclusionOverall and disease-free survival outcomes of a large cohort of HNC patients treated with definitive IMRT radiotherapy following treatment planning with PET-CT shows a similar high level of disease control and mortality rate as previously published outcome studies of shorter terms and/or smaller numbers of patients.

scholarly journals Prognostic Value of Tumor Infiltrating Lymphocytes in Nasopharyngeal Carcinoma Patients: Meta-Analysis

2021 ◽  
Vol 20 ◽  
pp. 153303382110342
Author(s):  
Birhanu Aberha Berele ◽  
Yuxiang Cai ◽  
Guifang Yang
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Cd4 Cells ◽  
Free Survival ◽  
Registration Number ◽  
Infiltrating Lymphocytes ◽  
Disease Free

Objective: To evaluate the prognostic value of tumor infiltrating lymphocytes (TILs) in nasopharyngeal carcinoma (NPC) patients. Method: Meta-analysis was performed on eligible studies that was identified by systematic searching of Google scholar, MEDLINE, CNKI, Scopus, PubMed, PMC, Embase and Web of Science databases. The study protocol was registered in International Platform of Registered Systematic Review and Meta-Analysis Protocols-INPLASY (registration number: INPLASY202160014). Databases were searched from inception to January 20, 2020 to identify eligible studies. Those studies that evaluated survival in the form of hazard ratio (HR) in TILs of NPC patients was analyzed. All statistical analysis was performed by using STATA version 16.0 software. Result: Fourteen studies with a total of 3025 patients was analyzed. The pooled result showed that high TILs was significantly associated with favorable overall survival (OS) (HR = 0.55; 95%CI = 0.39-0.77; P = 0.001) and disease free survival (DFS) (HR = 0.60; 95%CI = 0.44-0.81; P = 0.04). Interestingly, high intratumoral TILs had relatively better OS (HR = 0.45; 95%CI = 0.35-0.58; P = 0.006) than stromal TILs (HR = 0.59; 95%CI = 0.36-0.97; P = 0.03). Moreover, an increased level of CD4+ cells infiltration was correlated with favorable OS (HR = 0.4; 95%CI = 0.18-0.85; P = 0.01). CD3+, CD8+ and FoxP3+ lymphocyte’s better prognosis was not statistically significant for OS ( P = 0.09; P = 0.07; P = 0.52) and for DFS ( P = 0.13; P = 0.29) respectively. However, subgroup analysis of intratumoral CD3+ (HR = 0.48; 95%CI = 0.33-0.70; P = 0.05) and intratumoral CD8+ (HR = 0.32; 95%CI = 0.16-0.62; P = 0.001) was significantly associated with improved OS, but not significant in stromal CD3+ (HR = 0.66; 95%CI = 0.20-2.20; P = 0.62). Conclusion: TILs were variably correlated with better prognosis depending on their microanatomic location and subset of TILs in NPC patients. CD4+, intratumoral CD3+ and intratumoral CD8+ lymphocytes could predict favorable patient outcome which suggest that their role in mediating antitumor immune response could potentially be exploited in the treatment of NPC patients. Future large study on the prognostic value of microanatomic location of TILs is needed for confirmation.

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.

scholarly journals Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037150
Author(s):  
Si-Ting Lin ◽  
Dong-Fang Meng ◽  
Qi Yang ◽  
Wei Wang ◽  
Li-Xia Peng ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cohort Study ◽  
Nasopharyngeal Carcinoma ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Intensity Modulated ◽  
Kaplan Meier

ObjectivesGeographical disparities have been identified as a specific barrier to cancer screening and a cause of worse outcomes for patients with cancer. In the present study, our aim was to assess the influence of geographical disparities on the survival outcomes of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).DesignCohort study.SettingGuangzhou, China.ParticipantsA total of 1002 adult patients with NPC (724 males and 278 females) who were classified by area of residence (rural or urban) received IMRT from 1 January 2010 to 31 December 2014, at Sun Yat-sen University Cancer Center. Following propensity score matching (PSM), 812 patients remained in the analysis.Main outcome measuresWe used PSM to reduce the bias of variables associated with treatment effects and outcome prediction. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox regression was used to identify independent prognostic factors.ResultsIn the matched cohort, 812 patients remained in the analysis. Kaplan-Meier survival analysis revealed that the rural group was significantly associated with worse overall survival (OS, p<0.001), disease-free survival (DFS, p<0.001), locoregional relapse-free survival (LRRFS, p=0.003) and distant metastasis-free survival (DMFS, p<0.001). Multivariate Cox regression showed worse OS (HR=3.126; 95% CI 1.902 to 5.138; p<0.001), DFS (HR=2.579; 95% CI 1.815 to 3.665; p<0.001), LRRFS (HR=2.742; 95% CI 1.359 to 5.533; p=0.005) and DMFS (HR=2.461; 95% CI 1.574 to 3.850; p<0.001) for patients residing in rural areas.ConclusionsThe survival outcomes of patients with NPC who received the same standardised treatment were significantly better in urban regions than in rural regions. By analysing the geographic disparities in outcomes for NPC, we can guide the formulation of healthcare policies.

Open Versus Endoscopic Approach for Sinonasal Melanoma: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (2) ◽  
pp. 162-169 ◽  
Author(s):  
Kevin Hur ◽  
Paul Zhang ◽  
Alison Yu ◽  
Natalie Kim-Orden ◽  
Lynn Kysh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Endoscopic Approach ◽  
Cochrane Library ◽  
Survival Outcomes ◽  
Open Approach ◽  
Free Survival ◽  
Significant Difference ◽  
Disease Free

Background Open resection (OR) of sinonasal mucosal melanoma (SNM) traditionally has been the gold standard for treatment. However, endoscopic resection (ER) has recently become a surgical alternative. The aim of this study was to compare survival outcomes between OR and ER of SNM. Methods A literature search encompassing PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and Google Scholar was performed. Two reviewers independently screened for original studies comparing survival outcomes between OR and ER for SNM. Data were systematically collected on study design, patient demographics, outcomes, and level of evidence. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). Meta-analysis of overall survival and disease-free survival was performed using random-effects models. Results The initial search yielded 2078 abstracts, of which 9 cohort studies were included for a total of 510 patients from 6 different countries. The average quality of all included studies using the NOS was 7.7 stars. Six out of 7 studies reported no differences in the stages of SNM between patients receiving ER versus OR. Overall survival was longer in the ER group versus OR group (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.49–0.95). There was no significant difference in disease-free survival between groups (HR: 0.59, 95% CI: 0.28–1.25). Conclusion Based on the available literature, an endoscopic approach for SNM resection has survival outcomes that are similar or greater compared to an open approach.

scholarly journals 10 Complete Mesocolic Excision Produces Favorable Survival Outcomes Compared to Conventional Colectomy

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z G W Ow ◽  
W Sim ◽  
K R Y Nistala ◽  
C H Ng ◽  
C S Chong
Keyword(s):  
Meta Analysis ◽  
Disease Free Survival ◽  
Complete Mesocolic Excision ◽  
Survival Outcomes ◽  
Term Survival ◽  
Free Survival ◽  
Long Term Survival ◽  
Mesocolic Excision ◽  
Disease Free

Abstract Introduction Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are the standards of care for the surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are alternative, and more radical procedures, that provide greater lymph nodal clearance. However, controversy exists over the long-term survival benefits of CME/LND3 over non-CME colectomies (NCME)/LND2. Method In this study, we performed a meta-analysis to compare the survival outcomes of CME/LND3 with NCME/LND2. Medline and Embase databases were searched for articles reporting survival outcomes of both CME/LND3 and NCME/LND2, with comparisons presented using odds ratios (OR). Results Ten studies were included in this analysis. Overall and disease-free survival favored CME/LND3 (3-year OS: OR = 1.56; CI 1.22-2.00; p = 0.0004, 5-year OS: OR = 1.29; CI 1.02-1.64, p = 0.03, 3-year DFS: OR = 1.45; CI 1.12-1.88; p = 0.005, 5-year DFS: OR = 1.61; CI 1.14-2.28; p = 0.007). Overall and disease-free survival rates at five years were 79.8% and 85.9%, and 74.6% and 78.0%, in the CME/LND3 and NCME/LND2 groups respectively. Conclusions This is the first meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2, hence a strong case can be made for incorporating CME/LND3 into standard care practice.

scholarly journals Clinical Outcomes and Prognostic Factors of 695 Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Weidong Wang ◽  
Mei Feng ◽  
Zixuan Fan ◽  
Jie Li ◽  
Jinyi Lang
Keyword(s):  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Clinical Outcomes ◽  
Distant Metastasis ◽  
Clinical Target Volume ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Target Volume ◽  
Free Survival ◽  
Intensity Modulated

Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated.Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy.Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively.Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.

Outcomes for Patients With Cervical Cancer Treated With Extended-Field Intensity-Modulated Radiation Therapy and Concurrent Cisplatin

2013 ◽  
Vol 23 (1) ◽  
pp. 119-125 ◽  
Author(s):  
Lindsay G. Jensen ◽  
Michael D. Hasselle ◽  
Brent S. Rose ◽  
Sameer K. Nath ◽  
Yasmin Hasan ◽  
...  
Keyword(s):  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Late Toxicity ◽  
Free Survival ◽  
Intensity Modulated ◽  
Distant Failure ◽  
Extended Field ◽  
Competing Mortality ◽  
Disease Free

ObjectiveTo evaluate disease outcomes and toxicity in patients with cervical cancer treated with extended-field intensity-modulated radiotherapy.Materials and MethodsWe included all patients treated with extended-field intensity-modulated radiotherapy and concurrent weekly cisplatin from 2003 to 2010 at 2 institutions. Overall survival and disease-free survival were estimated using Kaplan-Meier method. Locoregional failure (LRF), distant failure, and competing mortality were calculated using cumulative incidence functions. Acute and late toxicity were graded using Common Terminology Criteria for Adverse Events (CTCAE) and Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.ResultsThe study included 21 patients, 14 and 20 of which had positive para-aortic and pelvic nodes, respectively. The median follow-up was 22 months. Eighteen-month overall survival and disease-free survival were 59.7% (95% confidence interval [CI], 41.2%–86.4%) and 42.9% (95% CI, 26.2%–70.2%). Eighteen-month cumulative incidences of LRF, distant failure, and competing mortality were 9.5% (95% CI, 1.5–26.8%), 42.9% (95% CI, 21.3–62.9%), and 4.8% (95% CI, 0.3–20.2%), respectively. Eighteen-month cumulative incidences of late grade 3 or higher-grade genitourinary and gastrointestinal toxicity were 4.8% (95% CI, 0.2%–20.3%) and 0%, respectively.ConclusionsIntensity-modulated extended-field radiotherapy was associated with low rates of late toxicity and LRF. High rates of distant failure indicate that this group of patients could benefit from intensified systemic therapy.

scholarly journals P22 Are Elderly Patients at Increased Perioperative Morbidity and Mortality from Oesophagectomy for Oesophageal Cancer? A Systematic Mapping Review and Meta-Analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Rohan R Gujjuri ◽  
Muhammed Elhadi ◽  
Hamza Umar ◽  
Manjunath S Subramanya ◽  
Richard P T Evans ◽  
...  
Keyword(s):  
Elderly Population ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
The Elderly ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Anastomotic Leaks ◽  
Free Survival ◽  
Younger Patients ◽  
Disease Free

Abstract Introduction Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients. Methods A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings. Results This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI 95%: 1.42 – 1.97), cardiac complications (OR: 1.62, CI 95%: 1.10 – 2.40), pulmonary complications (OR: 1.44, CI 95%: 1.11 – 1.87) and decreased 5-year overall survival (OR: 1.36, CI 95%: 1.11 – 1.66) and 5-year disease-free survival (OR: 1.66, CI 95%: 1.40 – 1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI 95%: 0.71 – 1.59). Conclusion Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent.

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