Adding Concurrent Chemotherapy Significantly Improves the Survival of Stage II-IVb Nasopharyngeal Carcinoma Patients Treated With Concurrent Anti-EGFR Agents

ObjectiveAnti-EGFR Targeted agents were found to be capable of modulating the antitumor immunity in head and neck cancer and become more and more frequently used in the treatment of nasopharyngeal carcinoma(NPC). We aimed to explore whether adding concurrent chemotherapy influences the survival outcome of patients with stage II-IVb NPC treated with concurrent anti-EGFR agents and intensity-modulated radiation therapy (IMRT) and explore other prognostic factors for the patients.Materials and MethodsA total of 656 stage II-IVb NPC patients treated with concurrent anti-EGFR agents plus IMRT between January 2011 and November 2015 were enrolled. Firstly, from these patients, a well-balanced cohort of 302 patients who received concurrent chemotherapy was created by matching potential prognostic factors. Furthermore, for all 656 stage II-IVb NPC patients, univariate and multivariate analyses of overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) were conducted to identify prognostic factors and to confirm the findings from the matching cohort.ResultsCompared with concurrent anti-EGFR agents alone, combining concurrent cisplatin and anti-EGFR agents significantly improved the OS (5-year 94.7% versus 84.3%, P=0.012) and PFS (5-year 82.0% versus 71.7%, P=0.039) of NPC patients with more severe hematologic toxicity and mucositis. The independent prognostic factors identified by multivariate analysis of OS and PFS included concurrent chemotherapy, epstein-barr virus(EBV) status and clinical stage. Patients treated without induction chemotherapy (IC) may achieve more benefits from the addition of concurrent chemotherapy to concurrent anti-EGFR agents.ConclusionsFor stage II-IVb NPC patients treated with concurrent anti-EGFR agents, the addition of concurrent chemotherapy can significantly improve the survival outcome.

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Concurrent Chemotherapy-Radiotherapy Compared With Radiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma: Progression-Free Survival Analysis of a Phase III Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2002.08.149 ◽

2002 ◽

Vol 20 (8) ◽

pp. 2038-2044 ◽

Cited By ~ 321

Author(s):

A.T.C. Chan ◽

P.M.L. Teo ◽

R.K. Ngan ◽

T.W. Leung ◽

W.H. Lau ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Progression Free Survival ◽

Patient Characteristics ◽

Tumor Stage ◽

Concurrent Chemotherapy ◽

Phase Iii ◽

Free Survival ◽

Advanced Tumor ◽

Nodal Size ◽

Significant Difference

PURPOSE: Nasopharyngeal carcinoma (NPC) is highly sensitive to both radiotherapy (RT) and chemotherapy. This randomized phase III trial compared concurrent cisplatin-RT (CRT) with RT alone in patients with locoregionally advanced NPC. PATIENTS AND METHODS: Patients with Ho’s N2 or N3 stage or N1 stage with nodal size ≥ 4 cm were randomized to receive cisplatin 40 mg/m2 weekly up to 8 weeks concurrently with radical RT (CRT) or RT alone. The primary end point was progression-free survival (PFS). RESULTS: Three hundred fifty eligible patients were randomized. Baseline patient characteristics were comparable in both arms. There were significantly more toxicities, including mucositis, myelosuppression, and weight loss in the CRT arm. There were no treatment-related deaths in the CRT arm, and one patient died during treatment in the RT-alone arm. At a median follow-up of 2.71 years, the 2-year PFS was 76% in the CRT arm and 69% in the RT-alone arm (P = .10) with a hazards ratio of 1.367 (95% confidence interval [CI], 0.93 to 2.00). The treatment effect had a significant covariate interaction with tumor stage, and a subgroup analysis demonstrated a highly significant difference in favor of the CRT arm in Ho’s stage T3 (P = .0075) with a hazards ratio of 2.328 (95% CI, 1.26 to 4.28). For T3 stage, the time to first distant failure was statistically significantly different in favor of the CRT arm (P = .016). CONCLUSION: Concurrent CRT is well tolerated in patients with advanced NPC in endemic areas. Although PFS was not significantly different between the concurrent CRT arm and the RT-alone arm in the overall comparison, PFS was significantly prolonged in patients with advanced tumor and node stages.

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Impact of Superselective Intra-Arterial and Systemic Chemoradiotherapy for Gingival Carcinoma; Analysis of Treatment Outcomes and Prognostic Factors

10.21203/rs.3.rs-56332/v1 ◽

2020 ◽

Author(s):

Yuki Mukai ◽

Yuichiro Hayashi ◽

Izumi Koike ◽

Toshiyuki Koizumi ◽

Madoka Sugiura ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Clinical Stage ◽

Performance Status ◽

Univariate Analysis ◽

Stage Iv ◽

Progression Free Survival ◽

Free Survival

Abstract Background: We compared outcomes and toxicity between radiation therapy (RT) with concurrent retrograde super-selective intra-arterial chemotherapy (IACRT) and RT with concurrent systemic chemoradiotherapy (SCRT), for gingival carcinoma (GC).　Methods: We included 84 consecutive patients who were treated for GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n=66; SCRT group: n=18).Results: Median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT group: 60 Gy; SCRT group:69 Gy). At 3 years, the two groups significantly differed in overall survival (OS; IACRT: 78.75%, 95% confidence interval [CI]: 66.00–87.62; SCRT: 50.37%, 95% CI: 27.58–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.64%, 95% CI: 62.69–85.17; SCRT: 41.96%, 95% CI: 17.65–70.90; P = 0.028) and local control (LC; IACRT: 77.17%, 95% CI: 64.23–86.41; SCRT: 41.96%, 95% CI: 17.65–70.90; P = 0.015). In univariate analysis, age ≥ 65, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with poor OS (P < 0.05). Patients with poorer PS had significantly worse PFS.Conclusions: This is the first report to compare outcomes from IACRT and SCRT among patients with GC. IACRT is an effective and organ-preserving treatment for GC.Trial registration: retrospectively registered

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Phase III Study of Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Advanced Nasopharyngeal Carcinoma: Positive Effect on Overall and Progression-Free Survival

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.158 ◽

2003 ◽

Vol 21 (4) ◽

pp. 631-637 ◽

Cited By ~ 501

Author(s):

Jin-Ching Lin ◽

Jian-Sheng Jan ◽

Chen-Yi Hsu ◽

Wen-Miin Liang ◽

Rong-San Jiang ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Concurrent Chemoradiotherapy ◽

Combined Treatment ◽

Survival Rates ◽

Progression Free Survival ◽

Patient Characteristics ◽

Concurrent Chemotherapy ◽

Phase Iii ◽

Rank Test ◽

Free Survival

Purpose: Nasopharyngeal carcinoma (NPC) is a radiosensitive and chemosensitive tumor. This randomized phase III trial compared concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in patients with advanced NPC. Patients and Methods: From December 1993 to April 1999, 284 patients with 1992 American Joint Committee on Cancer stage III to IV (M0) NPC were randomly allocated into two arms. Similar dosage and fractionation of RT was administered in both arms. The investigational arm received two cycles of concurrent chemotherapy with cisplatin 20 mg/m2/d plus fluorouracil 400 mg/m2/d by 96-hour continuous infusion during the weeks 1 and 5 of RT. Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Baseline patient characteristics were comparable in both arms. After a median follow-up of 65 months, 26.2% (37 of 141) and 46.2% (66 of 143) of patients developed tumor relapse in the CCRT and RT-alone groups, respectively. The 5-year overall survival rates were 72.3% for the CCRT arm and 54.2% for the RT-only arm (P = .0022). The 5-year progression-free survival rates were 71.6% for the CCRT group compared with 53.0% for the RT-only group (P = .0012). Although significantly more toxicity was noted in the CCRT arm, including leukopenia and emesis, compliance with the combined treatment was good. The second cycle of concurrent chemotherapy was refused by nine patients and was delayed for ≥ 1 week for another nine patients. There were no treatment-related deaths in either arm. Conclusion: We conclude that CCRT is superior to RT alone for patients with advanced NPC in endemic areas.

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

Radiology and Oncology ◽

10.2478/raon-2018-0016 ◽

2018 ◽

Vol 52 (2) ◽

pp. 195-203 ◽

Cited By ~ 6

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.

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The Most Efficacious Induction Chemotherapy Regimen for Locoregionally Advanced Nasopharyngeal Carcinoma: A Network Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.626145 ◽

2021 ◽

Vol 11 ◽

Author(s):

Horace Cheuk-Wai Choi ◽

Sik-Kwan Chan ◽

Ka-On Lam ◽

Sum-Yin Chan ◽

Sze-Chun Chau ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Induction Chemotherapy ◽

Fixed Effects ◽

Concurrent Chemoradiotherapy ◽

Meta Analysis ◽

Intensity Modulated Radiation Therapy ◽

Progression Free Survival ◽

Free Survival ◽

Hazard Ratios ◽

Analysis Models

BackgroundInduction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) for non-metastatic locoregionally advanced nasopharyngeal carcinoma (NPC) has gained considerable attention. However, the most efficacious IC regimens remain investigational. We aimed to compare the survival benefits of all available IC regimens followed by CCRT in this network meta-analysis.MethodsAll randomized-controlled trials of CCRT with or without IC in non-metastatic locoregionally advanced NPC were included, with an overall nine trials of 2,705 patients counted in the analysis. CCRT alone was the reference category. Eight IC regimens followed by CCRT were analyzed: docetaxel + cisplatin (DC), gemcitabine + carboplatin + paclitaxel (GCP), gemcitabine + cisplatin (GP), mitomycin + epirubicin + cisplatin + fluorouracil + leucovorin (MEPFL), cisplatin + epirubicin + paclitaxel (PET), cisplatin + fluorouracil (PF), cisplatin + capecitabine (PX) and cisplatin + fluorouracil (PF), cisplatin + capecitabine (PX). Fixed-effects frequentist network meta-analysis models was applied and P-score was used to rank the treatments.ResultsDC, GP, and PX were the top three IC regimens with the highest probability of benefit on overall survival (OS). Their corresponding hazard ratios (HRs) (95% CIs) compared with CCRT alone were of 0.24 (0.08–0.73), 0.43 (0.24–0.77), and 0.54 (0.27–1.09) and the respective P-scores were 94%, 82%, and 68%. The first three IC regimens showing significantly improved progression-free survival (PFS) were PX, followed by GP and DC with respective HRs of 0.46 (0.24–0.88), 0.51 (0.34–0.77), and 0.49 (0.20–1.20), and P-scores of 82%, 78%, and 74%. Among the studies in the intensity-modulated radiation therapy (IMRT) era, GP and PX were the best performed IC regimens, whilst DC performed the best among non-IMRT studies. Doublet and gemcitabine-based IC regimens had better survival benefits compared to triplet and taxane-based IC regimens, respectively.ConclusionsGiven its consistent superiority in both OS and PFS, DC, GP, and PX ranked among the three most efficacious IC regimens in both the overall and subgroup analysis of IMRT or non-IMRT studies. Exploratory analyses suggested that doublet and gemcitabine-based IC regimens showed better survival performance.

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IMRT Images Based on Swarm Intelligence Algorithm in the Treatment of Nasopharyngeal Carcinoma and Pain

Scientific Programming ◽

10.1155/2021/7007169 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Xiaoli Fu ◽

Minxiang Li ◽

Mantian Yin ◽

Qing Li ◽

Ying Chen

Keyword(s):

Nasopharyngeal Carcinoma ◽

Total Dose ◽

Survival Rates ◽

Intensity Modulated Radiation Therapy ◽

Progression Free Survival ◽

Target Volume ◽

Acute Radiation ◽

Free Survival ◽

Sliding Windows ◽

Technical Features

Objective. To investigate the IMRT treatment of nasopharyngeal carcinoma term effect, toxicity, and technical features. Methods. Sliding windows dynamic CT image-guided IMRT techniques on 31 patients for treatment of nasopharyngeal carcinoma radical radiotherapy, with 30 to 33 min irradiation. Target prescription dose GTVnx, GTVnd, CTV1, and CTV2 were 70∼76Gy, 68∼70Gy, 60∼66Gy, and 54Gy, while giving a dose of vital organs, the brain stem, and other restrictions to protect the parotid gland. Results. During 3 to 18 months of follow-up for a median period of 10 months, 1-year locoregional patients’ progression-free survival, distant metastasis-free survival, and overall survival rates were 93.5%, 87.1%, and 93.5%, respectively. Acute radiation reactions of grade I and II, xerostomia, and radioactive stomatitis were not observed. IMRT DVH analysis showed increased total dose and the irradiation target volume divided doses, reduced OARs illuminated, and the total dose divided doses. Conclusion. Intensity-modulated radiation therapy can achieve good short-term effects, significantly reduce the acute radiation response, and improve the quality of life of patients. It is worthy of promotion and application and in-depth research.

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A phase II study of chemoradiotherapy in patients with stage II, III esophageal squamous cell carcinoma (ESCC): (JCOG 9906)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15137 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15137-15137 ◽

Cited By ~ 1

Author(s):

K. Muro ◽

A. Ohtsu ◽

S. Ishikura ◽

N. Boku ◽

H. Takiuchi ◽

...

Keyword(s):

Radiation Pneumonitis ◽

Clinical Stage ◽

Survival Rates ◽

Progression Free Survival ◽

Stage Ii ◽

Study Objective ◽

Free Survival ◽

Secondary Endpoints ◽

Grade 3

15137 Background: The study objective was to evaluate the efficacy and toxicity of chemoradiotherapy (CRT) with cisplatin and 5- fluorouracil (5FU) in patients with stage II, III ESCC. Methods: Patients with clinical stage II or III (T1N1 or T2–3N0–1 and M0) thoracic ESCC, age of 70 or younger, preserved organ functions were eligible. Treatment consisted of two courses of cisplatin 40 mg/m2 (day 1, 8) and 5FU 400 mg/m2/day (days 1–5, 8–12), q5w combined with concurrent radiotherapy of 60 Gy in 30 fractions over 8 weeks with 2-week break. For responders, two courses of chemotherapy of cisplatin 80 mg/m2 (day 1) and 5FU 800 mg/m2/day (days 1–5) q4w were added. The primary endpoint was overall survival and the secondary endpoints were response, toxicity, and progression-free survival. Results: From April 2000 to March 2002, 76 patients were accrued from 12 institutions. Characteristics of all patients were as follows: median age of 61 (range 39–70), male/female; 68/8, PS 0/1; 59/17, stage IIA/IIB/III; 26/12/38. There were two ineligible cases with inadequate liver function and T4 disease. Grade 4 neutropenia, leukopenia, and anemia occurred in 1.3%, 1.3% and 2.6%. Grade 3/4 esophagitis, stomatitis and infection occurred in 17%, 8% and 17%. Grade 3/4 late toxicities occurred in the following incidences; esophagus (dysphagia, mucositis, stenosis, and fistula) in 13%, pericardial effusion in 17%, pleural effusion in 8%, and radiation pneumonitis in 4%. There were 4 treatment related deaths due to late toxicities such as esophageal fistula, radiation pneumonitis, and the other cardiopulmonary diseases. Of eligible 74 patients, there were 50 complete responses (CRs) with a CR rate of 68% (95% Confidence Interval (CI): 56–78%). Median survival time was 31 months and the 2, 3-year survival rates were 55% (95% CI: 43–67%), 47% (95% CI: 36–59%), respectively. Conclusion: CRT for stage II, III ESCC is effective with acceptable acute toxicities, however, careful follow up is necessary for late toxicities. No significant financial relationships to disclose.

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Mantle Irradiation Alone for Clinical Stage I-II Hodgkin's Disease: Long-Term Follow-Up and Analysis of Prognostic Factors in 261 Patients

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.1.230 ◽

1999 ◽

Vol 17 (1) ◽

pp. 230-230 ◽

Cited By ~ 21

Author(s):

A. Wirth ◽

M. Chao ◽

J. Corry ◽

C. Laidlaw ◽

K. Yuen ◽

...

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Progression Free Survival ◽

Stage I ◽

Stage Ii ◽

Multifactor Analysis

PURPOSE: To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS: We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS: There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION: These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.

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Efficacy and safety of cisplatin and paclitaxel (PlaTax regimen) in the neoadjuvant treatment of patients with stage II–III triple-negative breast cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2020-16-2-25-37 ◽

2020 ◽

Vol 16 (2) ◽

pp. 25-37

Author(s):

O. O. Gordeeva ◽

I. V. Kolyadina ◽

L. G. Zhukova ◽

I. P. Ganshina ◽

G. V. Vyshinskaya ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Progression Free Survival ◽

Stage Ii ◽

Efficacy And Safety ◽

Treatment Results ◽

Free Survival

Background. Treatment results for the patients with stage II–III triple negative breast cancer (TN BC) have to be improved. Not only the new treatment regimens, but new predictive and prognostic factors should to be developed.Materials and methods. We included 98 patients with stage II–III TN BC in our study. We studied efficacy and safety of PlaTax regimen (cisplatin 75 mg / m2 day 1 + paclitaxel 80 mg / m2 days 1, 8, 15, course every 4 weeks) in this cohort of patients. We assessed pathologic response, survival and factors, which were relevant for predicting response and prognose survival.Results. PlaTax regimen is characterized by high efficacy and tolerable toxicity. Clinical efficacy was 85.8 %, pCR achievement was 60.5 %, tpCR achievement was 58.1 %. The regimen has low haematological toxicity (neutropenia III–IV grades – 4.1 %); the most frequent adverse events were polyneuropathy (18.5 %) and decreased renal function (24.5 %). 3-year progression-free survival was 68.4 %, most of the relapses (92 %) occurred during first 2 years. 3 year overall survival was 77.6 %. The most relevant predictive factor was level of Ki-67 ≥50 % (pCR 38.5 % vs. 68.7 %, p = 0.038). pCR achievement was the most important prognostic factor, resulting in improved 3-year progressionfree survival (44.3 % vs. 89.1 %, p <0.0001), and 3-year overall survival (61.5 % vs. 91.6 %, p = 0.001). Not only the residual disease, but also the size of residual tumor was important from prognostic point of view. Other important prognostic factors were size of the tumor, status of regional lymph nodes, grade. Delay in surgical treatment more than a month lead to decreased 3-year progression-free survival: 87.1 % vs. 62.5 % (p = 0.047).Conclusions. Our data suggest that studied regimen could be an option for patients with stage II–III TN BC. The assessment of the predictive and prognostic factors will help improve the treatment results for patients with stage II–III TN BC.

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Explore the Usefulness of Concurrent Chemotherapy in Stage II Nasopharyngeal Carcinoma: A Retrospective Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.688528 ◽

2021 ◽

Vol 12 ◽

Author(s):

Pei-Jing Li ◽

Yu-Lin Lai ◽

Fang He ◽

Yuan-Yuan Chen ◽

Zhuo-Sheng Gu ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Distant Metastasis ◽

Protective Factor ◽

Cox Regression ◽

Univariate Analysis ◽

Concurrent Chemotherapy ◽

Stage Ii ◽

Free Survival ◽

Significant Difference ◽

The Impact

Objective: This study aims to compare the treatment outcomes of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in stage II nasopharyngeal carcinoma (NPC) patients.Methods: We retrospectively collected 601 stage II NPC patients treated in two hospitals between June 2003 to June 2016. All patients were divided into the CCRT group (n = 255) and the RT group (n = 346). Overall survival (OS), locoregional failure-free survival (LRFFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. The log-rank test was used to compare the differences between the groups. The Cox-regression hazards model was performed to determine potential prognostic factors.Results: The median follow-up was 99 months. No significant difference was found in locoregional recurrence, distant metastasis, disease progression, and death between the two groups (all p > 0.05). In univariate analysis, the 5-years OS, PFS, LRFFS, and DMFS had no significant differences between the CCRT and RT groups (all p > 0.05). Two-dimensional radiotherapy (2DRT) sub-analysis showed that CCRT remarkably increased DMFS, PFS, and OS rates (all p < 0.05) but not LRFFS (p = 0.258) compared with RT alone. While intensity-modulated radiotherapy (IMRT) sub-analysis showed that the prognosis of the two groups had no significant differences (all p > 0.05). In multivariate analyses, age was significantly and inversely related to OS, PFS, LRFFS, and DMFS. IMRT was an independent favorable factor for improving LRFFS, PFS, and OS. Concurrent chemotherapy was an independent protective factor for DMFS.Conclusion: In the context of 2DRT, it is definite that concurrent chemotherapy provides survival benefits for patients with stage II NPC. While in the IMRT era, the impact of chemotherapy on survival in patients with stage II NPC is weakened. Prospective randomized controlled studies are required to confirm these results.

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