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Liu H, Tang L, Li Y, Xie W, Zhang L, Tang H, Xiao T, Yang H, Gu W, Wang H, Chen P. Nasopharyngeal carcinoma: current views on the tumor microenvironment's impact on drug resistance and clinical outcomes. Mol Cancer 2024; 23:20. [PMID: 38254110 PMCID: PMC10802008 DOI: 10.1186/s12943-023-01928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
The incidence of nasopharyngeal carcinoma (NPC) exhibits significant variations across different ethnic groups and geographical regions, with Southeast Asia and North Africa being endemic areas. Of note, Epstein-Barr virus (EBV) infection is closely associated with almost all of the undifferentiated NPC cases. Over the past three decades, radiation therapy and chemotherapy have formed the cornerstone of NPC treatment. However, recent advancements in immunotherapy have introduced a range of promising approaches for managing NPC. In light of these developments, it has become evident that a deeper understanding of the tumor microenvironment (TME) is crucial. The TME serves a dual function, acting as a promoter of tumorigenesis while also orchestrating immunosuppression, thereby facilitating cancer progression and enabling immune evasion. Consequently, a comprehensive comprehension of the TME and its intricate involvement in the initiation, progression, and metastasis of NPC is imperative for the development of effective anticancer drugs. Moreover, given the complexity of TME and the inter-patient heterogeneity, personalized treatment should be designed to maximize therapeutic efficacy and circumvent drug resistance. This review aims to provide an in-depth exploration of the TME within the context of EBV-induced NPC, with a particular emphasis on its pivotal role in regulating intercellular communication and shaping treatment responses. Additionally, the review offers a concise summary of drug resistance mechanisms and potential strategies for their reversal, specifically in relation to chemoradiation therapy, targeted therapy, and immunotherapy. Furthermore, recent advances in clinical trials pertaining to NPC are also discussed.
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Affiliation(s)
- Huai Liu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Ling Tang
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Yanxian Li
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Wenji Xie
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Ling Zhang
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Hailin Tang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tengfei Xiao
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Hongmin Yang
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Wangning Gu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Hui Wang
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
| | - Pan Chen
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
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2
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Petit C, Lee A, Ma J, Lacas B, Ng WT, Chan ATC, Hong RL, Chen MY, Chen L, Li WF, Huang PY, Tan T, Ngan RKC, Zhu G, Mai HQ, Hui EP, Fountzilas G, Zhang L, Carmel A, Kwong DLW, Moon J, Bourhis J, Auperin A, Pignon JP, Blanchard P. Role of chemotherapy in patients with nasopharynx carcinoma treated with radiotherapy (MAC-NPC): an updated individual patient data network meta-analysis. Lancet Oncol 2023; 24:611-623. [PMID: 37269842 DOI: 10.1016/s1470-2045(23)00163-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The meta-analysis of chemotherapy for nasopharynx carcinoma (MAC-NPC) collaborative group previously showed that the addition of adjuvant chemotherapy to concomitant chemoradiotherapy had the highest survival benefit of the studied treatment regimens in nasopharyngeal carcinoma. Due to the publication of new trials on induction chemotherapy, we updated the network meta-analysis. METHODS For this individual patient data network meta-analysis, trials of radiotherapy with or without chemotherapy in patients with non-metastatic nasopharyngeal carcinoma that completed accrual before Dec 31, 2016, were identified and updated individual patient data were obtained. Both general databases (eg, PubMed and Web of Science) and Chinese medical literature databases were searched. Overall survival was the primary endpoint. A frequentist network meta-analysis approach with a two-step random effect stratified by trial based on hazard ratio Peto estimator was used. Global Cochran Q statistic was used to assess homogeneity and consistency, and p score to rank treatments, with higher scores indicating higher benefit therapies. Treatments were grouped into the following categories: radiotherapy alone, induction chemotherapy followed by radiotherapy, induction chemotherapy without taxanes followed by chemoradiotherapy, induction chemotherapy with taxanes followed by chemoradiotherapy, chemoradiotherapy, chemoradiotherapy followed by adjuvant chemotherapy, and radiotherapy followed by adjuvant chemotherapy. This study is registered with PROSPERO, CRD42016042524. FINDINGS The network comprised 28 trials and included 8214 patients (6133 [74·7%] were men, 2073 [25·2%] were women, and eight [0·1%] had missing data) enrolled between Jan 1, 1988, and Dec 31, 2016. Median follow-up was 7·6 years (IQR 6·2-13·3). There was no evidence of heterogeneity (p=0·18), and inconsistency was borderline (p=0·10). The three treatments with the highest benefit for overall survival were induction chemotherapy with taxanes followed by chemoradiotherapy (hazard ratio 0·75; 95% CI 0·59-0·96; p score 92%), induction chemotherapy without taxanes followed by chemoradiotherapy (0·81; 0·69-0·95; p score 87%), and chemoradiotherapy followed by adjuvant chemotherapy (0·88; 0·75-1·04; p score 72%), compared with concomitant chemoradiotherapy (p score 46%). INTERPRETATION The inclusion of new trials modified the conclusion of the previous network meta-analysis. In this updated network meta-analysis, the addition of either induction chemotherapy or adjuvant chemotherapy to chemoradiotherapy improved overall survival over chemoradiotherapy alone in nasopharyngeal carcinoma. FUNDING Institut National du Cancer and Ligue Nationale Contre le Cancer.
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Affiliation(s)
- Claire Petit
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Anne Lee
- Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Benjamin Lacas
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Wai Tong Ng
- Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ruey-Long Hong
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | - Lei Chen
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Fei Li
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | - Roger K C Ngan
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Guopei Zhu
- Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - George Fountzilas
- Aristotle University of Thessaloniki, Thessaloniki, Greece; Hellenic Cooperative Oncology Group, Athens, Greece; German Oncology Center, Limassol, Cyprus
| | - Li Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Alexandra Carmel
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Dora L W Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - James Moon
- Southwest Oncology Group Statistics and Data Management Center, Seattle, WA, USA
| | - Jean Bourhis
- Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Auperin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France.
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Lin Y, Yu X, Lu L, Chen H, Wu J, Chen Y, Lin Q, Wang X, Chen X, Chen X. Age is a significant biomarker for the selection of neoadjuvant chemotherapy plus radiotherapy versus concurrent chemoradiotherapy in patients with advanced nasopharyngeal carcinoma. Cancer Biomark 2023; 37:1-11. [PMID: 36938724 DOI: 10.3233/cbm-210357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND The optimal timing of combined chemotherapy with radiotherapy for locally advanced nasopharyngeal carcinoma (LA-NPC) is undetermined. OBJECTIVE This study aimed to compare the therapeutic efficacy of neoadjuvant chemotherapy (NACT) followed by radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). METHODS Five hundred and thirty-eight patients diagnosed with LA-NPC and treated with NACT + RT or CCRT alone were enrolled in the study. Restricted cubic spline regression (RCS) was used to determine the relationship between age and the hazard Ratio of death. A Kaplan-Meier analysis was performed to evaluate overall survival (OS) related to NACT + RT or CCRT alone. Cox proportional hazards models were used to adjust for potential confounding factors. RESULTS Compared with the CCRT alone regimen, the NACT + RT regimen showed a significantly better OS rate with a 62% decreased risk of death in a subgroup of patients aged ⩾ 45 years (hazard ratio, HR: 0.38; 95% confidence interval, CI: 0.24-0.61). In patients aged < 45 years, the risk of death was significantly increased when NACT + RT was chosen compared with CCRT (HR: 4.10; 95% CI: 2.09-8.07). CONCLUSIONS Age is a significant biomarker when selecting NACT + RT or CCRT alone in patients with advanced NPC.
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Affiliation(s)
- Yihong Lin
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiongbin Yu
- Department of Oncology, Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Medical University, Fuqing, Fujian, China
| | - Linbin Lu
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Hong Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Junxian Wu
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yaying Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Qin Lin
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xuewen Wang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiong Chen
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
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Jiang YT, Chen KH, Liang ZG, Yang J, Qu S, Li L, Zhu XD. A nomogram to predict survival and guide individualized induction chemotherapy in T3-4N1M0 nasopharyngeal carcinoma. Curr Probl Cancer 2022; 46:100897. [PMID: 36162165 DOI: 10.1016/j.currproblcancer.2022.100897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 01/30/2023]
Abstract
Induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) and CCRT alone were the optional treatment regimens for T3-4N1M0 nasopharyngeal carcinoma (NPC) patients. Therefore, we established a nomogram to predict clinical prognosis and guide individualized IC in T3-4N1M0 NPC. Overall, 699 T3-4N1M0 NPC patients treated with CCRT with or without IC between January 2010 and December 2018 were examined. Overall survival (OS) was the main endpoint. A nomogram was developed that included prognostic variables selected by multivariable analysis. The risk score, which was calculated according to the nomogram, was used for risk stratification. The survival difference of patients undergoing CCRT with or without IC was then compared in risk-stratified subgroups. The nomogram yielded C-indexes of 0.708 (95% confidence interval [CI]: 0.682-0.734) in the training cohort and 0.670 (95% CI: 0.625-0.715) in the validation cohort. Calibration curves for 1-, 3- and 5-year OS suggested a good association between the nomogram predicted and observed probabilities. High-risk patients stratified by nomogram benefited from IC (IC + CCRT vs CCRT: 5-year OS: 77.8% vs 58.8%; P = 0.040; 5-year disease-free survival: 75.0% vs 58.2%; P = 0.017), whereas in the low-risk group, the application of IC was associated with worse locoregional recurrence-free survival and distant metastasis-free survival. This nomogram can serve as a reliable model for prognostic prediction and can be used to guide individualized treatment of T3-4N1M0 NPC. High-risk patients are candidates for IC before CCRT, while the use of IC for low-risk patients should be considered carefully.
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Affiliation(s)
- Yu-Ting Jiang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jie Yang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, China.; Department of Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, China..
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5
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Chen AM, Qi L, Cress RD, Li Y, Beckett L, Li B. Effect of radiotherapy and chemotherapy on the survival rate of Asian Americans with nasopharyngeal carcinoma. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology University of California, Irvine, School of Medicine Orange California USA
| | - Lihong Qi
- Department of Public Health Sciences University of California Davis Davis California USA
| | - Rosemary D. Cress
- Department of Public Health Sciences University of California Davis Davis California USA
- Cancer Registry of Greater California Public Health Institute Sacramento California USA
| | - Yueju Li
- Department of Public Health Sciences University of California Davis Davis California USA
| | - Laurel Beckett
- Department of Public Health Sciences University of California Davis Davis California USA
| | - Baoqing Li
- Department of Radiation Oncology Weill Cornell Medical College New York New York USA
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Blanchard P, Lee AWM, Carmel A, Wai Tong N, Ma J, Chan ATC, Hong RL, Chen MY, Chen L, Li WF, Huang PY, Kwong DLW, Poh SSX, Ngan R, Mai HQ, Ollivier C, Fountzilas G, Zhang L, Bourhis J, Aupérin A, Lacas B, Pignon JP. Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients. Clin Transl Radiat Oncol 2021; 32:59-68. [PMID: 34935776 DOI: 10.1016/j.ctro.2021.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Chemotherapy, when added to radiotherapy, improves survival in locally advanced nasopharyngeal carcinoma (NPC). This article presents the second update of the Meta-Analysis of Chemotherapy in NPC. Methods Published or unpublished randomized trials assessing radiotherapy (±a second chemotherapy timing) with/without chemotherapy in non-metastatic NPC patients were identified. Updated data were sought for studies included in the previous rounds of the meta-analysis. The primary endpoint was overall survival. All trials were analyzed following the intent-to-treat principle using a fixed-effects model. Treatments were classified in five subsets according to chemotherapy timing. The statistical analysis plan was pre-specified. Results Eighteen new trials were identified. Individual patient data were available for seven. In total, the meta-analysis now included 26 trials and 7,080 patients. The addition of chemotherapy reduced the risk of death, with a hazard ratio (HR) of 0.79 (95% confidence interval (CI) [0.73; 0.85]), and an absolute survival increase at 5 and 10 years of 6.1% [+3.9; +8.3] and + 8.4% [+5.7; +11.1], respectively. The largest effect was observed for concomitant + adjuvant, induction (with concomitant in both arms) and concomitant chemotherapy, with respective HR [95%CI] of 0.68 [0.59; 0.79] (absolute survival increase at 5 years: 12.3% (7.0%;17.6%)), 0.73 [0.63; 0.86] (6.0% (2.5%;9.5%)) and 0.81 [0.70; 0.92] (5.2% (0.8%;9.6%)). The benefit of chemotherapy was also demonstrated by improvement in progression-free survival, cancer mortality, locoregional control and distant control. There was a significant interaction between patient age and chemotherapy effect. Conclusion This updated meta-analysis confirms the benefit of concomitant chemotherapy and concomitant + adjuvant chemotherapy, and suggests that addition of induction or adjuvant chemotherapy to concomitant chemotherapy improves tumor control and survival. The benefit of chemotherapy decreases with increasing patient age.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France Gustave-Roussy, Villejuif, France.,Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France
| | - Anne W M Lee
- University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China
| | - Alexandra Carmel
- Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Ng Wai Tong
- University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Lei Chen
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Fei Li
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dora L W Kwong
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | | | - Roger Ngan
- University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Camille Ollivier
- Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - George Fountzilas
- Aristotle University of Thessaloniki School of Medicine, Thessaloniki, and Hellenic Cooperative Oncology Group, Athens, Greece and German Oncology Center, Limassol, Cyprus
| | - Li Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jean Bourhis
- Department of Radiotherapy, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Benjamin Lacas
- Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
| | - Jean-Pierre Pignon
- Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.,Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France
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7
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Wong KCW, Hui EP, Lo KW, Lam WKJ, Johnson D, Li L, Tao Q, Chan KCA, To KF, King AD, Ma BBY, Chan ATC. Nasopharyngeal carcinoma: an evolving paradigm. Nat Rev Clin Oncol 2021; 18:679-695. [PMID: 34194007 DOI: 10.1038/s41571-021-00524-x] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
The past three decades have borne witness to many advances in the understanding of the molecular biology and treatment of nasopharyngeal carcinoma (NPC), an Epstein-Barr virus (EBV)-associated cancer endemic to southern China, southeast Asia and north Africa. In this Review, we provide a comprehensive, interdisciplinary overview of key research findings regarding NPC pathogenesis, treatment, screening and biomarker development. We describe how technological advances have led to the advent of proton therapy and other contemporary radiotherapy approaches, and emphasize the relentless efforts to identify the optimal sequencing of chemotherapy with radiotherapy through decades of clinical trials. Basic research into the pathogenic role of EBV and the genomic, epigenomic and immune landscape of NPC has laid the foundations of translational research. The latter, in turn, has led to the development of new biomarkers and therapeutic targets and of improved approaches for individualizing immunotherapy and targeted therapies for patients with NPC. We provide historical context to illustrate the effect of these advances on treatment outcomes at present. We describe current preclinical and clinical challenges and controversies in the hope of providing insights for future investigation.
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Affiliation(s)
- Kenneth C W Wong
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwok-Wai Lo
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Wai Kei Jacky Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - David Johnson
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Lili Li
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Qian Tao
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwan Chee Allen Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ann D King
- Department of Diagnostic Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
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Li P, Zhang Q, Luo D, Jiang F, Jin Q, Hua Y, Jin T, Chen X. Explore the Value of Adding Induction Chemotherapy to Concurrent Chemoradiotherapy in T3-4N0M0 Nasopharyngeal Carcinoma Patients: A Retrospective Study. Cancer Manag Res 2021; 13:7067-7076. [PMID: 34526821 PMCID: PMC8437383 DOI: 10.2147/cmar.s321471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 12/09/2022] Open
Abstract
Purpose Patients with T3-4N0M0 nasopharyngeal carcinoma (NPC) are a unique subgroup of locoregional advanced NPC, which generally have a better prognosis than others and are often excluded in most randomized controlled clinical trials focusing on locoregional advanced NPC. The management of this population is still controversial. This study aims to evaluate the outcomes of T3-4N0M0 NPC patients treated with sequential induction chemotherapy and concurrent chemoradiotherapy (IC+CCRT) or chemoradiotherapy (CCRT) alone. Patients and Methods We included 362 patients diagnosed with T3-4N0M0 NPC from two hospitals between December 2005 and December 2014. All patients were received IC + CCRT (n=146) or CCRT (n=216). Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were retrospectively estimated. Results The median follow-up was 95 (range: 11-168) months. Univariable analyses have shown that 5-year LRFFS, DFS and OS in the IC+CCRT group and the CCRT group were 87.4% vs 93.4% (P = 0.035), 80.4% vs 87.0% (P = 0.047) and 86.3% vs 93.0% (P = 0.040). Multivariate analyses demonstrated that only the T stage was the independent prognostic factor for LRFFS, DFS, and OS in the entire group analysis. Subgroup analysis revealed that patients with T3 tumors who received IC+CCRT had significantly lower LRFFS, DFS, and OS than those treated with CCRT. For T4 patients, the outcomes had no significant difference between the two groups. Conclusion This retrospective study showed that T3N0M0 patients who received CCRT had better prognosis than those treated with IC+CCRT. In terms of T4N0M0 disease, treatment outcomes are similar in both treatment groups. However, these results require further confirmation of large sample size, prospectively, randomized controlled trials.
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Affiliation(s)
- Peijing Li
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
| | - Qun Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
| | - Donghua Luo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Guangzhou, 510060, People's Republic of China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China
| | - Feng Jiang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
| | - Qifeng Jin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
| | - Yonghong Hua
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
| | - Ting Jin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
| | - Xiaozhong Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310000, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310000, People's Republic of China
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9
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Chen YP, Ismaila N, Chua MLK, Colevas AD, Haddad R, Huang SH, Wee JTS, Whitley AC, Yi JL, Yom SS, Chan ATC, Hu CS, Lang JY, Le QT, Lee AWM, Lee N, Lin JC, Ma B, Morgan TJ, Shah J, Sun Y, Ma J. Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. J Clin Oncol 2021; 39:840-859. [PMID: 33405943 DOI: 10.1200/jco.20.03237] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2020. Outcomes of interest included survival, distant and locoregional disease control, and quality of life. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 108 relevant studies to inform the evidence base for this guideline. Five overarching clinical questions were addressed, which included subquestions on radiotherapy (RT), chemotherapy sequence, and concurrent, induction, and adjuvant chemotherapy options. RECOMMENDATIONS Evidence-based recommendations were developed to address aspects of care related to chemotherapy in combination with RT for the definitive-intent treatment of stage II to IVA NPC.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
- Yu-Pei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | | | - Melvin L K Chua
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | | | - Shao Hui Huang
- Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Joseph T S Wee
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | - Jun-Lin Yi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Chao-Su Hu
- Fudan University Shanghai Cancer Center, Shanghai, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jin-Yi Lang
- Sichuan Cancer Hospital & Institute, Chengdu, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Quynh-Thu Le
- Stanford University School of Medicine, Stanford, CA
| | - Anne W M Lee
- The University of Hong Kong-Shenzhen Hospital, People's Republic of China, and The University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Nancy Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Brigette Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | | | - Jatin Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
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10
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Mané M, Benkhaled S, Dragan T, Paesmans M, Beauvois S, Lalami Y, Szturz P, Gaye PM, Vermorken JB, Van Gestel D. Meta-Analysis on Induction Chemotherapy in Locally Advanced Nasopharyngeal Carcinoma. Oncologist 2020; 26:e130-e141. [PMID: 32924198 PMCID: PMC7794190 DOI: 10.1002/onco.13520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Concurrent chemo radiotherapy (CCRT) has been the standard of care in locally advanced nasopharyngeal carcinoma (LA‐NPC) for many years. The role of induction chemotherapy (ICT) has always been controversial. This systematic review and meta‐analysis investigates the value of adding ICT to CCRT in LA‐NPC. Materials and Methods Two reviewers independently assessed the eligibility of randomized controlled trials (RCTs) comparing ICT followed by CCRT versus CCRT alone, including treatment‐naive adult patients with histologically proven nonmetastatic LA‐NPC. Results Eight RCTs with in total 2,384 randomized patients, of whom 69% had N2–N3 disease, were selected. ICT was the allocated treatment in 1,200 patients, of whom 1,161 actually received this. Treatment compliance varied, with a median rate of 92% (range, 86%–100%) of patients receiving all cycles of ICT. The percentage of patients completing radiotherapy was 96% and 95% [(Combined Risk difference(CRD)= 0.004; 95% Confidence Interval (CI) –0.001–0.01; p = 0.14)] in the ICT group and CCRT group, respectively, whereas chemotherapy during radiotherapy could be completed in only 28% of the ICT group versus 61% in the CCRT group (CRD, −0.243; 95% CI, −0.403 to −0.083; p = .003). Grade 3–4 acute toxicity was mostly hematologic during the ICT phase (496 events vs. 191 nonhematologic) and was predominant in the ICT group (1,596 events vs. 1,073 in the CCRT alone group) during the CCRT. Adding ICT to CCRT provided a significant benefit in overall survival (hazard ratio [HR], 0.680; 95% CI, 0.511–0.905; p = .001) and progression‐free survival (HR, 0.657; 95% CI, 0.568–0.760; p < .001). Conclusion Although ICT followed by CCRT is associated with more acute toxicity and a lower compliance of the chemotherapy during the CCRT phase, this association resulted in a clinically meaningful survival benefit. ICT should be considered as a standard option in patients with LA‐NPC, but further study on optimal patient selection for this treatment is warranted. Implications for Practice Locally advanced nasopharyngeal carcinoma (LA‐NPC) is a relatively common disease in some parts of the world, with a rather poor prognosis due to its high metastatic potential. The role of induction chemotherapy (ICT) has always been controversial. This meta‐analysis found that ICT followed by concurrent chemoradiotherapy (CCRT) in LA‐NPC is associated with a significant clinical improvement in both overall survival and progression‐free survival compared with CCRT alone. ICT should be considered as a standard option in patients with LA‐NPC. This review reports on the role of induction chemotherapy in locally advanced nasopharyngeal carcinoma, focusing on the effect of adding induction chemotherapy to concurrent chemoradiotherapy on overall and progression‐free survival.
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Affiliation(s)
- Maïmouna Mané
- Department of Radiation-Oncology, Dalal Jamm National Hospital Center, Dakar, Senegal
| | - Sofian Benkhaled
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Tatiana Dragan
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Marianne Paesmans
- Department of Biostatistics Unit-Data centre, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvie Beauvois
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Yassine Lalami
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Petr Szturz
- Department of Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - P Macoumba Gaye
- Department of Radiation-Oncology, Dalal Jamm National Hospital Center, Dakar, Senegal
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
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11
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Wardhani LK, Kentjono WA, Romdhoni AC. Association Between Dose and Duration of Cisplatin Exposure with Cytotoxicity Effect on Nasopharyngeal Carcinoma Stem Cell. Indian J Otolaryngol Head Neck Surg 2019; 71:373-377. [PMID: 31741989 DOI: 10.1007/s12070-018-1317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is ranked 6th of malignant tumors in Indonesia. To analyze the correlation of dose and duration of cisplatin exposure with cytotoxic effects on nasopharyngeal carcinoma stem cells. The biopsy NPC tissue was cultured and processed to obtain NPC stem cells to be treated with cisplatin different doses and durations (24 and 48 h). The number of dead cells after exposure will be calculated using a hemocytometer. Death stem cell density of NPC at exposure of 2 μg/ml cisplatin dose was 81.37%, while the smallest death cell density a dose of 0.05 μg/ml after a 72-h observation was 21.3%. The coefficient correlation 0.827 and value p = 0.000 (p < 0.05). The analysis of the correlation between cisplatin exposure duration and death cell was also significant with the correlation coefficient - 0.357 and the value p = 0.001 (p < 0.05). There was a correlation between the increased dose of cisplatin with the cytotoxicity effects on NPC stem cell.
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Affiliation(s)
- Laksmi Kusuma Wardhani
- Department of Otorhinolaryngology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Widodo Ario Kentjono
- Department of Otorhinolaryngology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Achmad Chusnu Romdhoni
- Department of Otorhinolaryngology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia
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12
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Zhang Q, Wang Y, Liao JF, Ren YF, Shen GP, Niu SQ, Luo W. Long-Term Survival and Prognostic Factors in Locoregionally Advanced Nasopharyngeal Carcinoma Patients Treated with TPF Induction Chemotherapy followed by Cisplatin-Combined Concurrent Chemoradiotherapy. J Cancer 2019; 10:3899-3907. [PMID: 31417633 PMCID: PMC6692629 DOI: 10.7150/jca.31663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/13/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose: The objective of this study was to report long-term results of docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and identify prognostic factors for this group of patients. Materials and Methods: From December 2010 to January 2015, 109 patients with locoregionally advanced (III-IVB) NPC were included. Patients were scheduled to complete TPF induction chemotherapy followed by cisplatin based CCRT. Failure-free survival (FFS), overall survival (OS), locoregional failure-free survival (LRFFS) and distant failure-free survival (DFFS) served as clinical outcomes. Kaplan-Meier method, Cox proportional hazards model and receiver operating characteristic (ROC) curves were used for analyzing. Results: With a median follow-up of 60.2 months (range, 7.9-91.6 months), 3-year FFS, OS, LRFFS, and DFFS were 76.8%, 85.1%, 88.3%, and 84.1%, respectively. The highest incidence rate of recurrence and metastasis were in the first year after treatment. Multivariate analyses showed that age, total time of radiation therapy (RTT), and total time of therapy (TTT) were independent prognostic factors for FFS and OS. Body mass index (BMI), RTT and TTT were significant variables predicting DFFS. TTT was the only independent prognostic factor for LRFFS. Conclusion: This study indicated that TPF regimen produced encouraging results in Asian patients with locoregionally advanced nasopharyngeal carcinoma. Toxicity was tolerable and reversible. However, overall treatment time is an important factor that we should take into consideration when make plans of induction chemotherapy related treatment.
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Affiliation(s)
- Qun Zhang
- Department of Radiotherapy, First affiliated hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yan Wang
- Department of Radiotherapy, First affiliated hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jun-Fang Liao
- Cancer Hospital Chinese Academy of Medical Science, Shenzhen Center, Shenzhen, People's Republic of China
| | - Yu-Feng Ren
- Department of Radiotherapy, First affiliated hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Guo-Ping Shen
- Department of Radiotherapy, First affiliated hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shao-Qing Niu
- Department of Radiotherapy, First affiliated hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wei Luo
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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13
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Petit C, Blanchard P, Pignon JP, Lueza B. Individual patient data network meta-analysis using either restricted mean survival time difference or hazard ratios: is there a difference? A case study on locoregionally advanced nasopharyngeal carcinomas. Syst Rev 2019; 8:96. [PMID: 30987679 PMCID: PMC6463649 DOI: 10.1186/s13643-019-0984-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed at applying the restricted mean survival time difference (rmstD) as an absolute outcome measure in a network meta-analysis and comparing the results with those obtained using hazard ratios (HR) from the individual patient data (IPD) network meta-analysis (NMA) on the role of chemotherapy for nasopharyngeal carcinoma (NPC) recently published by the MAC-NPC collaborative group (Meta-Analysis of Chemotherapy [CT] in NPC). PATIENTS AND METHODS Twenty trials (5144 patients) comparing radiotherapy (RT) with or without CT in non-metastatic NPC were included. Treatments were grouped in seven categories: RT alone (RT), induction CT followed by RT (IC-RT), RT followed by adjuvant CT (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival and locoregional control. The rmstD was estimated at t* = 10 years in each trial. Random-effect frequentist NMA models were applied. P score was used to rank treatments. Heterogeneity and inconsistency were evaluated. RESULTS The three treatments that had the highest effect on OS with rmstD were CRT-AC, IC-CRT, and CRT (respective P scores of 92%, 72%, and 64%) compared to CRT-AC, CRT, and IC-CRT when using HR (respective P scores of 96%, 71%, and 63%). Of the 32 HR and rmstD analyzed, 5 had a different interpretation, 3 with a direction change (different direction of treatment effect) and 2 with a change in significance (same direction but a change in statistical significance). Results for secondary endpoints were overall in agreement. CONCLUSION The use of either HR or rmstD impacts the results of NMA. Given the sensitivity of HR to non-proportional hazards, this finding could have implications in terms of meta-analysis methodology.
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Affiliation(s)
- C Petit
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France. .,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France. .,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
| | - P Blanchard
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France.,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - J P Pignon
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
| | - B Lueza
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
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14
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Jin T, Qin WF, Jiang F, Jin QF, Wei QC, Jia YS, Sun XN, Li WF, Chen XZ. Cisplatin and Fluorouracil Induction Chemotherapy With or Without Docetaxel in Locoregionally Advanced Nasopharyngeal Carcinoma. Transl Oncol 2019; 12:633-639. [PMID: 30797141 PMCID: PMC6383173 DOI: 10.1016/j.tranon.2019.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022] Open
Abstract
In this study, we aim to compare the progression-free survival (PFS) rates and side effects of induction chemotherapy based on docetaxel, cisplatin and fluorouracil (TPF) versus cisplatin and fluorouracil (PF) in patients with locoregionally-advanced nasopharyngeal carcinoma who received subsequent chemoradiotherapy. We randomly assigned 278 patients with stage III or IV NPC (without distant metastases) to receive either TPF or PF induction chemotherapy, followed by cisplatin-based chemoradiotherapy every 3 weeks and intensity-modulated radiation therapy for 5 days per week. After a minimum of 2 years follow-up, a PFS benefit was observed for TPF compared to PF, though this difference was not statistically significant (84.5% vs. 77.9%, P = .380). Due to increased frequencies of grade 3 or 4 neutropenia and diarrhea, significantly more patients in the TPF group required treatment delays and dose modifications. Our findings suggest that PF induction chemotherapy has substantially better tolerance and compliance rates than TPF induction chemotherapy. However, the treatment efficacy of PF is not superior to TPF induction chemotherapy in patients with locoregionally-advanced NPC (ClinicalTrials.gov number, NCT01536223).
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Affiliation(s)
- Ting Jin
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China; Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei-Feng Qin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Feng Jiang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Qi-Feng Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Qi-Chun Wei
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, People's Republic of China
| | - Yong-Shi Jia
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, People's Republic of China
| | - Xiao-Nan Sun
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, People's Republic of China
| | - Wen-Feng Li
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Xiao-Zhong Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China.
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15
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OuYang PY, Zhang XM, Qiu XS, Liu ZQ, Lu L, Gao YH, Xie FY. A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma. Oncologist 2019; 24:505-512. [PMID: 30782977 DOI: 10.1634/theoncologist.2018-0522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Locoregionally advanced nasopharyngeal carcinoma has high risk of distant metastasis and mortality. Induction chemotherapy is commonly administrated in clinical practice, but the efficacy was quite controversial in and out of randomized controlled trials. We thus conducted this pairwise meta-analysis. MATERIALS AND METHODS Trials that randomized patients to receive radiotherapy or concurrent chemoradiotherapy with or without induction chemotherapy were identified via searches of PubMed, MEDLINE, and ClinicalTrials.gov. RESULTS A total of ten trials (2,627 patients) were included. The pooled hazard ratios (HRs) based on fixed effect model were 0.68 (95% confidence interval [CI] 0.56-0.80, p < .001) for overall survival (OS) and 0.70 (95% CI 0.61-0.79, p < .001) for progression-free survival (PFS), which strongly favored the addition of induction chemotherapy. The absolute 5-year survival benefits were 8.47% in OS and 10.27% in PFS, respectively. In addition, based on the available data of eight trials, induction chemotherapy showed significant efficacy in reducing locoregional failure rate (risk ratio [RR] = 0.81, 95% CI 0.68-0.96, p = .017) and distant metastasis rate (RR = 0.69, 95% CI 0.58-0.82, p < .001). CONCLUSION This pairwise meta-analysis confirms the benefit in OS, PFS, and locoregional and distant controls associated with the addition of induction chemotherapy in nasopharyngeal carcinoma. IMPLICATIONS FOR PRACTICE According to the results of this meta-analysis of ten trials, induction chemotherapy can prolong overall survival and progression-free survival and improve locoregional and distant controls for nasopharyngeal carcinoma.
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Affiliation(s)
- Pu-Yun OuYang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Xiao-Min Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Xing-Sheng Qiu
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhi-Qiao Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Lixia Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Yuan-Hong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
| | - Fang-Yun Xie
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China
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Liu Y, Kou C, Bai W, Liu X, Song Y, Zhang L, Wang M, Zhang Y, You Y, Yin Y, Jiang X, Xin Y. Altered fractionation radiotherapy with or without chemotherapy in the treatment of head and neck cancer: a network meta-analysis. Onco Targets Ther 2018; 11:5465-5483. [PMID: 30233208 PMCID: PMC6129020 DOI: 10.2147/ott.s172018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives A Bayesian network meta-analysis (NMA) was conducted in patients with head and neck cancers (HNCs) to estimate the efficacy and safety of treatment with conventional fractionation radiotherapy (CF), conventional fractionation chemoradiotherapy (CF_CRT), hyperfractionated radiotherapy (HF), hyperfractionated chemoradiotherapy (HF_CRT), accelerated fractionation radiotherapy, accelerated fractionation chemoradiotherapy, accelerated hyperfractionated radiotherapy (HART) or accelerated hyperfractionated chemoradiotherapy (HACRT) to identify superior treatments to aid in clinical decisions. Methods PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for potentially eligible randomized controlled trials up to December 2016. Overall survival (OS), disease-free survival (DFS) and locoregional control (LRC) were considered efficacy outcomes, whereas acute toxicity and late toxicity on skin and mucosa were considered safety outcomes. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment in each index. Results Data from 72 trials with 21,868 participants were included in the analysis. Concerning OS, all treatments were associated with a significant advantage compared to CF alone, with HR effect sizes ranging from 0.64 to 0.83, and HACRT was significantly more effective than all the other treatments. The network comparisons of both HACRT vs HART and HF_CRT vs HF demonstrated a higher OS benefit, with an HR of 0.78 (95% credible interval [CrI]: 0.64–0.95) and 0.78 (95% CrI: 0.61–0.99), respectively. The results of SUCRA indicated that HACRT had the best ranking for OS and LRC, HF_CRT for DFS, HART for acute and late skin toxicity, CF_CRT for acute mucosal toxicity and HF_CRT for late mucosal toxicity. Conclusion The NMA results support the notion that HACRT is the preferable treatment modality for HNCs because it has better rankings in all three efficacy indexes, although it does present a high risk of acute mucosal toxicity.
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Affiliation(s)
- Yingyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yan Song
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lili Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Mohan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yangyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yueyue You
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue Yin
- Department of Radiation Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, Jilin, China,
| | - Ying Xin
- Department of Pathology, School of Basic Medicine, Jilin University, Changchun, Jilin, China,
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Li PJ, Mo HY, Luo DH, Hu WH, Jin T. The efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma in intensity modulated radiotherapy era. Oral Oncol 2018; 85:95-100. [PMID: 30220326 DOI: 10.1016/j.oraloncology.2018.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma (NPC) in era of intensity modulated radiotherapy (IMRT). METHODS AND MATERIALS A total of 173 patients with American Joint Committee on Cancer (AJCC) 7th stage II NPC from two institutions were included. All patients were divided into two groups: induction chemotherapy + concurrent chemoradiotherapy group (ICRT) group and concurrent chemoradiotherapy group (CCRT). Induction chemotherapy was consisted of one to three cycles of cisplatin plus fluorouracil (PF) or paclitaxel plus cisplatin (TP). Concurrent chemotherapy included one to three cycles of cisplatin. We retrospectively assessed overall survival (OS), progression-free survival (PFS), locoregional failure free survival (LRFFS) and distant metastasis free survival (DMFS) in patients of both groups. T-test, Chi-square test, Kaplan-Meier methodology and Cox proportional hazards model were used to analyze. RESULTS With a median follow up of 64.7 months, no significant difference was found in grade 3-4 hematologic toxicity, liver dysfunction and renal impairment between ICRT and CCRT group. Univariable analyses shown adding induction chemotherapy to CCRT significantly decreased 5-year OS (87.9% vs 95.5%, P = 0.033), 5-year PFS (74.0% vs 86.1%, P = 0.035), 5-year LRFFS (80.0% vs 91.2%, P = 0.016), but there was no statistically significant difference in 5-year DMFS (87.1% vs 94.7%, P = 0.095). In multivariable analyses, we found the consistent results that induction chemotherapy was a negative factor associated with OS (HR of death = 3.768, 95% CI = 1.117-12.709; P = 0.032), PFS (HR of progression = 2.156, 95% CI = 1.060-4.386; P = 0.034), LRFFS (HR of locoregional relapse = 2.435, 95% CI = 1.009-5.874; P = 0.048) and also DMFS (HR of metastasis = 2.873, 95% CI = 1.005-8.211; P = 0.049), in stage II NPC patients. CONCLUSION In present study, we found that induction chemotherapy caused deleterious effect on stage II NPC patients. However, this is a retrospective study and the adverse effects of induction chemotherapy has not been previously reported. It warrants further investigation.
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Affiliation(s)
- Pei-Jing Li
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, People's Republic of China
| | - Hao-Yuan Mo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Dong-Hua Luo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wei-Han Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, People's Republic of China.
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OuYang PY, You KY, Zhang LN, Xiao Y, Zhang XM, Xie FY. External validity of a prognostic nomogram for locoregionally advanced nasopharyngeal carcinoma based on the 8th edition of the AJCC/UICC staging system: a retrospective cohort study. Cancer Commun (Lond) 2018; 38:55. [PMID: 30176932 PMCID: PMC6122160 DOI: 10.1186/s40880-018-0324-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/24/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The tumor-node-metastasis (TNM) staging system does not perform well for guiding individualized induction or adjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We attempted to externally validate the Pan's nomogram, developed based on the 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system, for patients with locoregionally advanced disease. In addition, we investigated the reliability of Pan's nomogram for selection of participants in future clinical trials. METHODS This study included 535 patients with locoregionally advanced NPC who were treated between March 2007 and January 2012. The 5-year overall survival (OS) rates were calculated using the Kaplan-Meier method and compared with predicted outcomes. The calibration was tested using calibration plots and the Hosmer-Lemeshow test. Discrimination ability, which was assessed using the concordance index, as compared with other predictors. RESULTS Pan's nomogram was observed to underestimate the 5-year OS of the entire cohort by 8.65% [95% confidence interval (CI) - 9.70 to - 7.60%, P < 0.001] and underestimated the 5-year OS of each risk group. The differences between the predicted and observed 5-year OS rates were smallest among low-risk patients (< 135 points calculated using Pan's nomogram; which predicted minus observed OS, - 6.41%, 95% CI - 6.75 to - 6.07%, P < 0.001) and were largest among high-risk patients (≥ 160 points) (- 13.56%, 95% CI - 15.48 to - 11.63%, P < 0.001). The Hosmer-Lemeshow test suggested that the predicted and observed 5-year OS rates had no ideal relationship (P < 0.001). Pan's nomogram had better discriminatory ability compared with the levels of Epstein-Barr virus DNA acid (EBV DNA) and the 7th or 8th AJCC/UICC staging system, although not better compared with the combination of EBV DNA and the 8th staging system. Additionally, Pan's nomogram was marginally inferior to our predictive model, which included the 8th AJCC/UICC N-classification, age, gross primary tumor volume, lactate dehydrogenase, and body mass index. CONCLUSIONS Pan's nomogram underestimated the 5-year OS of patients with locoregionally advanced NPC at our cancer center, and may not be a precise tool for selecting participants for clinical trials.
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Affiliation(s)
- Pu-Yun OuYang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng East Road, Guangzhou, 510060 Guangdong P.R. China
| | - Kai-Yun You
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510060 Guangdong P.R. China
| | - Lu-Ning Zhang
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080 Guangdong P.R. China
| | - Yao Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng East Road, Guangzhou, 510060 Guangdong P.R. China
| | - Xiao-Min Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng East Road, Guangzhou, 510060 Guangdong P.R. China
| | - Fang-Yun Xie
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng East Road, Guangzhou, 510060 Guangdong P.R. China
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Díaz-Martínez JA, Esquenazi Y, Martir M, Citardi MJ, Karni RJ, Blanco AI. Planned Gamma Knife Boost After Chemoradiotherapy for Selected Sinonasal and Nasopharyngeal Cancers. World Neurosurg 2018; 119:e467-e474. [PMID: 30071329 DOI: 10.1016/j.wneu.2018.07.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the feasibility of a Gamma Knife boost after intensity-modulated radiation therapy in combination with multimodal therapy in patients with nasopharyngeal carcinoma and sinonasal malignancies with skull base or cavernous sinus involvement. METHODS Nine patients were treated with intensity-modulated radiation therapy followed by a Gamma Knife boost. In one case Gamma Knife was given as salvage treatment after resection. Five patients had sinonasal malignancies and 4 had nasopharyngeal carcinoma. The mean radiation therapy dose was 64.3 Gy (range, 54-70 Gy) at 2 Gy per fraction. The median interval from completion of radiation therapy to Gamma Knife boost was 2.2 months (range, 1-4 months). The most common indication for Gamma Knife boost was involvement of the cavernous sinus, which was identified in 7 patients. The median margin Gamma Knife dose delivered was 13 Gy (range, 12-20 Gy), with median prescription isodose of 50%. RESULTS All patients tolerated the procedure well, with minimal toxicity. Local control rates were achieved in all patients and no acute grade 3-5 toxicity was observed. One patient experienced late grade 4 toxicity, which was potentially attributable to treatment. Distant failure occurred in 3 patients (1 patient with nasopharyngeal carcinoma and 2 patients with sinonasal malignancies). CONCLUSIONS Planned Gamma Knife boost followed intensity-modulated radiation therapy is feasible, safe, and provides excellent local control in patients with sinonasal malignancies and nasopharyngeal carcinoma, particularly in cases with cavernous sinus involvement. Further follow-up will be necessary to determine the long-term effectiveness and complication profile.
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Affiliation(s)
- José Armando Díaz-Martínez
- Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Unit of Functional Neurosurgery, Stereotaxy and Radiosurgery, Mexico General Hospital, Mexico City, Mexico
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Houston, Texas, USA.
| | - Magda Martir
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Ron J Karni
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Angel I Blanco
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital, Houston, Texas, USA
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Yuan C, Xu XH, Luo SW, Wang L, Sun M, Ni LH, Xu L, Wang XL, Zeng G. Which neoadjuvant chemotherapy regimen should be recommended for patients with advanced nasopharyngeal carcinoma?: A network meta-analysis. Medicine (Baltimore) 2018; 97:e11978. [PMID: 30142830 PMCID: PMC6112937 DOI: 10.1097/md.0000000000011978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The clinical application has widespread disagreement on the different regimens of neoadjuvant chemotherapy (NCT) in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). We conducted a network meta-analysis (NMA) to evaluate the efficacy of the different NCT regimens in the treatment of NPC. METHODS A systematic literature search was performed using PubMed, Embase, and Cochran Library. Totally, 31 randomized controlled trials (RCTs) (n = 4062) met study selection criteria and were incorporated in this NMA study. RESULTS Our study showed that certain NCT regimens improved the prognosis of patients, and found out the relative best solution for each endpoint, such as paclitaxel, carboplatin, and gemcitabine for 1-year overall survival (OS) rate, cisplatin, calcium folinate, and 5-fluorouracil for 2-year OS rate, vinorelbine and cisplatin (NP) for 3-year OS rate, cyclophosphamide, cisplatin, and 5-fluorouracil for 5-year OS rate, NP for complete remission rate, cisplatin and gemcitabine for overall remission rate of the primary tumor. In addition, for certain grade 3 and above toxicity, the results of the NMA reflected certain NCT regimens can reduce toxicity of chemoradiotherapy (CRT) to a minimum, such as NP for anemia, mucositis, and thrombocytopenia, paclitaxel, epirubicin, and cisplatin for neutropenia and skin toxicity. CONCLUSION Our NMA showed that certain cisplatin-based NCT regimens improved the prognosis of patients with NPC and reduced the toxicity of CRT. However, in view of survival rate and response rate, the best NCT regimen is not entirely consistent. Therefore, which NCT regimen will benefit most patients will need further explored.
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Affiliation(s)
- Cheng Yuan
- Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University
| | - Xin-Hua Xu
- Department of Oncology, Yichang Central People's Hospital, Yichang, China
| | | | - Le Wang
- The Institute of Pathology, The First College of Clinical Medical Science, China Three Gorges University, Yichang
| | - Min Sun
- Taihe Hospital, Hubei University of Medicine, Shiyan
| | - Li-Hua Ni
- Zhongda Hospital, Southeast University, Nanjing, China
| | - Lu Xu
- Department of Oncology, Yichang Central People's Hospital, Yichang, China
| | | | - Guang Zeng
- Biomedical Engineering, Stony Brook University, Stony Brook, NY
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He J, Wu P, Tang Y, Liu S, Xie C, Luo S, Zeng J, Xu J, Zhao S. Chemoradiotherapy enhanced the efficacy of radiotherapy in nasopharyngeal carcinoma patients: a network meta-analysis. Oncotarget 2018; 8:39782-39794. [PMID: 28418901 PMCID: PMC5503653 DOI: 10.18632/oncotarget.16349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 12/03/2022] Open
Abstract
Object A Bayesian network meta-analysis (NMA) was conducted to estimate the overall survival (OS) and complete response (CR) performance in nasopharyngeal carcinoma (NPC) patients who have been given the treatment of radiotherapy, concurrent chemoradiotherapy (C), adjuvant chemotherapy (A), neoadjuvant chemotherapy (N), concurrent chemoradiotherapy with adjuvant chemotherapy (C+A), concurrent chemoradiotherapy with neoadjuvant chemotherapy (C+N) and neoadjuvant chemotherapy with adjuvant chemotherapy (N+A). Methods Literature search was conducted in electronic databases. Hazard ratios (HRs) accompanied their 95% confidence intervals (95%CIs) or 95% credible intervals (95%CrIs) were applied to measure the relative survival benefit between two comparators. Meanwhile odd ratios (ORs) with their 95% CIs or CrIs were given to present CR data from individual studies. RESULTS Totally 52 qualified studies with 10,081 patients were included in this NMA. In conventional meta-analysis (MA), patients with N+C exhibited an average increase of 9% in the 3-year OS in relation to those with C+A. As for the NMA results, five therapies were associated with a significantly reduced HR when compared with the control group when concerning 5-year OS. C, C+A and N+A also presented a decreased HR compared with A. There was continuity among 1-year, 3-year and 5-year OS status. Cluster analysis suggested that the three chemoradiotherapy appeared to be divided into the most compete group which is located in the upper right corner of the cluster plot. Conclusion In view of survival rate and complete response, the NMA results revealed that C, C+A and C+N showed excellent efficacy. As a result, these 3 therapies were supposed to be considered as the first-line treatment according to this NMA.
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Affiliation(s)
- Jian He
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ping Wu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yaoyun Tang
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sulai Liu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chubo Xie
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shi Luo
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Junfeng Zeng
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Xu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Suping Zhao
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Palazzi M, Guzzo M, Bossi P, Tomatis S, Cerrotta A, Cantú G, Locati LD, Licitra L. Regionally Advanced Nasopharyngeal Carcinoma: Long-Term Outcome after Sequential Chemotherapy and Radiotherapy. TUMORI JOURNAL 2018; 90:60-5. [PMID: 15143974 DOI: 10.1177/030089160409000114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64–70 Gy) and the neck (50–70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, M0; ECOG performance status 0–1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8%, III in 36% and IV in 56% of the patients; histology was WHO type 1–2 in 11% and WHO type 3 in 89% of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results Clinical failure has been observed in 30 patients (49%): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20%), regional alone in 10 (33%), local and regional in 1 (3%), regional and distant in 1 (3%), and distant alone in 12 patients (40%). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83%, 74% and 73%, respectively; overall and disease-free survival were 64% and 51%. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100%, 88%, 76% and 86%). Conclusions In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51% of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10%, raising 5-year survival to over 60%. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.
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Affiliation(s)
- Mauro Palazzi
- Department of Radiotherapy, National Cancer Institute, Milan, Italy.
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Mnejja W, Toumi N, Fourati N, Bouzguenda R, Ghorbel A, Frikha M, Siala W, Daoud J. [Neoadjuvant chemotherapy with concurrent chemoradiotherapy in the treatment of nasopharyngeal cancer: Southern Tunisian experience]. Bull Cancer 2018; 105:450-457. [PMID: 29650393 DOI: 10.1016/j.bulcan.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/09/2022]
Abstract
PURPOSE A retrospective study to evaluate the efficacy and safety of the addition of neoadjuvant chemotherapy to concurrent chemoradiotherapy in the treatment of nasopharyngeal carcinoma. PATIENTS AND METHODS Data from 62 patients treated for non-metastatic nasopharyngeal carcinoma were analyzed by comparing two groups of patients: a first group of 32 patients treated with 3 cycles of neoadjuvant chemotherapy based on docetaxel, cisplatin and 5-fluoro-uracil every 21 days followed by concurrent chemoradiotherapy (weekly cisplatin 40mg/m2 with radiotherapy 70Gy, 2Gy per session, 5 sessions per week) and a second group of 30 patients treated with the same concurrent chemoradiotherapy. RESULTS After a median follow-up of 53.5 months, neoadjuvant chemotherapy showed a significant reduction in the rate of a distant metastatic relapses (3.3% vs. 10%, P=0.03). No significant difference in disease-free survival at 5 years (65.6% vs. 68.8%, P=0.46) or overall survival at 5 years (68.8% vs. 73.3%, P=0.46) was noted between the two groups. Induction chemotherapy was associated with febrile neutropenia of 15.6%. During concurrent chemoradiotherapy, hematological complications were greater in the first chemotherapy group (53% vs. 33%). CONCLUSION Induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil is a safe and effective option in the treatment of nasopharyngeal carcinoma. A better definition of high risk of relapse group would optimize the indications of this chemotherapy in the therapeutic arsenal.
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Affiliation(s)
- Wafa Mnejja
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Nabil Toumi
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Nejla Fourati
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie.
| | - Racem Bouzguenda
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Abdelmonem Ghorbel
- CHU Habib Bourguiba, service ORL, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Mounir Frikha
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Wicem Siala
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Jamel Daoud
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
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SAIJOH S, MATSUZUKA T, SATO H, SUZUKI M, IKEDA M, SUZUKI R, NAKAEGAWA Y, OMORI K. Long-term outcomes of alternating chemoradiotherapy in patients with advanced nasopharyngeal cancer: a single-centre experience over the last decade. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:103-108. [PMID: 29967557 PMCID: PMC6028817 DOI: 10.14639/0392-100x-1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/01/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY We assessed the long-term outcomes of alternating chemoradiotherapy (ACRT) using 5-fluorouracil and cisplatin (FP) in 25 patients with stage II or advanced nasopharyngeal cancer treated at our institution between April 1999 and April 2010. Median follow-up duration was 87 months (range 2-189). According to the 2009 TNM classification (UICC), six patients were in stage II, nine in stage III, and 10 in stage IV. Treatment completion, response and five-year survival rates were retrospectively assessed. ACRT was performed with a first course of chemotherapy administered followed by the initial round of radiotherapy (36 Gy). Then, a second course of chemotherapy with additional radiotherapy (20-30 Gy) was administered, followed by a final third course of chemotherapy. For chemotherapy, 5-fluorouracil (5-FU, 800 mg/m2/24 h) was intravenously administered for five days, and cisplatin (CDDP, 50 mg/m2/24 h) was administered on the last two days. Treatment completion rate was 96% (24 of 25 cases), and the response rate was 100% (CR: 24 cases and PR: 1 case). Additionally, the five-year overall survival rate was 89.3%. We have demonstrated that ACRT is an effective regimen to treat nasopharyngeal cancer, revealing higher treatment completion, response, and five-year overall survival rates compared with other combinatorial radiotherapy and chemotherapy treatment regimens.
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Affiliation(s)
- S. SAIJOH
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - T. MATSUZUKA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - H. SATO
- Department of Radiation Oncology, Fukushima Medical University, Fukushima, Japan
| | - M. SUZUKI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - M. IKEDA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - R. SUZUKI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Y. NAKAEGAWA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - K. OMORI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
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25
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Jin T, Zhang Q, Jiang F, Qin WF, Jin QF, Cao CN, Piao YF, Feng XL, Luo W, Chen XZ. Neoadjuvant chemotherapy with different dose regimens of docetaxel, cisplatin and fluorouracil (TPF) for locoregionally advanced nasopharyngeal carcinoma: a retrospective study. Oncotarget 2017; 8:100764-100772. [PMID: 29246020 PMCID: PMC5725062 DOI: 10.18632/oncotarget.21992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Compare high- vs. low-dose TPF neoadjuvant chemotherapy with chemoradiotherapy in Chinese patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and Methods Retrospective analysis of 210 stage III/IV NPC patients treated between April 1, 2012 and April 1, 2014; 138 received three cycles of high-dose TPF (H-TPF) every 3 weeks at Zhejiang Cancer Hospital and 72, three cycles of low-dose TPF (L-TPF) every 3 weeks at Sun Yat-Sen University Cancer Center. H-TPF was docetaxel (75 mg/m2; 1 h infusion), cisplatin (75 mg/m2; 0.5-3 h), then 5-fluorouracil (600 mg/m2/day; 4 days). L-TPF was docetaxel (60 mg/m2), cisplatin (65 mg/m2), then 5-fluorouracil (550 mg/m2/day; 5 days). All patients received chemoradiotherapy. Results During neoadjuvant chemotherapy, treatment delays were more frequent for H-TPF than L-TPF (33.3% vs. 19.4%; P = 0.034). During chemoradiotherapy, grade III-IV anemia, thrombocytopenia and neutropenia were more common for H-TPF than L-TPF (P < 0.001, P < 0.001, P = 0.048). Fewer patients in the H-TPF group finished two cycles of concurrent chemotherapy (81.2% vs. 100%, P < 0.001). Three-year PFS (84.5% vs. 80.6%, P = 0.484) and OS (91.1% vs. 93.5%, P = 0.542) were not significantly different between H-TPF and L-TPF. Conclusions L-TPF neoadjuvant chemotherapy has substantially better tolerance and compliance rates and similar treatment efficacy to H-TPF neoadjuvant chemotherapy in locoregionally-advanced NPC.
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Affiliation(s)
- Ting Jin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qun Zhang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Feng Jiang
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei-Feng Qin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qi-Feng Jin
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Cai-Neng Cao
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yong-Feng Piao
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xing-Lai Feng
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei Luo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
| | - Xiao-Zhong Chen
- Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
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26
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You R, Cao YS, Huang PY, Chen L, Yang Q, Liu YP, Zou X, Zhang YN, Jiang R, Zhang MX, Duan CY, Lin AH, Hong MH, Chen MY. The Changing Therapeutic Role of Chemo-radiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma from Two/Three-Dimensional Radiotherapy to Intensity-Modulated Radiotherapy: A Network Meta-Analysis. Theranostics 2017; 7:4825-4835. [PMID: 29187906 PMCID: PMC5706102 DOI: 10.7150/thno.21815] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/19/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose: We used randomized trials of radiotherapy (RT) with or without chemotherapy in non-metastatic nasopharyngeal carcinoma to investigate the survival benefit of chemoradiotherapy regimens between two/three-dimensional radiotherapy (2D/3D RT) and intensity-modulated radiotherapy (IMRT). Methods: Overall, 27 trials and 7,940 patients were included. Treatments were grouped into seven categories including RT alone, induction chemotherapy (IC) followed by RT (IC-RT), RT followed by adjuvant chemotherapy (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concurrent chemo-radiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). To distinguish between 2D/3D RT and IMRT, three categories in IMRT were newly added, including CRT in IMRT, IC-CRT in IMRT, and CRT-AC in IMRT. The P score was used to rank the treatments. Results: Both fixed- and random-effects frequentist and Bayesian network meta-analysis models were applied, which provided similar results and the same ranking. IC-CRT was the most effective regimen compared with CRT-AC and CRT in the IMRT era for overall survival (OS) (HR, 95% CI, IC-CRT vs. CRT-AC, 0.61 (0.45, 0.82); IC-CRT vs. CRT 0.65 (0.47, 0.91)), progression-free survival (PFS) (0.69 (0.54, 0.88); 0.63 (0.49, 0.80)), and distant metastasis-free survival (DMFS) (0.58 (0.28, 1.21); 0.60 (0.42, 0.85)). CRT-AC achieved the highest survival benefit compared with CRT, and IC-CRT for loco-regional relapse-free survival (LRRFS) (0.44 (0.15, 1.28); 0.72 (0.22, 2.33)). Among these 10 categories, after distinguishing between 2D/3D RT and IMRT, IC-CRT in IMRT ranked first for OS, PFS, and DMFS, and CRT-AC in IMRT ranked first for LRRFS. Conclusion: IC-CRT should be the most suitable regimen for loco-regionally advanced NPC in the IMRT era.
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Ou X, Xu T, He X, Ying H, Hu C. Who benefited most from higher cumulative dose of cisplatin among patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiation therapy? A retrospective study of 527 cases. J Cancer 2017; 8:2836-2845. [PMID: 28928873 PMCID: PMC5604216 DOI: 10.7150/jca.19725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose: Our previous study demonstrated the benefit of cumulative dose of cisplatin during the whole treatment on locally advanced nasopharyngeal carcinoma (NPC) treated with various chemotherapy strategies. The purpose of this study is to identify the subgroup of locally advanced NPC who benefits from higher dose of cisplatin, and to clarify whether cumulative dose of cisplatin during the whole treatment brings survival benefit to those treated with concurrent chemoradiotherapy (CCRT). Materials and methods: This retrospective study enrolled 527 patients with locally advanced NPC treated with intensity-modulated radiation therapy (IMRT) and chemotherapy in our institution from 2009 to 2010. The median cumulative dose of cisplatin of 300mg/m2 was chose to be the cutoff value of low and high dose subgroups. Survival curves were estimated using the Kaplan-Meier method. Univariate analysis was conducted using the log-rank test. Multivariate analyses (MVA) were performed using Cox proportional hazards regression model. Results: With a median follow-up of 54.5 (1-76.7) months, high-dose subgroup had a significant higher distant metastasis-free survival (DMFS) (82.0% vs. 76.5%, p=0.029) and overall survival (OS) (84.1% vs. 74.0%, p=0.028). Cumulative dose of cisplatin were demonstrated an independent prognostic factors for DMFS (HR=0.524, 95% CI 0.340-0.806) and OS (HR=0.577, 95% CI 0.373-0.893) for the entire cohort upon MVA. As for T1-2N2-3, high-dose subgroup had a trend of better DMFS (85.7% vs. 76.3%, p=0.069) and a significant improvement in OS (87.8% vs. 76.3%, p=0.041). Similarly, in the subgroup of T3-4N2-3, higher dose of cisplatin was associated with higher OS (80.3% vs. 52.3%, p=0.032). Cumulative dose of cisplatin was an independent prognostic factor for DMFS (HR=0.483, 95%CI 0.292-0.798) and OS (HR=0.429, 95%CI 0.258-0.715) for patients with T1-4N2-3 disease upon MVA. However, the benefit of higher dose of cisplatin was not observed in the subgroup of T3-4N0-1. For patients receiving CCRT (n=278), those treated with higher dose of cisplatin had a significantly higher DMFS (87.7% vs. 75.4%, p=0.004). The benefit mainly derived from T3-4N2-3 patients treated with CCRT (5y DMFS: 87.9% vs. 58.2%, p=0.034). Cumulative dose of cisplatin was associated with a lower risk of distant metastasis (HR=0.427, 95% CI 0.228-0.801) for patients treated with CCRT upon MVA. Conclusions: Our study identified that patients with N2-3 disease were those benefited from higher cumulative dose. The benefit of higher cumulative dose maintained in those treated with CCRT. The intensity of chemotherapy may be tailored based on various stage subgroups in locally advanced NPC.
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Affiliation(s)
- Xiaomin Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. Department of Oncology, Shanghai Medical College, Shanghai, China
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28
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Rotolo F, Pignon JP, Bourhis J, Marguet S, Leclercq J, Tong Ng W, Ma J, Chan ATC, Huang PY, Zhu G, Chua DTT, Chen Y, Mai HQ, Kwong DLW, Soong YL, Moon J, Tung Y, Chi KH, Fountzilas G, Zhang L, Hui EP, Lee AWM, Blanchard P, Michiels S. Surrogate End Points for Overall Survival in Loco-Regionally Advanced Nasopharyngeal Carcinoma: An Individual Patient Data Meta-analysis. J Natl Cancer Inst 2017; 109:djw239. [PMID: 27927756 PMCID: PMC6059121 DOI: 10.1093/jnci/djw239] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/11/2016] [Accepted: 09/22/2016] [Indexed: 11/14/2022] Open
Abstract
Background Our objective was to evaluate progression-free survival (PFS) and distant metastasis-free survival (DMFS) as surrogate end points for overall survival (OS) in randomized trials of chemotherapy in loco-regionally advanced nasopharyngeal carcinomas (NPCs). Methods Individual patient data were obtained from 19 trials of the updated Meta-Analysis of Chemotherapy in Nasopharyngeal Carcinoma (MAC-NPC) plus one additional trial (total = 5144 patients). Surrogacy was evaluated at the individual level using a rank correlation coefficient ρ and at the trial level using a correlation coefficient R2 between treatment effects on the surrogate end point and OS. A sensitivity analysis was performed with two-year PFS/DMFS and five-year OS. Results PFS was strongly correlated with OS at the individual level (ρ = 0.93, 95% confidence interval [CI] = 0.93 to 0.94) and at the trial level (R2 = 0.95, 95% CI = 0.47 to 1.00). For DMFS, too, the individual-level correlation with OS was strong (ρ = 0.98, 95% CI = 0.98 to 0.98); at trial level, the correlation was high but the regression adjusted for measurement error could not be computed (unadjusted R2 = 0.96, 95% CI = 0.94 to 0.99). In the sensitivity analysis, two-year PFS was highly correlated with five-year OS at the individual level (ρ = 0.89, 95% CI = 0.88 to 0.90) and at the trial level (R2 = 0.85, 95% CI = 0.46 to 1.00); two-year DMFS was highly correlated with five-year OS at the individual level (ρ = 0.95, 95% CI = 0.94 to 0.95) and at the trial level (R2 = 0.78, 95% CI = 0.33 to 1.00). Conclusions PFS and DMFS are valid surrogate end points for OS to assess treatment effect of chemotherapy in loco-regionally advanced NPC, while PFS can be measured earlier.
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Affiliation(s)
- Federico Rotolo
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Jean-Pierre Pignon
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Jean Bourhis
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Sophie Marguet
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Julie Leclercq
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Wai Tong Ng
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Jun Ma
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Anthony T. C. Chan
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Pei-Yu Huang
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Guopei Zhu
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Daniel T. T. Chua
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Yong Chen
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Hai-Qiang Mai
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Dora L. W. Kwong
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Yoke Lim Soong
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - James Moon
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Yuk Tung
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Kwan-Hwa Chi
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - George Fountzilas
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Li Zhang
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Edwin Pun Hui
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Anne W. M. Lee
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Pierre Blanchard
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - Stefan Michiels
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
| | - on behalf of the MAC-NPC Collaborative Group
- Affiliations of authors: Service de Biostatistique et d’Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, SM, JL, PB, SM); INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (FR, JPP, SM, PB, SM); Ligue Nationale Contre le Cancer Meta-Analysis Platform, Gustave Roussy Cancer Campus, Villejuif, France (FR, JPP, JL, SM); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (JB); Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (WTN, AWML); State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (JM, PYH, YC); Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China (ATCC, EPH); Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China (GZ); Hong Kong Sanatorium and Hospital, Hong Kong, China (DTTC); Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China (HQM, LZ); Queen Mary Hospital, Hong Kong, China (DLWK); National Cancer Centre, Singapore, Singapore (YLS); SWOG Statistical Center, Seattle, WA (JM); Tuen Mun Hospital Hong Kong, China (YT); Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (KHC); Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece (GF); Department of Radiation Therapy, Gustave Roussy, Villejuif, France (PB)
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Ke LR, Xia WX, Qiu WZ, Huang XJ, Yang J, Yu YH, Liang H, Liu GY, Ye YF, Xiang YQ, Guo X, Lv X. Safety and efficacy of lobaplatin combined with 5-fluorouracil as first-line induction chemotherapy followed by lobaplatin-radiotherapy in locally advanced nasopharyngeal carcinoma: preliminary results of a prospective phase II trial. BMC Cancer 2017; 17:134. [PMID: 28202000 PMCID: PMC5311839 DOI: 10.1186/s12885-017-3080-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/23/2017] [Indexed: 12/27/2022] Open
Abstract
Background Due to improvements in imaging and radiological techniques as well as the use of chemotherapy, distant metastasis has become the predominant mode of treatment failure in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). Platinum-based systemic chemotherapy has shown survival benefits and is now the standard strategy for systemic therapy in patients with LA-NPC. Notably, the third-generation platinum reagent lobaplatin has shown anti-tumor effects in several solid tumors with lower incidences of gastrointestinal, hepatic and renal toxicity relative to other platinum drugs. However, the safety and efficacy of lobaplatin as a first-line regimen in patients with LA-NPC are undetermined. Methods Patients with stage III–IVa-b NPC received lobaplatin at a dose of 30 mg/m2 on days 1 and 22 combined with a continuous 120-h intravenous injection of 5-fluorouracil at a dose of 4 g/m2 followed by lobaplatin at a dose of 50 mg/m2 on days 43 and 64 concomitant with intensity-modulated radiation therapy. Objective response rates and acute toxicity were assessed based on RECIST (1.1) and CTCAE v.3.0, respectively. Kaplan-Meier analysis was used to calculate survival rates. Results Fifty-nine patients were enrolled, and 44 patients (74.6%) received allocated cycles of chemotherapy. The objective response rates were 88.1% (95% confidence interval [CI], 0.77 to 0.95) and 100% after induction chemotherapy (ICT) and concurrent chemoradiotherapy (CRT), respectively. With a median follow-up period of 44 months, the 3-year estimated progression-free survival and overall survival were 86.4% (95% CI, 69.8 to 98.8) and 94.9% (95% CI, 89.5 to 100), respectively. The most common grade 3–4 toxicities were neutropenia (8.5%) and thrombocytopenia (40.7%) after ICT and CRT, respectively. Conclusion Lobaplatin combined with 5-fluorouracil followed by lobaplatin-RT treatment showed encouraging anti-tumor effects with tolerable toxicities in patients with LA-NPC. Randomized controlled trials of lobaplatin in patients with LA-NPC are warranted. Trial registration This trial was registered with the Chinese Clinical Trials Registry and approved on March 31st, 2012, number ChiCTR-ONC-12002060.
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Affiliation(s)
- Liang-Ru Ke
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Wei-Xiong Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Wen-Ze Qiu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Xin-Jun Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Jing Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Ya-Hui Yu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Hu Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Guo-Ying Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Yan-Fang Ye
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China
| | - Yan-Qun Xiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China. .,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China. .,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.
| | - Xing Lv
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China. .,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, 510060, China.
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Ribassin-Majed L, Marguet S, Lee AW, Ng WT, Ma J, Chan AT, Huang PY, Zhu G, Chua DT, Chen Y, Mai HQ, Kwong DL, Cheah SL, Moon J, Tung Y, Chi KH, Fountzilas G, Bourhis J, Pignon JP, Blanchard P. What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis. J Clin Oncol 2017; 35:498-505. [PMID: 27918720 PMCID: PMC5791836 DOI: 10.1200/jco.2016.67.4119] [Citation(s) in RCA: 218] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The role of adjuvant chemotherapy (AC) or induction chemotherapy (IC) in the treatment of locally advanced nasopharyngeal carcinoma is controversial. The individual patient data from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma database were used to compare all available treatments. Methods All randomized trials of radiotherapy (RT) with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma were considered. Overall, 20 trials and 5,144 patients were included. Treatments were grouped into seven categories: RT alone (RT), IC followed by RT (IC-RT), RT followed by AC (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). P-score was used to rank the treatments. Fixed- and random-effects frequentist network meta-analysis models were applied. Results The three treatments with the highest probability of benefit on overall survival (OS) were CRT-AC, followed by CRT and IC-CRT, with respective hazard ratios (HRs [95% CIs]) compared with RT alone of 0.65 (0.56 to 0.75), 0.77 (0.64 to 0.92), and 0.81 (0.63 to 1.04). HRs (95% CIs) of CRT-AC compared with CRT for OS, progression-free survival (PFS), locoregional control, and distant control (DC) were, respectively, 0.85 (0.68 to 1.05), 0.81 (0.66 to 0.98), 0.70 (0.48 to 1.02), and 0.87 (0.61 to 1.25). IC-CRT ranked second for PFS and the best for DC. CRT never ranked first. HRs of CRT compared with IC-CRT for OS, PFS, locoregional control, and DC were, respectively, 0.95 (0.72 to 1.25), 1.13 (0.88 to 1.46), 1.05 (0.70 to 1.59), and 1.55 (0.94 to 2.56). Regimens with more chemotherapy were associated with increased risk of acute toxicity. Conclusion The addition of AC to CRT achieved the highest survival benefit and consistent improvement for all end points. The addition of IC to CRT achieved the highest effect on DC.
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Affiliation(s)
- Laureen Ribassin-Majed
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sophie Marguet
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne W.M. Lee
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Wai Tong Ng
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jun Ma
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anthony T.C. Chan
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pei-Yu Huang
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guopei Zhu
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Daniel T.T. Chua
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yong Chen
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hai-Qiang Mai
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dora L.W. Kwong
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Shie-Lee Cheah
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - James Moon
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yuk Tung
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kwan-Hwa Chi
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - George Fountzilas
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Bourhis
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Pierre Pignon
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre Blanchard
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - on behalf of the Meta-Analysis of Chemotherapy in Nasopharyngeal Collaborative Group
- Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Dong YY, Xiang C, Lu JX, Su YX, Pan YF, Cai R, Zhang RJ, He ZK, Liu ML, Huang H, Bai X, Tang HY, Shi YH, Wang Y, Jiang W. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma : A matched-pair multicenter analysis of outcomes. Strahlenther Onkol 2016; 192:394-402. [PMID: 27215563 DOI: 10.1007/s00066-016-0970-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT. METHODS Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan-Meier method and log-rank test. Toxicities and response rates were compared using Fisher's exact test. RESULTS Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72 %, 61 %, 71 %, and 81 %, respectively, for the CCRT arm, compared to 74 % (hazard ratio, HR 0.89; 95 % confidence interval, CI 0.64-1.23; P = 0.474), 62 % (HR 0.91, 95 % CI 0.68-1.20, P = 0.489), 73 % (HR 0.84, 95 % CI 0.59-1.18, P = 0.316), and 84 % (HR 0.84, 95 % CI 0.52-1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3-4 toxicities in the CCRT/AC arm. The most common grade 3-4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43 %), leukopenia/neutropenia (23 %), thrombocytopenia (8.8 %), and anemia (6.2 %). CONCLUSION Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.
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Affiliation(s)
- Yi-Yuan Dong
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
- Department of Otorhinolaryngology, Guilin Medical University Affiliated Hospital, 15 Lequn Road, 541001, Guilin, PR China
| | - Chun Xiang
- Department of Otorhinolaryngology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China
| | - Jian-Xun Lu
- Department of Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, 18 Zhongshan Second Road, 533000, Baise, PR China
| | - Yi-Xin Su
- Department of Radiation Oncology, Lingshan People's Hospital, 1 Zhongxiu Road, 535400, Lingshan, PR China
| | - Yu-Fei Pan
- Department of Radiation Oncology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China
| | - Rui Cai
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Rong-Jun Zhang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Zhuo-Kai He
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Mei-Lian Liu
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Hui Huang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Xue Bai
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Hua-Ying Tang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Yun-Hua Shi
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Yan Wang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China
| | - Wei Jiang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
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Lee JT, Ko CY. Has survival improved for nasopharyngeal carcinoma in the United States? Otolaryngol Head Neck Surg 2016; 132:303-8. [PMID: 15692545 DOI: 10.1016/j.otohns.2004.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To analyze the epidemiologic patterns and survival rates for patients with nasopharyngeal carcinoma over the last three decades. METHODS: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program tumor registries were used to identify patients with nasopharyngeal carcinoma in the United States from 1973 to 1999. Incidence and survival rates for each decade were then determined according to age, gender, race, histological type, and stage using the SEER statistical program. RESULTS: From 1973 to 1999, 4680 cases of patients with nasopharyngeal carcinoma in the United States were sampled by the NCI/SEER database. Overall incidence rates for each decade essentially remained unchanged over time (0.7/100,000). Asians exhibited the highest incidence rates (3.0–4.2), followed by blacks (0.7–1.1) and then whites (0.4–0.7). In contrast, survival rates have gradually improved over time for all stages and histological types (35.7% 5-year survival in the 1970s vs. 44.1% in the 1980, and 51% in the 1990s). With respect to race, Asians demonstrated the best 5-year survival rate (62.9%) followed by whites (42.6%) and then blacks (36.2%). However, this may be due to histology, because Asians were also found to have a greater proportion of World Health Organization (WHO) type III cases (27.6%) in comparison to the other 2 groups (22.4% for blacks and 15% for whites). CONCLUSIONS: Although the incidence rates of nasopharyngeal carcinoma have remained essentially unchanged in the United States in the last 3 decades, survival rates for each stage and histological subtype have exhibited considerable improvement over time. The higher survival rates in Asians may be partially attributed to the more favorable histology (type III) often seen in this group. EBM rating: B-3.
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Affiliation(s)
- Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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Liang ZG, Chen ZT, Li L, Qu S, Zhu XD. Progresses and Challenges in Chemotherapy for Loco- Regionally Advanced Nasopharyngeal Carcinoma. Asian Pac J Cancer Prev 2016; 16:4825-32. [PMID: 26163598 DOI: 10.7314/apjcp.2015.16.12.4825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Incidence rates of nasopharyngeal carcinoma are high in Indonesia, Singapore and South-Eastern China. Chemoradiotherapy has been the standard regimen for locally advanced nasopharyngeal carcinoma according to guidelines from the National Comprehensive Cancer Network. Recently, advances in the management of nasopharyngeal carcinoma have transferred into better treatment outcomes. Most phase III clinical trials support the addition of concurrent chemotherapy to radiotherapy for the initial treatment of these patients. Studies evaluating effects and toxicity of concurrent chemotherapy with different regimens have been reported. However, the status of adding adjuvant chemotherapy or induction chemotherapy remains controversial. Recent studies have shown that adjuvant chemotherapy with two or three cycles may improve survival for nasopharyngeal carcinoma with stage N2-3 disease or with persistently detectable plasma EBV DNA after radiotherapy. This review examines the pertinent issues and latest studies concerning the management of loco-regionally advanced NPC, regarding concurrent chemotherapy, adjuvant chemotherapy, and induction chemotherapy in decades.
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Affiliation(s)
- Zhong-Guo Liang
- Department of Radiation Oncology, the Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China E-mail :
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Laskar SG, Baijal G, Rangarajan V, Purandare N, Sengar M, Shah S, Gupta T, Budrukkar A, Murthy V, Pai PS, D'Cruz AK, Agarwal JP. Fluorodeoxyglucose-positron emission tomography in carcinoma nasopharynx: Can we predict outcomes and tailor therapy based on postradiotherapy fluorodeoxyglucose-positron emission tomography? Indian J Med Paediatr Oncol 2016; 37:47-52. [PMID: 27051158 PMCID: PMC4795376 DOI: 10.4103/0971-5851.177030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET-CT) is an emerging modality for staging and response evaluation in carcinoma nasopharynx. This study was conducted to evaluate the impact of PET-CT in assessing response and outcomes in carcinoma nasopharynx. MATERIALS AND METHODS Forty-five patients of nonmetastatic carcinoma nasopharynx who underwent PET-CT for response evaluation at 10-12 weeks posttherapy between 2004 and 2009 were evaluated. Patients were classified as responders (Group A) if there was a complete response on PET-CT or as nonresponders (Group B) if there was any uptake above the background activity. Data regarding demographics, treatment, and outcomes were collected from their records and compared across the Groups A and B. RESULTS The median age was 41 years. 42 out of 45 (93.3%) patients had WHO Grade 2B disease (undifferentiated squamous carcinoma). 24.4%, 31.1%, 15.6, and 28.8% patients were in American Joint Committee on Cancer Stage IIb, III, Iva, and IVb. All patients were treated with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy. Forty-five patients, 28 (62.2%) were classified as responders, whereas 17 (37.8%) were classified as nonresponders. There was no significant difference in the age, sex, WHO grade, and stage distribution between the groups. Compliance to treatment was comparable across both groups. The median follow-up was 25.3 months (759 days). The disease-free survival (DFS) of the group was 57.3% at 3 years. The DFS at 3 years was 87.3% and 19.7% for Group A and B, respectively (log-rank test, P < 0.001). Univariate and multivariate analysis revealed Groups to be the only significant factor predicting DFS (P value 0.002 and < 0.001, respectively). In Group B, the most common site of disease failure was distant (9, 53%). CONCLUSION PET-CT can be used to evaluate response and as a tool to identify patients at higher risk of distant failure. Further, this could be exploited to identify patients who may need treatment intensification. This needs to be validated prospectively.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gunjan Baijal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Nilendu Purandare
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Bio-Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Advanced Centre for Treatment Research and Education in Cancer, Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A K D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Yu H, Gu D, He X, Gao X, Bian X. The role of induction and adjuvant chemotherapy in combination with concurrent chemoradiotherapy for nasopharyngeal cancer: a Bayesian network meta-analysis of published randomized controlled trials. Onco Targets Ther 2016; 9:159-70. [PMID: 26793000 PMCID: PMC4708240 DOI: 10.2147/ott.s96983] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Whether the addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to concurrent chemoradiotherapy (CCRT) is superior to CCRT alone for locally advanced nasopharyngeal cancer is unknown. A Bayesian network meta-analysis was performed to investigate the efficacy of CCRT, IC + CCRT, and CCRT + AC on locally advanced nasopharyngeal cancer. The overall survival (OS) with hazard ratios (HRs) and locoregional recurrence rates (LRRs) and distant metastasis rates (DMRs) with risk ratios (RRs) were investigated. After a comprehensive database search, eleven studies involving 2,626 assigned patients were included in this network meta-analysis. Compared with CCRT alone, IC + CCRT resulted in no significant improvement in OS or LRR and a marginal improvement in DMR (OS: HR =0.67, 95% credible interval (CrI) 0.32-1.18; LRR: RR =1.79, 95% CrI 0.80-3.51; DMR: RR =1.79, 95% CrI 0.24-1.04) and CCRT + AC exhibited no beneficial effects on any of the endpoints of OS, LRR, or DMR (OS: HR =0.99, 95% CrI 0.64-1.43; LRR: RR =0.78, 95% CrI 0.43-1.32; DMR: RR =0.85, 95% CrI 0.57-1.24). As a conclusion, for locally advanced nasopharyngeal cancer, no significant differences in the treatment efficacies of CCRT, IC + CCRT, and CCRT + AC were found, with the exception of a marginally significant improvement in distant control observed following IC + CCRT compared with CCRT alone.
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Affiliation(s)
- Hongliang Yu
- Department of Radiation Oncology, Jiangsu Cancer Hospital affiliated with Nanjing Medical University, Nanjing, People's Republic of China
| | - Dayong Gu
- Department of Radiation Oncology, Jiangsu Cancer Hospital affiliated with Nanjing Medical University, Nanjing, People's Republic of China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital affiliated with Nanjing Medical University, Nanjing, People's Republic of China
| | - Xianshu Gao
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Xiuhua Bian
- Department of Radiation Oncology, Jiangsu Cancer Hospital affiliated with Nanjing Medical University, Nanjing, People's Republic of China
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Sung SY, Kang MK, Kay CS, Keum KC, Kim SH, Kim YS, Kim WT, Kim JY, Kim JH, Moon SH, Ahn YC, Oh YT, Wu HG, Lee CG, Chung WK, Cho KH, Cho MJ, Choi JH. Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea. Radiat Oncol J 2015; 33:188-97. [PMID: 26484302 PMCID: PMC4607572 DOI: 10.3857/roj.2015.33.3.188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/17/2015] [Accepted: 08/07/2015] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. MATERIALS AND METHODS A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. RESULTS Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. CONCLUSION Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.
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Affiliation(s)
- Soo Yoon Sung
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Taek Kim
- Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Ho Moon
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwan Ho Cho
- Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Moon-June Cho
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hwa Choi
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea
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Chen YP, Sun Y, Chen L, Mao YP, Tang LL, Li WF, Liu X, Zhang WN, Zhou GQ, Guo R, Lin AH, Ma J. Surrogate endpoints for overall survival in combined chemotherapy and radiotherapy trials in nasopharyngeal carcinoma: Meta-analysis of randomised controlled trials. Radiother Oncol 2015; 116:157-66. [PMID: 26243677 DOI: 10.1016/j.radonc.2015.07.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE We used a literature-based meta-analysis to assess whether failure-free survival (FFS) or progression-free survival (PFS) could be reliable surrogate endpoints for overall survival (OS) in trials of combined chemotherapy and radiotherapy for nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS We identified randomised trials that evaluated combined chemoradiotherapy strategies, and reported FFS or PFS and OS in NPC. We analysed the treatment effects on FFS or PFS, and OS. We used the coefficient of determination (R(2)), and the surrogate threshold effect (STE) to assess the trial-level correlation. RESULTS Twenty-one trials (5212 patients), with sixteen treatment-control comparisons for FFS, and nine for PFS, were analysed. FFS was strongly correlated with OS (R(2)=0.88, STE=0.84), as was PFS (R(2)=0.90, STE=0.88). Moreover, FFS and PFS at 3 years were still strongly correlated with 5-year OS (R(2)=0.80, STE=0.83; R(2)=0.85, STE=0.84). CONCLUSIONS Both FFS and PFS could be valid surrogate endpoints for OS in trials of combined chemotherapy and radiotherapy for NPC; PFS may be a more acceptable surrogate endpoint compared with FFS.
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Affiliation(s)
- Yu-Pei Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Lei Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yan-Ping Mao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ling-Long Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wen-Fei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xu Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wen-Na Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Guan-Qun Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Rui Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
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Wee CW, Keam B, Heo DS, Sung MW, Won TB, Wu HG. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy. Radiat Oncol J 2015; 33:98-108. [PMID: 26157679 PMCID: PMC4493434 DOI: 10.3857/roj.2015.33.2.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Materials and Methods Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. Results With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. Conclusion CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.
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Affiliation(s)
- Chan Woo Wee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Radiation Research Institute, Medical Research Center, Seoul National University, Seoul, Korea
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Yan M, Kumachev A, Siu LL, Chan KKW. Chemoradiotherapy regimens for locoregionally advanced nasopharyngeal carcinoma: A Bayesian network meta-analysis. Eur J Cancer 2015; 51:1570-9. [PMID: 26044925 DOI: 10.1016/j.ejca.2015.04.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy followed by adjuvant chemotherapy (CRT-A) is often the regimen of choice in locoregionally advanced nasopharyngeal carcinoma (NPC). Many alternative regimens have been reported in the literature, however, it is unknown how effective these regimens are compared to each other due to the lack of direct comparisons. Our objective was to perform a network meta-analysis (NMA) to determine the relative survival benefits of these treatments for locoregionally advanced NPC. METHODS We performed a systematic review following the Cochrane methodology, using MEDLINE, EMBASE and CENTRAL to identify all randomised controlled trials (RCTs) that compared different chemoradiotherapy regimens for locoregionally advanced NPC. Overall survival (OS) was the primary outcome of interest, and hazard ratios (HRs) were extracted using the Parmar method. Bayesian NMAs with random effects were conducted using WinBUGS. RESULTS Twenty-five RCTs (5576 patients) were included in this review. All together, these trials compared seven different regimens: radiotherapy (RT), concurrent chemoradiotherapy (CRT), neoadjuvant followed by CRT (N-CRT), CRT-A, RT-A, N-RT and N-RT-A. All regimens that contained CRT performed significantly better than RT. CRT-A did not improve survival compared to CRT alone (0.98; 95% credible regions: 0.71-1.34). For N-CRT versus CRT, the HR was 1.03 (0.69-1.47). When CRT-A was compared against N-CRT, the resulting HR was 0.96 (0.64-1.48). CONCLUSIONS Adjuvant chemotherapy does not appear to improve survival following CRT. The efficacies of CRT, CRT-A and N-CRT all appeared to be similar. Further studies are warranted to determine the value of additional chemotherapy phases in specific patient subgroups.
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Affiliation(s)
- Marie Yan
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Alexander Kumachev
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Lillian L Siu
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, Ontario M5G 2M9, Canada
| | - Kelvin K W Chan
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Division of Medical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Blanchard P, Lee A, Marguet S, Leclercq J, Ng WT, Ma J, Chan ATC, Huang PY, Benhamou E, Zhu G, Chua DTT, Chen Y, Mai HQ, Kwong DLW, Cheah SL, Moon J, Tung Y, Chi KH, Fountzilas G, Zhang L, Hui EP, Lu TX, Bourhis J, Pignon JP. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Lancet Oncol 2015; 16:645-55. [PMID: 25957714 DOI: 10.1016/s1470-2045(15)70126-9] [Citation(s) in RCA: 513] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A previous individual patient data meta-analysis by the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) collaborative group to assess the addition of chemotherapy to radiotherapy showed that it improves overall survival in nasopharyngeal carcinoma. This benefit was restricted to patients receiving concomitant chemotherapy and radiotherapy. The aim of this study was to update the meta-analysis, include recent trials, and to analyse separately the benefit of concomitant plus adjuvant chemotherapy. METHODS We searched PubMed, Web of Science, Cochrane Controlled Trials meta-register, ClinicalTrials.gov, and meeting proceedings to identify published or unpublished randomised trials assessing radiotherapy with or without chemotherapy in patients with non-metastatic nasopharyngeal carcinoma and obtained updated data for previously analysed studies. The primary endpoint of interest was overall survival. All trial results were combined and analysed using a fixed-effects model. The statistical analysis plan was pre-specified in a protocol. All data were analysed on an intention-to-treat basis. FINDINGS We analysed data from 19 trials and 4806 patients. Median follow-up was 7·7 years (IQR 6·2-11·9). We found that the addition of chemotherapy to radiotherapy significantly improved overall survival (hazard ratio [HR] 0·79, 95% CI 0·73-0·86, p<0·0001; absolute benefit at 5 years 6·3%, 95% CI 3·5-9·1). The interaction between treatment effect (benefit of chemotherapy) on overall survival and the timing of chemotherapy was significant (p=0·01) in favour of concomitant plus adjuvant chemotherapy (HR 0·65, 0·56-0·76) and concomitant without adjuvant chemotherapy (0·80, 0·70-0·93) but not adjuvant chemotherapy alone (0·87, 0·68-1·12) or induction chemotherapy alone (0·96, 0·80-1·16). The benefit of the addition of chemotherapy was consistent for all endpoints analysed (all p<0·0001): progression-free survival (HR 0·75, 95% CI 0·69-0·81), locoregional control (0·73, 0·64-0·83), distant control (0·67, 0·59-0·75), and cancer mortality (0·76, 0·69-0·84). INTERPRETATION Our results confirm that the addition of concomitant chemotherapy to radiotherapy significantly improves survival in patients with locoregionally advanced nasopharyngeal carcinoma. To our knowledge, this is the first analysis that examines the effect of concomitant chemotherapy with and without adjuvant chemotherapy as distinct groups. Further studies on the specific benefits of adjuvant chemotherapy after concomitant chemoradiotherapy are needed. FUNDING French Ministry of Health (Programme d'actions intégrées de recherche VADS), Ligue Nationale Contre le Cancer, and Sanofi-Aventis.
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Affiliation(s)
- Pierre Blanchard
- Gustave-Roussy, Villejuif, France; Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
| | - Anne Lee
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Wai Tong Ng
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Anthony T C Chan
- Partner State Key Laboratory of Oncology in South China, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Ellen Benhamou
- Gustave-Roussy, Villejuif, France; Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
| | - Guopei Zhu
- Fudan University Shanghai Cancer Center, Shanghai, PR China
| | | | - Yong Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | | | | | - James Moon
- SWOG Statistical Center, Seattle, WA, USA
| | - Yuk Tung
- Tuen Mun Hospital, Hong Kong, China
| | - Kwan-Hwa Chi
- Shin Kong Wu Ho-Su, Memorial Hospital, Tapei, Taiwan
| | - George Fountzilas
- Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Li Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Edwin Pun Hui
- Partner State Key Laboratory of Oncology in South China, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China
| | - Tai-Xiang Lu
- Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Pierre Pignon
- Gustave-Roussy, Villejuif, France; Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France.
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Kang MK, Oh D, Cho KH, Moon SH, Wu HG, Heo DS, Ahn YC, Park K, Park HJ, Park JS, Keum KC, Cha J, Kim JW, Kim YS, Kang JH, Oh YT, Kim JY, Kim SH, Kim JH, Lee CG. Role of Chemotherapy in Stage II Nasopharyngeal Carcinoma Treated with Curative Radiotherapy. Cancer Res Treat 2015; 47:871-8. [PMID: 25687858 PMCID: PMC4614208 DOI: 10.4143/crt.2014.141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To define the role of neoadjuvant and concurrent chemotherapy in stage II nasopharyngeal carcinoma, we compared the treatment outcomes of patients treated with curative radiotherapy with or without chemotherapy. Materials and Methods From 2004 to 2011, 138 patients with American Joint Committee on Cancer (AJCC) 2002 stage II nasopharyngeal carcinoma were treated with curative radiotherapy in 12 hospitals in South Korea. Treatment methods included radiotherapy alone in 34 patients, neoadjuvant chemotherapy followed by radiotherapy alone in seven, concurrent chemoradiotherapy in 80, and neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in 17. Adjuvant chemotherapy was used in 42 patients. Total radiation dose ranged from 64 Gy to 74.2 Gy (median, 70 Gy). Results Median follow-up was 48 months (range, 7 to 97 months) for all patients. At the last follow-up, 13 patients had died and 32 had experienced treatment failure; locoregional failure occurred in 14, distant failure in 16, and both in two. Five-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were 86.2%, 85.5%, 74.4%, and 88.2%, respectively. Multivariate analyses showed that the significant prognostic factors were concurrent chemotherapy and N stage for locoregional relapse-free survival, concurrent chemotherapy for progression-free survival, and age and N stage for overall survival. Neither neoadjuvant nor concurrent chemotherapy improved distant metastasis-free survival. Conclusion Concurrent chemotherapy significantly improved 5-year locoregional relapse-free survival and progression-free survival in stage II nasopharyngeal carcinoma. However, neoadjuvant chemotherapy failed to improve either.
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Affiliation(s)
- Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jung Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Su Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jihye Cha
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyoung Kang
- Department of Medical Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Yoon Kim
- Department of Radiation Oncology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin-Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Miyaushiro S, Kitanaka A, Kubuki Y, Hidaka T, Shide K, Kameda T, Sekine M, Kamiunten A, Umekita Y, Kawabata T, Ishiguro Y, Shimoda K. Nasopharyngeal carcinoma with bone marrow metastasis: positive response to weekly paclitaxel chemotherapy. Intern Med 2015; 54:1455-9. [PMID: 26028007 DOI: 10.2169/internalmedicine.54.3917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 51-year-old man with nasopharyngeal carcinoma underwent chemoradiotherapy with cisplatin and 5-fluorouracil, followed by a left cervical lymphadenectomy. Distant metastatic disease was excluded using fluoro-deoxyglucose positron emission tomography. Seven months later, bone marrow metastasis and disseminated intravascular coagulation were diagnosed. The patient received weekly paclitaxel therapy and maintained a good performance status for seven months. During the treatment period, the patient developed no severe organ toxicity except for neutropenia. Weekly paclitaxel may therefore be considered as the treatment of choice in patients with advanced or recurrent nasopharyngeal carcinoma with bone marrow metastasis.
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Affiliation(s)
- Sae Miyaushiro
- Clinical Training Center after Graduation, University of Miyazaki Hospital, Japan
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43
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Loong HH, Chan AT. Controversies in the systemic treatment of Nasopharyngeal carcinoma. Oral Oncol 2014; 50:785-90. [DOI: 10.1016/j.oraloncology.2014.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/11/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
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Abstract
Cancer of the nasopharynx is an uncommon malignancy in France (incidence = 0.5/year/100,000 men) but is endemic in areas like in South-East Asia. Exclusive radiation therapy used to be the standard and results in local control rates for T3-T4 tumors around 50-75 %. Intensity-modulated radiotherapy (IMRT) improves tumor coverage with a sparing of organs at risk and has to be privileged. Concurrent chemotherapy with IMRT achieved significant survival benefice with 5-year overall survival above 75 %. Concurrent radiochemotherapy with platinum is the most frequent scheme but induction and adjuvant chemotherapies are discussed to reduce distant failure: studies are currently ongoing. Follow-up aims to detect early local failures with a chance of cure and to manage long-term toxicities.
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45
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Moretto F, Rampino M, Munoz F, Ruo Redda MG, Reali A, Balcet V, Badellino S, Piva C, Schena M, Airoldi M, Ostellino O, Pecorari G, Ragona R, Ricardi U. Conventional 2D (2DRT) and 3D conformal radiotherapy (3DCRT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer treatment. LA RADIOLOGIA MEDICA 2014; 119:634-41. [PMID: 24424659 DOI: 10.1007/s11547-013-0359-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Nasopharyngeal carcinoma represents a distinct entity as compared to other head and neck tumours. Radio-chemotherapy is the treatment of first choice in non-metastatic disease. Intensity-modulated radiation therapy (IMRT) allows the sparing of parotid glands, improving the toxicity profile. The aim of this study was to compare the results obtained with IMRT with those obtained with conventional 2D (2DRT) and 3D conformal radiation therapy (3DCRT) in terms of tumour control, survival, acute and late toxicity. MATERIALS AND METHODS We reviewed the clinical records of 52 patients with histologically proven carcinoma of the nasopharynx (stage I-IVB according to the 2002 American Joint Committee on Cancer staging system) treated with curative intent between January 2003 and August 2011: 26 patients were treated with 2D or 3D technique (arm A) and 26 with IMRT technique (arm B) with simultaneous integrated boost. Fifty patients (96 %) received chemotherapy. Local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), acute and late toxicity were retrospectively evaluated. RESULTS After a median follow-up of 37.6 months (69 months in arm A and 23 months in arm B), 69 % of patients were alive and disease-free, 10 % were alive with disease and 21 % died of disease, with an OS of 81 % at 2 years and 79 % at 5 years, a LC rate of 88 % at 2 years and 78 % at 5 years, a LRC rate of 80 % at 2 years and 73 % at 5 years and a DFS of 74 % at 2 years and 65 % at 5 years, with no statistically significant differences between IMRT and 2DRT/3DCRT. In multivariate analysis, the TNM stage and the volume treated at high dose correlated with DFS. No factor was found to be related to OS. Chronic toxicity was not statistically different in the two study groups and in particular ≥ G2 xerostomia rates were 67 and 41 % in arm A and B, respectively (p = 0.10). CONCLUSIONS The findings of this study confirm that IMRT associated with chemotherapy, even with moderately hypofractionated regimens, allows good disease control with better results in terms of late xerostomia, although without statistically significant differences compared to 2DRT and 3DCRT. The hypothesis of an impact of IMRT on survival has yet to be confirmed.
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Affiliation(s)
- Francesco Moretto
- Dipartimento di Oncologia, Radioterapia U, Università di Torino, Turin, Italy,
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Tham IWK, Lu JJ. Controversies and challenges in the current management of nasopharyngeal cancer. Expert Rev Anticancer Ther 2014; 10:1439-50. [DOI: 10.1586/era.10.97] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Arango BA, Castrellon AB, Perez CA, Raez LE, Santos ES. Nasopharyngeal carcinoma: alternative treatment options after disease progression. Expert Rev Anticancer Ther 2014; 10:377-86. [DOI: 10.1586/era.10.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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OuYang P, Xie C, Mao Y, Zhang Y, Liang X, Su Z, Liu Q, Xie F. Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials. Ann Oncol 2013; 24:2136-46. [DOI: 10.1093/annonc/mdt146] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Phase II trial of neoadjuvant docetaxel and cisplatin followed by intensity-modulated radiotherapy with concurrent cisplatin in locally advanced nasopharyngeal carcinoma. Cancer Chemother Pharmacol 2013; 71:1577-83. [PMID: 23549883 DOI: 10.1007/s00280-013-2157-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/24/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of neoadjuvant chemotherapy involving docetaxel and cisplatin followed by intensity-modulated radiotherapy (IMRT) with concurrent cisplatin in patients with newly diagnosed stage III to IVB nasopharyngeal carcinoma (NPC). METHODS Docetaxel (75 mg/m(2) on day 1) and cisplatin (75 mg/m(2) on day 1) were administered on a 3-week cycle for 2 courses, followed by radical IMRT (72 Gy/33F/6.5-7 W) with concurrent cisplatin (75 mg/m(2), on day 1) every 3 weeks for 2 cycles. RESULTS From June 2008 to October 2010, forty-six patients were recruited in this trial. Forty-five patients completed neoadjuvant setting, and all patients completed planned concurrent chemoradiotherapy (CCRT). The complete and partial response rates were 28.3 and 56.5 % after neoadjuvant chemotherapy, and 91.3, 8.7 % after CCRT, respectively. After median follow-up of 26 months (range 12-39 months), one patient experienced local recurrence and 4 patients developed distant metastasis. The 3-year overall survival and progression-free survival rate were 94.1 and 72.7 %, respectively. Neutropenia (37.0 %) and vomiting (28.3 %) were the most common Grade 3-4 adverse effects during neoadjuvant course, while mucositis (30.4 %), xerostomia (30.4 %) and radiodermatitis (21.7 %) were the most common Grades 3 acute toxicities during CCRT. Xerostomia (73.9 %), dysphagia (56.5 %), hear loss (30.4 %) and skin reaction (21.7 %) were the common Grade 1-2 late effects. There were no Grades 3-4 late toxicities. CONCLUSIONS The protocol of neoadjuvant docetaxel and cisplatin followed by IMRT with concurrent cisplatin was well tolerated, with outstanding compliance and efficacy in locally advanced NPC, which deserved further follow-up.
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Zhang L, Chen QY, Liu H, Tang LQ, Mai HQ. Emerging treatment options for nasopharyngeal carcinoma. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:37-52. [PMID: 23403548 PMCID: PMC3565571 DOI: 10.2147/dddt.s30753] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nasopharyngeal carcinoma is endemic in Asia and is etiologically associated with Epstein–Barr virus. Radiotherapy is the primary treatment modality. The role of systemic therapy has become more prominent. Based on multiple phase III studies and meta-analyses, concurrent cisplatin-based chemoradiotherapy is the current standard of care for locally advanced disease (American Joint Committee on Cancer manual [7th edition] stages II–IVb). The reported failure-free survival rates from phase II trials are encouraging for induction + concurrent chemoradiotherapy. Data from ongoing phase III trials comparing induction + concurrent chemoradiotherapy with concurrent chemoradiotherapy will validate the results of these phase II studies. Intensity-modulated radiotherapy techniques are recommended if the resources are available. Locoregional control exceeding 90% and reduced xerostomia-related toxicities can now be achieved using intensity-modulated radiotherapy, although distant control remains the most pressing research problem. The promising results of targeted therapy and Epstein–Barr virus-specific immunotherapy from early clinical trials should be validated in phase III clinical trials. New technology, more effective and less toxic chemotherapy regimens, and targeted therapy offer new opportunities for treating nasopharyngeal carcinoma.
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Affiliation(s)
- Lu Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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