1
|
Dechaphunkul A, Danchaivijitr P, Jiratrachu R, Dechaphunkul T, Sookthon C, Jiarpinitnun C, Paoin C, Setakornnukul J, Suktitipat B, Pattaranutaporn P, Ngamphaiboon N. Real-world evidence of cisplatin versus carboplatin in patients with locally advanced nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: A multicenter analysis. Asia Pac J Clin Oncol 2023; 19:51-61. [PMID: 35394108 DOI: 10.1111/ajco.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Though concurrent chemoradiotherapy (CCRT) with cisplatin remains a standard of care for patients with locally advanced nasopharyngeal carcinoma (LA-NPC), carboplatin has alternatively been used without sufficient supportive evidences. Thus, we evaluated an efficacy and tolerability of carboplatin CCRT compared with cisplatin in LA-NPC patients. METHODS Patients with LA-NPC treated with CCRT were identified through the Thai multicenter head and neck cancer database. Patient tolerability and survival were analyzed and compared between regimens. Survivals were calculated by using the Kaplan-Meier method, and compared by the log-rank test. A p-value of <0.05 was considered statistically significant. RESULTS A total of 135 of 980 patients (13.8%) were treated with carboplatin. Patients treated with carboplatin were significantly associated with older age (p < 0.001), smoking (p = 0.003), more comorbidity (p = 0.014), kidney disease (p = 0.016), and lower baseline creatinine clearance (p < 0.001). Intensity-modulated radiation therapy was used significantly more in the cisplatin group than carboplatin group (p < 0.001). Patients who received carboplatin were associated with delay (p = 0.049) and hospitalization (p = 0.006), whereas cisplatin CCRT had more dose reduction (p = 0.001). Patients treated with cisplatin had CCRT interruption from grade 3-4 mucositis (p = 0.019) more than carboplatin, whereas carboplatin had more grade 3-4 thrombocytopenia (p < 0.001). The 5-year overall survival (OS) of patients treated with cisplatin and carboplatin was 59% and 49%, respectively (p = 0.128). Cisplatin or carboplatin CCRT was not a significant predictor for OS and locoregional recurrence-free survival in multivariate analysis. CONCLUSIONS Carboplatin CCRT provided acceptable efficacy and tolerability profiles in real-world practice. Carboplatin should be considered as an alternative regimen, particularly in cisplatin-ineligible patients with LA-NPC treated with CCRT.
Collapse
Affiliation(s)
- Arunee Dechaphunkul
- Unit of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Pongwut Danchaivijitr
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungarun Jiratrachu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Tanadech Dechaphunkul
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Chatsuda Sookthon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chuleeporn Jiarpinitnun
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chatchanok Paoin
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Setakornnukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bhoom Suktitipat
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Integrative Computational BioScience (ICBS) Center, Mahidol University, Bangkok, Thailand
| | - Poompis Pattaranutaporn
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapong Ngamphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Liang X, Liu Q, Yao W, Yang S. Efficacy and toxicity of three concurrent chemoradiotherapy regimens in treating nasopharyngeal carcinoma: Comparison among cisplatin, nedaplatin, and lobaplatin. Medicine (Baltimore) 2022; 101:e31187. [PMID: 36626436 PMCID: PMC9750602 DOI: 10.1097/md.0000000000031187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Few studies directly compare efficacy and toxicity among lobaplatin, nedaplatin and cisplatin concurrently with intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). Totally 141 treatment-naïve NPC without distant metastasis receiving IMRT concurrent with cisplatin or nedaplatin or lobaplatin were retrospectively enrolled. Their response rate, toxicity and long-term survival were compared. Complete response (CR) rates of concurrent lobaplatin (CR-nasopharynx [CR-nx], 82.7%; CR-cervical lymph node [CR-nd], 94.2%) were lower than those of cisplatin (CR-nx, 89.3%; CR-nd, 98.2%) and nedaplatin (CR-nx, 93.9%; CR-nd, 97.0%), but statistical significance wasn't detected. Estimated five-year overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) weren't statistically significant between three groups. Multivariable analysis by COX proportional hazards model showed concurrent chemotherapy regimen wasn't an independent prognostic factor. Gastrointestinal toxicity was prevalent in platinum-based concurrent chemotherapy; cisplatin group suffered heavier (≥grade 2) than other two groups. More nephrotoxicity happened in cisplatin group (17.9%) than nedaplatin (9.1%) and lobaplatin (2.0%) groups. Incidence of dermatitis of ≥grade 2 was higher in cisplatin group (60.7%) than nedaplatin (27.3%) and lobaplatin (9.6%) groups. More patients in lobaplatin and nedaplatin groups suffered from any grade thrombocytopenia (P < .001), but incidence of severe thrombocytopenia (≥grade 3) was similar. Economic cost was significant less in lobaplatin group. Cisplatin, nedaplatin and lobaplatin are equally effective when used concurrently with IMRT in NPC. Lobaplatin and nedaplatin have potential to be alternatives to cisplatin in terms of less severe acute side-effects and economic cost.
Collapse
Affiliation(s)
- Xuexia Liang
- Department of Cancer Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
- * Correspondence: Xuexia Liang, Department of Cancer Centre, Guangdong Provincial Key Laboratory of Biomedical Imaging, Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Road, Zhuhai, 519000, People’s Republic of China (e-mail: )
| | - Qiaodan Liu
- Department of Head and Neck Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Wei Yao
- Department of Cancer Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Shuai Yang
- Department of Radiotherapy and Minimally Invasive Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| |
Collapse
|
3
|
Jiang N, Zhao L, Zong D, Yin L, Wu L, Chen C, Song X, Zhang Q, Jiang X, He X, Feng J. Long non-coding RNA LUADT1 promotes nasopharyngeal carcinoma cell proliferation and invasion by downregulating miR-1207-5p. Bioengineered 2021; 12:10716-10728. [PMID: 34738862 PMCID: PMC8810096 DOI: 10.1080/21655979.2021.2001952] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a typical type of malignant tumor. This research paper aims to study the function and mechanism of long non-coding RNA lung adenocarcinoma-related transcript 1 (lncRNA-LUADT1) in the progression of NPC. In this study, the expressions of lncRNA-LUADT1, miR-1207-5p, and TEAD1 in NPC tissues and cell lines were detected by RT-qPCR. Initially, the expression of lncRNA-LUADT1 and TEAD1 were significantly up-regulated in NPC tissues and cells, while miR-1207-5p was significantly down-regulated. Next, miR-1207-5p was confirmed to bind to lncRNA-LUADT1 or TEAD1 by bioinformatics and luciferase reporter assay. In addition, after interfering with lncRNA-LUADT1 expression, experiments of CCK8, EDU staining, and Transwell invasion were used to detect proliferation, invasion, and migration of NPC cells. The results showed that interfering with lncRNA-LUADT1 expression could inhibit the proliferation, invasion, and migration of NPC cells. Western blot showed that lncRNA-LUADT1 knockdown significantly decreased the expression of Hippo/YAP pathway protein (YAP1 and TAZ). However, interfering with the expression of miR-1207-5p reversed these results. In addition, the nude mouse tumor formation experiment suggested that low-expressed lncRNA-LUADT1 reduced the volume and weight of tumor tissues. In summary, lncRNA-LUADT1 down-regulation could inhibit NPC cell proliferation and invasion, which may be achieved through regulating miR-1207-5p expression and affecting TEAD1 expression, thus inhibiting the activation of Hippo/YAP signaling pathway.
Collapse
Affiliation(s)
- Ning Jiang
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Lijun Zhao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Dan Zong
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Li Yin
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Lirong Wu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Cheng Chen
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Xue Song
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Qian Zhang
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Xuesong Jiang
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Xia He
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210003, China
| | - Jifeng Feng
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210003, China
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Wu Y, Wei X, Yuan Z, Xu H, Li Y, Li Y, Hu L, Han G, Qian Y, Hu D. Phase II study of induction chemotherapy followed by concurrent chemoradiotherapy with raltitrexed and cisplatin in locally advanced nasopharyngeal carcinoma. Chin J Cancer Res 2020; 32:665-672. [PMID: 33223761 PMCID: PMC7666785 DOI: 10.21147/j.issn.1000-9604.2020.05.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective For locally advanced nasopharyngeal carcinoma (LA-NPC) patients, high incidences of distant metastases and severe treatment related toxicities are the main obstacles needed to be overcome. Raltitrexed, a specific thymidylate synthase inhibitor with a convenient administration schedule, has an acceptable and manageable toxicity, and possesses radio-sensitizing properties. To investigate the efficacy and safety of raltitrexed and cisplatin induction chemotherapy and concurrent chemoradiotherapy (IC+CCRT) in patients with LA-NPC, a phase II clinical study was conducted. Methods Sixty eligible patients with LA-NPC were enrolled into this study. A raltitrexed-cisplatin combination was used as part of an IC+CCRT regimen. Raltitrexed-cisplatin IC was given once every 3 weeks (q3w) for two cycles, followed by raltitrexed-cisplatin based CCRT q3w for two cycles. Intensity-modulated radiotherapy (IMRT) was given for all enrolled patients. Results All patients were included in survival analysis according to the intent-to-treat principle. The objective response rate (ORR) 3 months after treatment was 98%. The 2-year overall survival (OS) rate was 92%. The median relapse-free survival (RFS) time was 30.5 [95% confidence interval (95% CI), 28.4−32.3] months. The 2-year RFS rate was 85%. The 2-year local failure-free survival (LFFS) rate was 97% and the 2-year distant metastasis-free survival (DMFS) rate was 88%. Acute toxicities were mostly grade 2 and 3 reactions in bone marrow suppression, gastrointestinal side effect and oropharyngeal mucositis. Only two patients occurred grade 4 acute toxicities, one was bone marrow suppression and the other was dermatitis radiation. Conclusions The combination of raltitrexed and cisplatin has a comparable efficacy to those in standard first-line therapy.
Collapse
Affiliation(s)
- Yuan Wu
- Department of Radiation Oncology
| | | | | | | | | | - Ying Li
- Department of Radiation Oncology
| | - Liu Hu
- Department of Radiation Oncology
| | | | - Yu Qian
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430071, China
| | | |
Collapse
|
6
|
Two-year outcome of concurrent chemoradiation with carboplatin with or without adjuvant carboplatin/fluorouracil in nasopharyngeal cancer: A multicenter randomized trial. Curr Probl Cancer 2020; 45:100620. [PMID: 32713518 DOI: 10.1016/j.currproblcancer.2020.100620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to the noninferiority result of chemoradiation with carboplatin in our previous nasopharyngeal carcinoma (NPC) study along with the inconclusive data on the efficacy of adjuvant chemotherapy (AC) following concurrent chemoradiotherapy (CCRT), we designed to assess the role of adjuvant carboplatin/fluorouracil following CCRT with carboplatin in locoregionally advanced NPC. MATERIALS AND METHODS A multicenter randomized trial was conducted at 5 cancer centers in Thailand. We enrolled in stage T2N0M0-T4N2M0 (American Joint Cancer Committee 7th edition) WHO Type 2 NPC patients. N3 or metastatic disease patients were excluded. Participants were randomized into 2 groups: CCRT plus AC group vs the CCRT alone group. Patients in both groups received weekly carboplatin 100 mg/m2 for 6 cycles concurrently with radiotherapy 69.96-70 Gy. Patients in the AC group subsequently received 3 cycles of carboplatin area under curve-5 plus 1000 mg/m2/day of fluorouracil infusion within 96 hours every 3 weeks. We report the 2-year overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Treatment-related toxicities and compliance were also explored. RESULTS Of 175 patients, 82 (46.9%) were assigned to the AC group, and 93 (53.1%) to the CCRT group. The compliance rate during CCRT was 90% and 86% in the AC and CCRT group, whereas 81.7% during adjuvant treatment in the AC group. With a median follow-up time of 24.4 months (interquartile range 17.9-24.4), the 2-year OS rate was 89.6% in the AC group and 81.8% in the CCRT group (P= 0.167). The 2-year DFS rate was 86.8% in the AC group and 74.6% in the CCRT group (P = 0.042). The 2-year LRFS rate was 91.5% in the AC group and 88.2% in the CCRT group (P = 0.443). The 2-year DMFS rate was 85.4% in the AC group and 79.6% in the CCRT group (P = 0.294). The most frequent serious (grade 3/4) nonhematologic toxicity was acute mucositis, which occurred 5% in the AC group vs 4% in the CCRT group (P = 0.498). For hematologic toxicity, grade 3-4 leukopenia were found 10% and 5% in the adjuvant and CCRT groups, respectively (P = 0.003). Multivariate analyses determined stage N2 disease was an adverse prognostic factor associated with shorter OS, DFS, and DMFS. And the adjuvant treatment was a significant protective factor for only DFS. CONCLUSIONS The addition of adjuvant carboplatin/fluorouracil following CCRT with carboplatin significantly improved 2-year DFS in stage T2N0M0-T4N2M0 NPC albeit there was a nonsignificant trend in favor of a higher 2-year OS, LRFS, and DMFS. Long-term efficacy and late toxicities of AC still require exploration.
Collapse
|
7
|
Lang J, Hu C, Lu T, Pan J, Lin T. Chinese expert consensus on diagnosis and treatment of nasopharyngeal carcinoma: evidence from current practice and future perspectives. Cancer Manag Res 2019; 11:6365-6376. [PMID: 31372041 PMCID: PMC6628961 DOI: 10.2147/cmar.s197544] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a rare type of head and neck cancer, with a higher incidence reported only in Southeast Asia and Northern Africa. Owing to the rarity of NPC occurrence, no internationally accepted consensus or guideline for its diagnosis and treatment is available. Based on the current evidences and practices, the Chinese experts on multidisciplinary diagnosis and treatment of NPC were designated to develop a national consensus for the treatment strategy of NPC. In this consensus, we report the development for improving the treatment efficacy and quality of life of NPC patients in China. The consensus also describes and recommends the role of multidisciplinary management approach in the management of NPC. A multidisciplinary team should include experts from different domains who can cater to the individualized needs of patients with NPC in a much more efficient manner. In addition, the team may also play a key role in developing guiding principles for future research, contributing to the improvement in the management of NPC.
Collapse
Affiliation(s)
- Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Taixiang Lu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Tongyu Lin
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| |
Collapse
|
8
|
Alami Z, Bouhafa T, Elmazghi A, Hassouni K. [Contribution of concomitant radiochemotherapy in the management of undifferentiated carcinoma of the nasopharynx in adults]. Pan Afr Med J 2019; 31:98. [PMID: 31019648 PMCID: PMC6465754 DOI: 10.11604/pamj.2018.31.98.14951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/09/2018] [Indexed: 11/18/2022] Open
Abstract
L'objectif de l'étude et d'Analyser les caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutives du carcinome indifférencié du nasopharynx de l'adulte. Il s'agit d'une étude cohorte rétrospective portant sur 163 patients âgés de 17 ans et plus, traités pour un carcinome indifférencié du nasopharynx non métastatique. L'âge moyen des patients était de 46,5ans, avec un sexe-ratio de 1,7. 35,57% des patients étaient atteints de tumeurs localement évoluées (T3-T4) et 52,27% avec une atteinte ganglionnaire régionale avancée (N2-N3). Sur le plan thérapeutique une chimiothérapie neoadjuvante a été réalisée chez 77% des patients et 93,8% des patients ont bénéficié d'une radio-chimiothérapie concomitante. Après un recul moyen de 40,8 mois la survie globale était de 92,9% et la survie sans récidive (SSR) était de 78,9%. L'analyse de la survie sans récidive SSR en fonction des différents facteurs pronostiques a montré une différence statistiquement significative pour l'atteint ganglionnaire avec des taux de SSR à trois ans de 88%, 82,6%, 80,8% et 61,5% en cas de tumeur classée N0, N1, N2 et N3 respectivement (p = 0,02). Le cancer du nasopharynx est une maladie complexe, mais des progrès ont été accomplis grâce à des percées en radiothérapie et en biologie moléculaire. La radio-chimiothérapie concomitante représente le standard thérapeutique des stades cliniques supérieur ou égal à T2, ou supérieur ou égal à N1. Les techniques innovantes d'irradiation semblent prometteuses et pourraient pallier aux problèmes de toxicité tardive tout en assurant un excellent taux de contrôle local.
Collapse
Affiliation(s)
- Zenab Alami
- Service de Radiothérapie, CHU Hassan II, Faculté de Médecine et de Pharmacie de Fès, Maroc
| | - Touria Bouhafa
- Service de Radiothérapie, CHU Hassan II, Faculté de Médecine et de Pharmacie de Fès, Maroc
| | - Abderrahmane Elmazghi
- Service de Radiothérapie, CHU Hassan II, Faculté de Médecine et de Pharmacie de Fès, Maroc
| | - Khalid Hassouni
- Service de Radiothérapie, CHU Hassan II, Faculté de Médecine et de Pharmacie de Fès, Maroc
| |
Collapse
|
9
|
Nasopharyngeal cancer in Saudi Arabia: Epidemiology and possible risk factors. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
10
|
Abstract
Head and neck cancers comprise 4% of the cancer burden in the United States each year. Many types of head and neck cancers present as an asymptomatic, nontender neck mass or nonspecific symptoms, such as hoarseness, sore throat, and pain. Head and neck cancers are frequently diagnosed incidentally by the primary care physician or dentist. This review summarizes the epidemiology, clinical manifestations, diagnosis, and treatment of several common head and neck cancers in order to provide an increased awareness for the internist to facilitate early detection of these diseases.
Collapse
Affiliation(s)
- Kenneth Yan
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Nishant Agrawal
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Zhen Gooi
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| |
Collapse
|
11
|
Wu M, Ou D, He X, Hu C. Long-term results of a phase II study of gemcitabine and cisplatin chemotherapy combined with intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma. Oral Oncol 2017; 73:118-123. [PMID: 28939063 DOI: 10.1016/j.oraloncology.2017.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate long-term results of a phase II study of induction and adjuvant gemcitabine and cisplatin (GP) chemotherapy with intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and methods One hundred and twelve patients (Stage III: 65, IVA-B: 47) with locoregionally advanced NPC were enrolled in this study. All patients received induction chemotherapy consisting of 1000 mg/m2 gemcitabine on day 1 and 8, and cisplatin 25 mg/m2 on day 1–3, every 3 weeks for 2 cycles. Adjuvant chemotherapy for 2 cycles of the same regime was given 28 days after the end of IMRT. The IMRT technique was utilized for all patients. Results In total, 97.3% patients completed 2 cycles of induction chemotherapy. The overall response rate (RR) of cervical lymph nodes was 89.0%. Acute toxicities were mainly grade 1–2 myleosuppression and vomiting. And 83.9% patients completed 2 cycles of adjuvant chemotherapy. All patients finished IMRT with RR at the end of IMRT for nasopharynx, lymph nodes of neck and retropharyngeal area being 99.1%, 97.9% and 97.7%, respectively. The 5-year local control, regional control, distant metastasis-free and overall survival rates were 93.2%, 92.3%, 89.0% and 82.1%, respectively. The 5-year overall survival of stage III and IVA-B were 87.0%, and 75.5%, respectively. The incidence of grade 3–4 acute radiotherapy-related mucositis was 28.6%. Severe late toxicities were uncommon. Conclusion IMRT combined with GP for locoregionally advanced NPC is well tolerated, effective, and convenient, and warrants further studies.
Collapse
Affiliation(s)
- Mingyao Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Dan Ou
- 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.
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| |
Collapse
|
12
|
Sun J, Huang Z, Hu Z, Sun R. Benefits of local tumor excision and pharyngectomy on the survival of nasopharyngeal carcinoma patients: a retrospective observational study based on SEER database. J Transl Med 2017; 15:116. [PMID: 28558725 PMCID: PMC5450381 DOI: 10.1186/s12967-017-1204-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is ongoing debate about surgery of primary site in nasopharyngeal carcinoma patients. METHODS 3919 patients with nasopharyngeal carcinoma identified in the SEER registry between 2004 and 2013. The benefit of surgery of primary nasopharynx tumor site on overall and cancer-specific survival was assessed by risk-adjusted multivariate Cox proportional hazard regression and propensity score matching modeling. RESULTS Surgery was marginally associated with better overall survival (hazard ratio (HR) = 0.816, 95% CI 0.656-1.015, p = 0.07) and cancer-specific survival (HR = 0.749, 95% CI 0.552-1.018, p = 0.06) in the propensity score model. Among 398 cases who underwent primary site surgery, 282 (70.85%) received local tumor excision and 79 (20.31%) received pharyngectomy. Local tumor excision and pharyngectomy had almost the same effect on survival in propensity score matching analysis. The benefit was significant in subgroups of white, age <60 year, and patients with T3, N1, M0, AJCC stage III, or moderately differentiated tumors. Further survival analysis showed surgery to promote survival in both radiotherapy and non-radiotherapy patients. CONCLUSION This is the first population-based analysis using propensity score model to provide evidence of a positive impact of surgery on survival in nasopharyngeal carcinoma. Moreover, surgery demonstrated the significant benefit in subgroups of patients with specific clinical characteristics.
Collapse
Affiliation(s)
- Jian Sun
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road, East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zhongying Huang
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road, East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zheyu Hu
- Department of Clinical Research and Teaching, First Hospital of Changsha City, No. 311 Yinpan Road, East, Changsha, 410005, People's Republic of China.
| | - Rui Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| |
Collapse
|
13
|
Ma WL, Liu R, Huang LH, Zou C, Huang J, Wang J, Chen SJ, Meng XG, Yang JK, Li H, Yang GP, Guo CX. Impact of polymorphisms in angiogenesis-related genes on clinical outcomes of radiotherapy in patients with nasopharyngeal carcinoma. Clin Exp Pharmacol Physiol 2017; 44:539-548. [PMID: 28199751 DOI: 10.1111/1440-1681.12738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Wan-Le Ma
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Rong Liu
- Department of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha Hunan China
| | - Li-Hua Huang
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Chan Zou
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Jie Huang
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Jing Wang
- Jiangxi Province Tumour Hospital; Nanchang Jiangxi China
| | - Shao-Jun Chen
- Department of Oncology; Fourth Affiliated Hospital; Guangxi Medical University; Liuzhou Guangxi China
| | - Xiang-Guang Meng
- Laboratory of Cardiovascular Disease and Drug Research; Zhengzhou No. 7 People's Hospital; Zhengzhou Henan China
| | - Jing-Ke Yang
- Department of Haematology; Affiliated Cancer Hospital; Zhengzhou University; Zhengzhou Henan China
| | - Han Li
- Zhang Zhongjing College of Chinese Medicine; Nanyang Institute of Technology; Nanyang Henan China
| | - Guo-Ping Yang
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| | - Cheng-Xian Guo
- Centre of Clinical Pharmacology; the Third Xiangya Hospital; Central South University; Changsha Hunan China
| |
Collapse
|
14
|
Effects of gene polymorphisms in the endoplasmic reticulum stress pathway on clinical outcomes of chemoradiotherapy in Chinese patients with nasopharyngeal carcinoma. Acta Pharmacol Sin 2017; 38:571-580. [PMID: 28216622 DOI: 10.1038/aps.2016.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/18/2016] [Indexed: 12/16/2022] Open
Abstract
There is considerable inter-individual variabil¬ity in chemoradiotherapy responses in nasopharyngeal carcinoma (NPC) patients receiv¬ing the same or similar treatment protocols. In this study we evaluated the association between the gene polymorphisms in endoplasmic reticulum (ER) stress pathway and chemoradiation responses in Chinese NPC patients. A total of 150 patients with histopathologically conformed NPC and treated with concurrent chemoradiotherapy were enrolled. Genotypes in ER stress pathway genes, including VCP (valosin-containing protein) rs2074549, HSP90B1 rs17034943, CANX (calnexin) rs7566, HSPA5 [heat shock protein family A (Hsp70) member 5] rs430397, CALCR (calcitonin receptor) rs2528521, and XBP1 (X-box binding protein 1) rs2269577 were analyzed by Sequenom MassARRAY system. The short-term effects of primary tumor and lymph node after radiotherapy were assessed based on the Response Evaluation Criteria in Solid Tumors (RECIST) of WHO. And acute radiation-induced toxic reactions were evaluated according to the Radiation Therapy Oncology Group or European Organization for Research and Treatment of Cancer (RTOG/EORTC). The effects of gene polymorphisms on clinical outcomes of chemoradiotherapy were assessed by chi-square test, univariate and multivariate logistic regression analyses. We found that CT and CT+CC genotypes of CANX rs7566 was significantly correlated with primary tumor treatment efficacy at 3 months after chemoradiotherapy and with occurrence of radiation-induced myelosuppression in Chinese NPC patients. CT and CT+CC genotypes of CALCR rs2528521 were significantly correlated with cervical lymph node efficacy at 3 months after chemoradiotherapy. And CC and CT+CC genotypes of VCP rs2074549 were significantly associated with occurrence of myelosuppression. In conclusion, SNPs of VCP rs2074549, CANX rs7566 and CALCR rs2528521 in ER stress pathway genes may serve as predictors for clinical outcomes of chemoradiotherapy in Chinese NPC patients.
Collapse
|
15
|
Alorabi M, Shonka NA, Ganti AK. EGFR monoclonal antibodies in locally advanced head and neck squamous cell carcinoma: What is their current role? Crit Rev Oncol Hematol 2015; 99:170-9. [PMID: 26797287 DOI: 10.1016/j.critrevonc.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/25/2015] [Accepted: 12/15/2015] [Indexed: 01/29/2023] Open
Abstract
Treatment options for locally advanced squamous cell carcinoma of the head and neck (SCCHN) include either surgical resection followed by radiation or chemoradiation, or definitive chemoradiation for which single-agent cisplatin is the best studied and established. The increasing understanding of the molecular biology of SCCHN has led to an interest in the development of targeted therapies. The epidermal growth factor receptor (EGFR) is over-expressed in nearly 80-90% of cases of SCCHN and correlates with poor prognosis and resistance to radiation. Preclinical evidence showed that blocking EGFR restores radiation sensitivity and enhances cytotoxicity. This finding led to clinical trials evaluating this class of agents and the approval of cetuximab in combination with radiation for the treatment of locally advanced SCCHN. This review is focused on the anti-EGFR monoclonal antibodies and their role either with radiotherapy or chemoradiation in unresectable LA SCCHN.
Collapse
Affiliation(s)
- Mohamed Alorabi
- Department of Clinical Oncology, Ain Shams University Hospitals, Cairo, Egypt
| | - Nicole A Shonka
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
| |
Collapse
|
16
|
Expression and Prognostic Significance of Macrophage Inflammatory Protein-3 Alpha and Cystatin A in Nasopharyngeal Carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:617143. [PMID: 26634210 PMCID: PMC4655043 DOI: 10.1155/2015/617143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
This study aims to investigate the expression of macrophage inflammatory protein-3 alpha (MIP-3α) and cystatin A in nasopharyngeal carcinoma (NPC) and their association with clinical characteristics and prognosis. Primary tumor specimens from 114 NPC patients and associated clinical follow-up data were collected, and the expression of MIP-3α and cystatin A proteins was investigated by immunohistochemistry. Expression of MIP-3α was significantly associated with TNM stage in patients with NPC (P < 0.05). NPC patients with positive expression of MIP-3α exhibited shorter median overall survival (OS) and distant metastasis-free survival (DMFS), compared with patients with negative expression (OS: 50.5 months versus 59.0 months, P = 0.013; DMFS: 50.1 months versus 60.2 months, P = 0.003). NPC patients with positive expression of cystatin A exhibited shorter median OS, local recurrence-free survival (LRFS), and DMFS, compared with patients with negative expression (OS: 51.1 months versus 60.0 months, P = 0.004; LRFS: 54.5 months versus 59.5 months, P = 0.036; DMFS: 52.3 months versus 58.8 months, P = 0.036). Both MIP-3α and cystatin A overexpressions in NPC tumor tissues were strong independent factors of poor prognosis in NPC patients. MIP-3α and cystatin A expressions may be valuable prognostic markers in NPC patients.
Collapse
|
17
|
Su M, Zhao L, Wei H, Lin R, Zhang X, Zou C. 18F-fluorodeoxyglucose positron emission tomography for predicting tumor response to radiochemotherapy in nasopharyngeal carcinoma. Strahlenther Onkol 2015; 191:642-8. [PMID: 25981635 DOI: 10.1007/s00066-015-0842-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/09/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to evaluate the value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting tumor response to radiochemotherapy in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS From July 2012 to March 2014, 46 NPC patients who had undergone PET scanning before receiving definitive intensity-modulated radiotherapy (IMRT) treatment in our hospital were enrolled. Factors potentially affecting tumor response to treatment were studied by multiple logistic regression analysis. RESULTS After radiochemotherapy, 32 patients had a clinical complete response (CR), making the CR rate 69.6%. Multiple logistic regression analysis demonstrated that the maximal standard uptake value (SUV max) of the primary tumor was the only factor related to tumor response (p = 0.001), and that the logistic model had a high positive predictive value (90.6%). The area under the receiver operating characteristic (ROC) curve was 0.809, with a best cutoff threshold at 10.05. Patients with SUV max ≤ 10 had a higher CR rate than those with SUV max > 10 (p < 0.001). CONCLUSION The SUV max of the primary tumor before treatment is an independent predictor of tumor response in NPC.
Collapse
Affiliation(s)
- Meng Su
- Department of Radiation Oncology and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Street, 325000, Wenzhou, Zhejiang province, P.R. China
| | | | | | | | | | | |
Collapse
|
18
|
Efficacy of intensity-modulated radiotherapy with concurrent carboplatin in nasopharyngeal carcinoma. Radiol Oncol 2015; 49:155-62. [PMID: 26029027 PMCID: PMC4387992 DOI: 10.2478/raon-2014-0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/01/2014] [Indexed: 11/20/2022] Open
Abstract
Background. The aim of the prospective phase II study was to evaluate the efficacy and toxicities of concurrent carboplatin with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC). Patients and methods. Between October 2005 and November 2011, 73 stage II–IVB NPC patients received IMRT 70 Gy concurrently with three cycles of carboplatin (AUC 5) every three weeks, followed by three cycles of adjuvant carboplatin (AUC 5) and 5-FU (1,000 mg/m2/day for four days) every four weeks. All patients were evaluated for tumour response using response evaluation criteria in solid tumour (RECIST) criteria, survival analysis using Kaplan-Meier methods, and toxicities according to common terminology criteria for adverse events (CTCAE) version 4.0. Results. At three months after chemoradiation, 82.2% and 17.8% of patients achieved complete and partial response, respectively. With a median follow-up of 48.1 months (1.3–97.8 months), 9.6% and 17.8% had local recurrence and distant metastasis, respectively. The median survival was not reached. A three-year overall survival was 83.6% and a progression-free survival was 65.3%. Regarding treatment compliance, 97.2%, 68.5% and 69.8% completed radiation treatment, concurrent carboplatin and adjuvant chemotherapy, respectively. Grade 3–4 acute toxicities were oral mucositis (16.4%), dysphagia (16.4%), xerostomia (15.1%) and haematotoxicity (6.8%). Conclusions. Carboplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. This should be considered as an alternative treatment for NPC patients.
Collapse
|
19
|
Li J, Chen QY, He J, Li ZL, Tang XF, Chen SP, Xie CM, Li YQ, Huang LX, Ye SB, Ke ML, Tang LQ, Liu H, Zhang L, Guo SS, Xia JC, Zhang XS, Zheng LM, Guo X, Qian CN, Mai HQ, Zeng YX. Phase I trial of adoptively transferred tumor-infiltrating lymphocyte immunotherapy following concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. Oncoimmunology 2015; 4:e976507. [PMID: 25949875 DOI: 10.4161/23723556.2014.976507] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
Adoptive cell therapy (ACT) for cancers using autologous tumor-infiltrating lymphocytes (TILs) can induce immune responses and antitumor activity in metastatic melanoma patients. Here, we aimed to assess the safety and antitumor activity of ACT using expanded TILs following concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Twenty-three newly diagnosed, locoregionally advanced NPC patients were enrolled, of whom 20 received a single-dose of TIL infusion following CCRT. All treated patients were assessed for toxicity, survival and clinical and immunologic responses. Correlations between immunological responses and treatment effectiveness were further studied. Only mild adverse events (AEs), including Grade 3 neutropenia (1/23, 5%) consistent with immune-related causes, were observed. Nineteen of 20 patients exhibited an objective antitumor response, and 18 patients displayed disease-free survival longer than 12 mo after ACT. A measurable plasma Epstein-Barr virus (EBV) load was detected in 14 patients at diagnosis, but a measurable EBV load was not found in patients after one week of ACT, and the plasma EBV load remained undetectable in 17 patients at 6 mo after ACT. Expansion and persistence of T cells specific for EBV antigens in peripheral blood following TIL therapy were observed in 13 patients. The apparent positive correlation between tumor regression and the expansion of T cells specific for EBV was further investigated in four patients. This study shows that NPC patients can tolerate ACT with TILs following CCRT and that this treatment results in sustained antitumor activity and anti-EBV immune responses. A larger phase II trial is in progress.
Collapse
Key Words
- ACT, adoptive cell therapy
- CCRT, concurrent chemoradiotherapy
- CR, complete response
- DFS, disease-free survival, EBNA1
- EBV, Epstein–Barr virus
- EBV-CTLs, EBV-specific cytotoxic T cells
- ELISPOT, enzyme-linked immunospot
- Epstein–Barr virus nuclear antigen 1
- FACS, fluorescence-activated cell sorting
- GMP, good manufacturing practices
- LMP1, latent membrane protein-1
- LMP2, latent membrane protein-2
- NPC, nasopharyngeal carcinoma
- PBMCs, peripheral blood mononuclear cells
- PD, progressive disease
- PR, partial response
- REP, rapid expansion protocol
- SFCs, spot-forming cells
- TILs, tumor-infiltrating lymphocytes
- adoptive cell therapy
- nasopharyngeal carcinoma
- tumor-infiltrating lymphocytes
Collapse
Affiliation(s)
- Jiang Li
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Qiu-Yan Chen
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Jia He
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Ze-Lei Li
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Xiao-Feng Tang
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Shi-Ping Chen
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Chuan-Miao Xie
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Imaging Diagnostic and Interventional Center; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Yong-Qiang Li
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Li-Xi Huang
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Shu-Bio Ye
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Miao-La Ke
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Huai Liu
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Lu Zhang
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Shan-Shan Guo
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Jian-Chuan Xia
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Xiao-Shi Zhang
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Li-Min Zheng
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Biotherapy; Sun Yat-sen University Cancer Center ; Guangzhou, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Department of Nasopharyngeal Carcinoma
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China; Sun Yat-sen University Cancer Center ; Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine; Sun Yat-sen University Cancer Center ; Guangzhou, China
| |
Collapse
|
20
|
Xu JH, Guo WJ, Bian XH, Wu JF, Jiang XS, Guo YS, He X. A comparative study of locoregionally advanced nasopharyngeal carcinoma treated with intensity modulated irradiation and platinum-based chemotherapy. Cancer Radiother 2013; 17:297-303. [PMID: 23849438 DOI: 10.1016/j.canrad.2013.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the prognosis of three subgroups of locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy and platinum-based chemotherapy. PATIENTS AND METHODS Hundred and eighty-one consecutive patients with locoregionally advanced untreated nasopharyngeal carcinoma were retrospectively divided into three subgroups: locally advanced group (T3-4N0-1M0), regionally advanced group (T1-2N2-3M0) and the mixed group (T3-4N2-3M0). They were all treated with definitive intensity-modulated radiotherapy and platinum-based chemotherapy. Their prognosis were investigated and compared. Multivariate analysis was applied to identify the independent risk factors of study endpoints. RESULTS The 3-year locoregional control rates for locally advanced group, regionally advanced group, and the mixed group were 91.5%, 90.6% and 84.3% respectively, no significant difference was observed (P=0.656, P=0.429). The 3-year distant metastasis-free survival rates were 89.6%, 75.7% and 76.3%, respectively. The distant metastasis-free survival rate of the locally advanced group was significantly higher than the other two subgroups (P=0.028, P=0.028). The 3-year progression-free survival rates were 85.5%, 67.9% and 67.1% respectively with significance also favoring the locally advanced group (P=0.043, P=0.023). Nodal stage and the performance status were the independent risk factors of distant metastasis in the observed period. CONCLUSIONS In the context of intensity-modulated radiotherapy and platinum-based chemotherapy, the locally advanced group had a better prognosis compared with the regionally advanced group and the mixed group. Treatment stratification may be based on nodal stage.
Collapse
Affiliation(s)
- J H Xu
- Department of Radiation Oncology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, 42# Baiziting, Xuanwu District, Nanjing 210009, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
21
|
Wu X, Huang PY, Peng PJ, Lu LX, Han F, Wu SX, Hou X, Zhao HY, Huang Y, Fang WF, Zhao YY, Xue C, Hu ZH, Zhang J, Zhang JW, Ma YX, Liang WH, Zhao C, Zhang L. Long-term follow-up of a phase III study comparing radiotherapy with or without weekly oxaliplatin for locoregionally advanced nasopharyngeal carcinoma. Ann Oncol 2013; 24:2131-6. [PMID: 23661293 DOI: 10.1093/annonc/mdt163] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previous results from our trial showed that adding oxaliplatin to radiotherapy (RT) increased survival in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) at 2 years. Here, we present the data of long-term efficacy and late toxic effects. PATIENTS AND METHODS Between January 2001 and January 2003, 115 Patients with nonkeratinizing/undifferentiated locoregionally advanced NPC were randomly to receive either RT alone (n = 56) or plus concurrent oxaliplatin 70 mg/m(2) weekly for six cycles (n = 59). RESULTS After a median follow-up of 114 months (range 18-139 months), the 5-year overall survival (OS) and metastasis-free survival (MFS) rates in the concurrent chemoradiotherapy (CCRT) group were significantly higher than those observed in the RT-alone group (OS, 73.2% versus 60.2%, P = 0.028; MFS, 74.7% versus 63.0%, P = 0.027). However, CCRT did not improve locoregional failure-free survival significantly. Subgroup analyses showed that the superiorities of CCRT mainly existed in the T3-4N0-1 stage subgroup (OS: HR = 0.394, P = 0.034). The grade 3/4 late toxic effects were similar in the two groups. CONCLUSION(S) The long-term follow-up data confirms the role of CCRT as a treatment of locoregionally advanced NPC. Oxaliplatin can be considered as an alternative optional therapeutic regimen for these patients due to its high efficiency and low toxic effect.
Collapse
Affiliation(s)
- X Wu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Jilani OK, Singh P, Wernicke AG, Kutler DI, Kuhel W, Christos P, Nori D, Sabbas A, Chao KC, Parashar B. Radiation therapy is well tolerated and produces excellent control rates in elderly patients with locally advanced head and neck cancers. J Geriatr Oncol 2012; 3:S1879-4068(12)00045-8. [PMID: 24386015 DOI: 10.1016/j.jgo.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Management of locally advanced head and neck cancer (LAHNC) in the elderly is challenging due to multiple co-morbidities, poor organ function and performance status. The aim of this study was to evaluate efficacy of radiation therapy (RT) in elderly patients, defined as 65 years and older, with high-risk LAHNC. MATERIALS AND METHODS An IRB approved retrospective chart review of elderly patients was performed, of whom 73 patients were selected for analysis. The stages included were II/III-IV. Sites included were oropharynx, oral cavity, larynx, salivary gland, nasopharynx, nasal cavity, paranasal sinus, hypopharynx and unknown primary. RESULTS Median age was 74 years. Thirty nine (53%) patients received concurrent chemotherapy. Median time to completion of RT was 53 days. Median external beam radiotherapy (EBRT) dose was 66 Gy. With a median follow-up of 24 months, overall local control (LC) was 80% and distant metastasis (DM) was 12%. Sixty patients (82%) were alive at the time of study. Two-year overall survival (OS) was 96% (95% CI=87%, 99%). Chemotherapy did not improve LC [80% (chemo) vs 79% (no chemo), p=0.88] or DM [11% (chemo) vs 14% (no chemo), p=0.73]. Interestingly, patients receiving RT using intensity-modulated radiation therapy (IMRT) had a significantly higher rate of LC vs three-dimensional conformal radiotherapy (3DCRT) (94% vs 68%, respectively, p=0.008). Grade 2/3 toxicity was seen in 70/73 (96%) patients while grade 4 toxicity was seen in three patients (4%). CONCLUSION Elderly patients with LAHNC have high rates of LC and OS. Prospective studies can reveal more insight into this increasingly important clinical problem in elderly patients.
Collapse
Affiliation(s)
- Omar K Jilani
- Stich Radiation Center, Weill Cornell Medical Center, New York, NY 10065
| | | | | | - David I Kutler
- Department of Otorhinolaryngology, Weill Cornell Medical Center, New York, NY 10065
| | - William Kuhel
- Department of Otorhinolaryngology, Weill Cornell Medical Center, New York, NY 10065
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical Center, New York, NY 10065
| | - Dattatreyudu Nori
- Stich Radiation Center, Weill Cornell Medical Center, New York, NY 10065
| | - Albert Sabbas
- Stich Radiation Center, Weill Cornell Medical Center, New York, NY 10065
| | - Ks Clifford Chao
- Stich Radiation Center, Weill Cornell Medical Center, New York, NY 10065
| | - Bhupesh Parashar
- Stich Radiation Center, Weill Cornell Medical Center, New York, NY 10065
| |
Collapse
|
23
|
Wang J, Shi M, Hsia Y, Luo S, Zhao L, Xu M, Xiao F, Fu X, Li J, Zhou B, Long X. Failure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China: a pilot study. Radiat Oncol 2012; 7:2. [PMID: 22233756 PMCID: PMC3269351 DOI: 10.1186/1748-717x-7-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/10/2012] [Indexed: 12/18/2022] Open
Abstract
Purpose To evaluate the clinical outcomes and patterns of failure in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiotherapy (IMRT) in Northwest China. Methods and materials From January 2006 to December 2009, 138 NPC patients were treated at Xijing Hospital. Of them, 25 cases with stage I-II received IMRT only, 113 cases with stage III-IVb received IMRT plus accomplished platinum-based chemotherapy. The IMRT prescribed dose was PTV 68-74 Gy to gross disease in nasopharynx and 66-72 Gy to positive lymph nodes in 30-33 fractions, and high risk and low risk region PTV was 60-63 Gy and 50.4~56 Gy in 30~33 and 28 fractions respectively. Plasma Epstein Barr virus (EBV) DNA load was measured before treatment. The clinical toxicities, outcomes and patterns of failure were observed. Results The median follow up time was 23 months (range 2 to 53 months). EBV infection positive was only 15.9%. Overall disease failure developed in 36 patients, 99% belonged to stage III/IV disease. Among these, there were 26 distant metastases, 6 local recurrence, and 4 regional recurrence. The 3-year local control rate(LCR), distant metastasis-free survival (MFS), disease-free survival (DFS) and the overall survival (OS) was 93.9%, 79.5%, 70% and 83.1% respectively. Multivariate analyses revealed that age and anemia pre-radiotherapy were independent predictors for OS. Conclusion IMRT with or without chemotherapy can improve the long term survival of NPC patients in Northwest China. Distant metastasis becomes the main cause of treatment failure. Age and anemia before radiotherapy were the main prognosis factors of NPC patients.
Collapse
Affiliation(s)
- Jianhua Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No,15 Changle West Road, Xi'an, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|