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Erschienen in:

06.09.2024 | Head and Neck Oncology

Evaluating the Efficacy of Different Treatment Intensities in Nasopharyngeal Carcinoma Patients: A Nationwide Cancer Registry-Based Study

verfasst von: Chung-Wen Jen, MD, Han-Ching Chan, PhD, Chun-Ju Chiang, PhD, Wen-Chung Lee, MD, PhD, Tzu-Pin Lu, PhD, Skye Hung-Chun Cheng, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2024

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Abstract

Objective

The aim of this study was to evaluate the efficacy of different treatment intensities (TIs) in patients with nasopharyngeal carcinoma (NPC).

Methods

The study assessed newly diagnosed, non-metastatic NPC patients from the Taiwan Cancer Registry between 2010 and 2017. TIs were divided into four groups: TI1 [radiotherapy (RT) alone or induction chemotherapy (IC) followed by RT); TI2 (concurrent chemoradiotherapy (CRT) alone); TI3 (IC followed by CRT or CRT followed by adjuvant chemotherapy (AC)]; and TI4 (IC followed by CRT followed by AC). The primary outcome was cancer-specific survival (CSS).

Results

The study included 9863 patients. For stage I–II NPC patients, there was no significant difference in CSS among the different TI groups. For stage III patients, those receiving TI3 had better CSS (hazard ratio [HR] 0.69) compared with those receiving TI1. No significant differences in CSS were noted among those receiving TI2, TI3, and TI4. For stage IVA–B patients, those receiving TI2 (HR 0.70), TI3 (HR 0.49), and TI4 (HR 0.43) had better CSS compared with those receiving TI1. Compared with stage IVA–B patients receiving TI2, those receiving TI3 (HR 0.70) and TI4 (HR 0.61) had significantly better CSS. No differences in CSS were noted between those receiving TI3 and TI4.

Conclusions

For stage I–II NPC patients, RT alone is appropriate. For stage III and IVA–B patients, IC + CRT or CRT + AC may be needed to achieve optimal outcomes. No advantage of IC + CRT + AC over IC + CRT or CRT + AC was observed.

Zhang MX, Li J, Shen GP, et al. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: a 10-year experience with a large cohort and long follow-up. Eur J Cancer. 2015;51(17):2587–95. https://doi.org/10.1016/j.ejca.2015.08.006.CrossRefPubMed

Yeh SA, Hwang TZ, Wang CC, et al. Outcomes of patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. J Radiat Res. 2021;62(3):438–47. https://doi.org/10.1093/jrr/rrab008.CrossRefPubMedPubMedCentral

Li X, Kitpanit S, Lee A, et al. Toxicity profiles and survival outcomes among patients with nonmetastatic nasopharyngeal carcinoma treated with intensity-modulated proton therapy versus intensity-modulated radiation therapy. JAMA Netw Open. 2021;4(6):e2113205. https://doi.org/10.1001/jamanetworkopen.2021.13205.CrossRefPubMedPubMedCentral

Blanchard P, Lee AWM, Carmel A, et al. Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): an update on 26 trials and 7080 patients. Clin Transl Radiat Oncol. 2022;32:59–68. https://doi.org/10.1016/j.ctro.2021.11.007.CrossRefPubMed

Ribassin-Majed L, Marguet S, Lee AWM, et al. What is the best treatment of locally advanced nasopharyngeal carcinoma? An individual patient data network meta-analysis. J Clin Oncol. 2017;35(5):498–505. https://doi.org/10.1200/JCO.2016.67.4119.CrossRefPubMed

Huang X, Chen X, Zhao C, et al. Adding concurrent chemotherapy to intensity-modulated radiotherapy does not improve treatment outcomes for stage ii nasopharyngeal carcinoma: a phase 2 multicenter clinical trial. Front Oncol. 2020;10:1314. https://doi.org/10.3389/fonc.2020.01314.CrossRefPubMedPubMedCentral

Chen YP, Ismaila N, Chua MLK, et al. Chemotherapy in combination with radiotherapy for definitive-intent treatment of stage II–IVA nasopharyngeal carcinoma: CSCO and ASCO guideline. J Clin Oncol. 2021;39(7):840–59. https://doi.org/10.1200/JCO.20.03237.CrossRefPubMed

Chiang CJ, Wang YW, Lee WC. Taiwan’s nationwide cancer registry system of 40 years: past, present, and future. J Formos Med Assoc. 2019;118(5):856–8. https://doi.org/10.1016/j.jfma.2019.01.012.CrossRefPubMed

Au KH, Ngan RKC, Ng AWY, et al. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: a report of 3328 patients (HKNPCSG 1301 study). Oral Oncol. 2018;77:16–21. https://doi.org/10.1016/j.oraloncology.2017.12.004.CrossRefPubMed

10.

Pan XB, Li L, Qu S, Chen L, Liang SX, Zhu XD. The efficacy of chemotherapy in survival of stage II nasopharyngeal carcinoma. Oral Oncol. 2020;101:104520. https://doi.org/10.1016/j.oraloncology.2019.104520.CrossRefPubMed

11.

Li XY, Chen QY, Sun XS, et al. Ten-year outcomes of survival and toxicity for a phase III randomised trial of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma. Eur J Cancer. 2019;110:24–31. https://doi.org/10.1016/j.ejca.2018.10.020.CrossRefPubMed

12.

Liu F, Jin T, Liu L, Xiang Z, Yan R, Yang H. The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0194733. https://doi.org/10.1371/journal.pone.0194733.CrossRefPubMedPubMedCentral

13.

Tang LL, Guo R, Zhang N, et al. Effect of radiotherapy alone vs radiotherapy with concurrent chemoradiotherapy on survival without disease relapse in patients with low-risk nasopharyngeal carcinoma: a randomized clinical trial. JAMA. 2022;328(8):728–36. https://doi.org/10.1001/jama.2022.13997.CrossRefPubMedPubMedCentral

14.

Argyriou AA, Bruna J, Marmiroli P, Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): an update. Crit Rev Oncol Hematol. 2012;82(1):51–77. https://doi.org/10.1016/j.critrevonc.2011.04.012.CrossRefPubMed

15.

Rademaker-Lakhai JM, Crul M, Zuur L, et al. Relationship between cisplatin administration and the development of ototoxicity. J Clin Oncol. 2006;24(6):918–24. https://doi.org/10.1200/JCO.2006.10.077.CrossRefPubMed

16.

Pabla N, Dong Z. Cisplatin nephrotoxicity: mechanisms and renoprotective strategies. Kidney Int. 2008;73(9):994–1007. https://doi.org/10.1038/sj.ki.5002786.CrossRefPubMed

17.

Wang C, Wang F, Min X, et al. Toxicities of chemoradiotherapy and radiotherapy in nasopharyngeal carcinoma: an updated meta-analysis. J Int Med Res. 2019;47(7):2832–47. https://doi.org/10.1177/0300060519858031.CrossRefPubMedPubMedCentral

18.

Zhang Y, Chen L, Hu GQ, et al. Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N Engl J Med. 2019;381(12):1124–35. https://doi.org/10.1056/NEJMoa1905287.CrossRefPubMed

19.

Hong RL, Hsiao CF, Ting LL, et al. Final results of a randomized phase III trial of induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in patients with stage IVA and IVB nasopharyngeal carcinoma-Taiwan Cooperative Oncology Group (TCOG) 1303 Study. Ann Oncol. 2018;29(9):1972–9. https://doi.org/10.1093/annonc/mdy249.CrossRefPubMed

20.

Li WF, Chen NY, Zhang N, et al. Concurrent chemoradiotherapy with/without induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma: long-term results of phase 3 randomized controlled trial. Int J Cancer. 2019;145(1):295–305. https://doi.org/10.1002/ijc.32099.CrossRefPubMed

21.

Yang Q, Cao SM, Guo L, et al. Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: long-term results of a phase III multicentre randomised controlled trial. Eur J Cancer. 2019;119:87–96. https://doi.org/10.1016/j.ejca.2019.07.007.CrossRefPubMed

22.

Frikha M, Auperin A, Tao Y, et al. A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006–02). Ann Oncol. 2018;29(3):731–6. https://doi.org/10.1093/annonc/mdx770.CrossRefPubMed

23.

Chen L, Hu CS, Chen XZ, et al. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer. 2017;75:150–8. https://doi.org/10.1016/j.ejca.2017.01.002.CrossRefPubMed

24.

Chen YP, Liu X, Zhou Q, et al. Metronomic capecitabine as adjuvant therapy in locoregionally advanced nasopharyngeal carcinoma: a multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial. Lancet. 2021;398(10297):303–13. https://doi.org/10.1016/S0140-6736(21)01123-5.CrossRefPubMed

25.

Tang LL, Huang CL, Zhang N, et al. Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial. Lancet Oncol. 2022;23(4):479–90. https://doi.org/10.1016/S1470-2045(22)00058-4.CrossRefPubMed

26.

Mai H-Q, Yang J-H, Guo S-S, et al. Reduced-dose radiotherapy for pretreatment EBV DNA selected low-risk stage III nasopharyngeal carcinoma: a single-arm, phase II trial. J Clin Oncol. 2022;40(16 Suppl):6002. https://doi.org/10.1200/JCO.2022.40.16_suppl.6002.CrossRef

27.

Chan ATC, Hui EP, Ngan RKC, et al. Analysis of plasma epstein-barr virus DNA in nasopharyngeal cancer after chemoradiation to identify high-risk patients for adjuvant chemotherapy: a randomized controlled trial. J Clin Oncol. 2018;36:3091–100. https://doi.org/10.1200/JCO.2018.77.7847.CrossRef

28.

Zhang Y, Chen L, Hu GQ, et al. Final overall survival analysis of gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma: a multicenter, randomized phase III trial. J Clin Oncol. 2022;40(22):2420–5. https://doi.org/10.1200/JCO.22.00327.CrossRefPubMed

29.

Lu T, Hu Y, Xiao Y, et al. Prognostic value of radiologic extranodal extension and its potential role in future N classification for nasopharyngeal carcinoma. Oral Oncol. 2019;99:104438. https://doi.org/10.1016/j.oraloncology.2019.09.030.CrossRefPubMed

30.

Ai QY, King AD, Poon DMC, et al. Extranodal extension is a criterion for poor outcome in patients with metastatic nodes from cancer of the nasopharynx. Oral Oncol. 2019;88:124–30. https://doi.org/10.1016/j.oraloncology.2018.11.007.CrossRefPubMed

31.

Ai QH, Hung KF, So TY, et al. Prognostic value of cervical nodal necrosis on staging imaging of nasopharyngeal carcinoma in era of intensity-modulated radiotherapy: a systematic review and meta-analysis. Cancer Imaging. 2022;22(1):24. https://doi.org/10.1186/s40644-022-00462-6.CrossRefPubMedPubMedCentral

32.

Zhang M, Wei S, Su L, Lv W, Hong J. Prognostic significance of pretreated serum lactate dehydrogenase level in nasopharyngeal carcinoma among Chinese population: a meta-analysis. Medicine (Baltimore). 2016;95(35):e4494. https://doi.org/10.1097/MD.0000000000004494.CrossRefPubMedPubMedCentral

33.

Tsai MH, Wu SY, Lu HH, Yu T, Tsai ST, Wu YH. Improved overall survival is associated with adjuvant chemotherapy after definitive concurrent chemoradiotherapy for N3 nasopharyngeal cancer. Sci Rep. 2022;12(1):13390. https://doi.org/10.1038/s41598-022-16422-w.CrossRefPubMedPubMedCentral

Titel: Evaluating the Efficacy of Different Treatment Intensities in Nasopharyngeal Carcinoma Patients: A Nationwide Cancer Registry-Based Study
verfasst von: Chung-Wen Jen, MD
Han-Ching Chan, PhD
Chun-Ju Chiang, PhD
Wen-Chung Lee, MD, PhD
Tzu-Pin Lu, PhD
Skye Hung-Chun Cheng, MD
Publikationsdatum: 06.09.2024
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 13/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16145-4

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Evaluating the Efficacy of Different Treatment Intensities in Nasopharyngeal Carcinoma Patients: A Nationwide Cancer Registry-Based Study