A retrospective study of concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy on curative effect for treatment of patients with N3 stage nasopharyngeal carcinoma

Abstract

IntroductionThe purpose of this study was to analyze the efficacy and safety of concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy for N3 stage nasopharyngeal carcinoma (NPC).MethodsThis study included 44 N3 stage NPC patients treated with concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy. The intensity-modulated radiation therapy doses were planning target volume (PTV) 70–72 Gy for gross disease in the nasopharynx and 66–70 Gy for positive lymph nodes. The doses for high-risk- and low-risk region PTV were 60–62 and 54–56 Gy in 31–33 fractions. All patients received a concurrent chemotherapy program consisting of cisplatin 100 mg/m2, day 1, and the cycle repetition was every 21 days. The adjuvant chemotherapy program consisted of 4 cycles of S-1. The dose of S-1 was determined according to the body surface area (BSA): 40 mg twice a day for BSA <1.25 m2; 50 mg twice a day for 1.25 m2≤BSA<1.5 m2; and 60 mg twice a day for BSA ≥1.5 m2. S-1 was given on days 1–28, given 6 weeks apart.ResultsAll 44 patients completed at least 2 cycles of concurrent chemotherapy and 4 cycles of adjuvant chemotherapy. The total efficiency of therapy was 100.0%. The 3-year overall survival (OS), distant metastasis-free survival (DMFS), local-regional control, and progression-free survival rates were 86.4%, 84.1%, 97.7%, and 81.8%, respectively. There were no differences in the OS, DMFS, and efficiency between fast-fading group (reaching partial response before the second cycle of concurrent chemotherapy) and general-fading group (the rest of the group). The incidence of rash in the entire group was low, and there was also no association with prognosis.ConclusionIn patients with N3 stage NPC, concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy yielded an excellent survival benefit, and the toxicities were mild and tolerable. Distant metastasis was the main cause of treatment failure.

Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma

“…A retrospective study has shown that the oral fluorouracil analog tegafur can effectively reduce the rate of distant metastasis in patients with NPC with high metastatic risk . Maintenance chemotherapy with S1 and capecitabine in a variety of metastatic cancers effectively improves the OS and has tolerable toxicity . Our results are consistent with these previous studies.…”

Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma

“…Only three patients were required to reduce the dose of MC and were unwilling to continue with their therapy due to the grade 2 leukopenia. The gastrointestinal toxicities and stomatitis are other commonly reported toxicities of MC with S-1 [5]. However, as demonstrated in this study, only one patient (4.5%) encountered grade II gastrointestinal toxicities and no nephrotoxicity was observed.…”

“…Despite of the fact that several high level studies had verified that compared to concurrent chemoradiotherapy (CCRT) alone, adjuvant chemotherapy (AC) following CCRT (CCRT-AC), which is hypothesized to eradicate micrometastases, had not achieved survival benefits in advanced NPC [1]; although it had been thought to benefit survival of N3-NPC patients [4, 5]. However, intensive AC should be conducted cautiously due to potential patient intolerance to chemotherapy that can result from the acute toxicity of CCRT [6].…”

“…It is designed to enhance the clinical utility of an oral fluoropyrimidineand is associated with low gastrointestinal toxicity [13]. Several researches have demonstrated that S-1 alone or in combination with other chemotherapy drugs yielded an excellent survival benefit in NPC patients as first or second line of chemotherapy [5, 14, 15]. Furthermore, S-1 is considered an appropriate regimen drug for MC owing to its convenience for outpatient oral administration, tolerable toxicity, favorable antitumor activity and improved survival [16, 17].…”

<p>Etiology and management of nasopharyngeal hemorrhage after radiotherapy for nasopharyngeal carcinoma</p>

“…Nasopharyngeal carcinoma (NPC) is the most common head and neck cancer in southern China, affecting 30 out of 100,000 people. It is usually diagnosed with a high degree of malignancy and consequently leads to >34,000 deaths annually 1. Currently, the primary treatment modality for NPC is radical radiation therapy, with chemotherapy as an auxiliary option.…”