Comparing the 7th and 8th editions of UICC/AJCC staging system for nasopharyngeal carcinoma in the IMRT era

He, Tao; Yan, Ruo-Nan; Chen, Huaying; Zeng, Yuanyuan; Liu, Fang; Shao, Bianfei; Ma, Jiang; Wang, Xiran; Liu, Lei

doi:10.1186/s12885-021-08036-8

Cited by 15 publications

(14 citation statements)

References 25 publications

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“…Given that our primary end point was safety and toxic effects, we do not believe that the change in the staging system would be associated with changes in our end point. Furthermore, 10 patients in the entire cohort may possibly be downstaged given the change in the staging system since the completion of this study, and therefore, we do not feel that excellent treatment outcomes were purely outcomes associated with staging migration from T4 (AJCC Staging Manual, 7th Edition) to T2 (AJCC Staging Manual, 8th Edition) …”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma

et al. 2023

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ImportanceThe long-term outcomes associated with adding bevacizumab, a vascular endothelial growth factor inhibitor, to standard chemoradiation have continued to be favorable for a group of patients with locoregionally advanced nasopharyngeal carcinoma (NPC).ObjectiveTo assess long-term toxic effects and clinical outcomes associated with chemotherapy, radiation therapy (RT), and bevacizumab for NPC.Design, Setting, and ParticipantsThis single-arm phase II nonrandomized controlled trial was conducted by the National Cancer Trials Network group and NRG Oncology (formerly Radiation Therapy Oncology Group), with accrual from December 13, 2006, to February 5, 2009, and data analysis from June 26 to July 1, 2019. The study was conducted at 19 cancer centers with a median (IQR) follow-up of 9.0 (7.7-9.3) years. Included patients were adults (aged ≥18 years) with NPC that was World Health Organization (WHO) histologic grade I to IIb or III, American Joint Committee on Cancer stage IIB or greater, and with or without lymph node involvement.InterventionsPatients received 3 cycles of bevacizumab (15 mg/kg) concurrently with standard cisplatin (100 mg/m2) and RT (69.96 Gy) followed by 3 cycles of adjuvant bevacizumab (15 mg/kg) given concurrently with cisplatin (80 mg/m2) and fluorouracil (1000 mg/m2/d).Main Outcomes and MeasuresThe primary end point was grade 4 hemorrhage or grade 5 adverse events in the first year. Secondary end points were locoregional progression–free (LRPF) interval, distant metastasis–free (DMF) interval, progression-free survival (PFS), overall survival (OS), and other adverse events. Long-term toxic effects and clinical outcomes were reported due to the limited follow-up in the initial report for this trial and the importance of long-term outcomes when combining bevacizumab with chemoradiation.ResultsAmong 46 patients with NPC who were enrolled, 44 patients were analyzed (29 males [65.9%]; 23 Asian [52.3%], 2 Black [4.5%], and 16 White [36.4%]; 38 not Hispanic [86.4%]; median [IQR] age, 48.5 [39.0-56.0] years). There were 33 patients with a Zubrod performance status of 0, indicating that they were fully functional and asymptomatic (75.0%); 32 patients with a WHO histologic grade of IIb or III (72.7%); and 39 patients with stage III or IVB disease (88.6%). Among analyzed patients, 42 individuals received radiation therapy of 69.96 Gy or greater (95.5%; dose range, 65.72-70.00 Gy); 30 patients received 3 cycles of cisplatin (68.2%) with RT, and 31 patients received 3 cycles of bevacizumab with RT (70.5%); this was followed by 3 cycles of adjuvant cisplatin in 21 patients (47.7%), fluorouracil in 24 patients (54.5%), and bevacizumab in 23 patients (52.3%). No grade 4 hemorrhage or grade 5 AEs were reported in the first year or thereafter. Late grade 3 AEs occurred in 16 patients (36.4%), including 7 patients with dysphagia (15.9%), 6 patients with hearing impairment (13.6%), and 2 patients with dry mouth (4.5%). The 1- and 5-year rates of feeding tube use were 5 of 41 patients (12.2%) and 0 of 27 patients, respectively. There were 19 patients (43.2%) who progressed or died without disease progression (6 patients with locoregional progression [13.6%], 8 patients with distant progression [18.2%], and 5 patients who died without progression [11.4%]). The 5- and 7-year rates were 79.5% (95% CI, 67.6%-91.5%) and 69.7% (95% CI, 55.9%-83.5%) for OS, 61.2% (95% CI, 46.8%-75.6%) and 56.3% (95% CI, 41.5%-71.1%) for PFS, 74.9% (95% CI, 61.4%-86.6%) and 72.3% (95% CI, 58.4%-84.7%) for LRPF interval, and 79.5% (95% CI,66.4%-90.0%) for both times for DMF interval. Among 13 patients who died, death was due to disease in 8 patients (61.5%).Conclusions and RelevanceIn this nonrandomized controlled trial, no grade 4 hemorrhage or grade 5 AEs were reported in the first year or thereafter among patients with NPC receiving bevacizumab combined with chemoradiation. The rate of distant metastasis was low although 89% of patients had stage III to IVB disease, suggesting that further investigation may be warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT00408694

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Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma

et al. 2023

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“…Radiotherapy is recognized worldwidely as the primary treatment for non‐metastatic NPC and T4 disease is closely associated with poor prognosis. Based on previous literature reports, the 5‐year survival rate of T4 NPC was 56.5%–68.2%, which is significantly inferior to T1, T2, and T3 NPC 3–7 …”

Section: Introductionmentioning

confidence: 94%

“…Based on previous literature reports, the 5-year survival rate of T4 NPC was 56.5%-68.2%, which is significantly inferior to T1, T2, and T3 NPC. [3][4][5][6][7] Concurrent chemoradiotherapy was recommended for locally advanced NPC based on the results of twodimensional conventional radiotherapy (2D-CRT) era. 8 While in the era of intensity-modulated radiation therapy (IMRT), improved treatment outcomes and lessened side effects were obtained for NPC patients due to the advantages of distributing highly conformal dose to tumor while sparing the adjacent organs at risk (OARs).…”

Section: Introductionmentioning

confidence: 99%

Deletion of concurrent chemotherapy on the basis of sequential chemoradiotherapy for non‐metastatic stage T4 nasopharyngeal carcinoma in IMRT era

Zheng,

Xue,

et al. 2024

Cancer Medicine

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PurposeIntensity‐modulated radiotherapy (IMRT) combined with concurrent chemotherapy is deemed as the mainstay treatment in locoregionally advanced nasopharyngeal carcinoma (NPC). Nevertheless, the tolerance of severe acute toxicity of concurrent chemotherapy was unsatisfied. In addition, T4 is the predicting factor of poor prognosis for NPC patients. In this retrospective analysis, the long‐term outcomes IMRT combined by induction chemotherapy deleting concurrent chemotherapy with or without adjuvant chemotherapy for T4 non‐metastatic NPC were analyzed.Materials and MethodsFrom January 2005 to November 2016, a total of 145 biopsy‐proven non‐metastatic T4 NPC was treated with IMRT combined by induction chemotherapy with or without adjuvant chemotherapy. The survival and side effects of the patients were analyzed.ResultsMedian follow‐up time was 74 months (ranges, 8–186 months). 10.0%, 61.3%, 27.3%, and 1.3% developed grade 1, 2, 3, and 4 mucositis during IMRT, respectively. 5.5% and 2.0% patients experienced grade 1 and 2 nausea and vomiting; no patients developed grade 3 or 4 nausea and vomiting. Of 145 patients enrolled, 5‐year and 10‐year overall survival(OS) rates were 73.7% and 53.9%, local progression‐free survival(LPFS) rates were 86.1% and 71.6%, regional progression‐free survival(RPFS) rates were 96.7% and 92.8%, distant metastasis‐free survival (DMFS) rates were 86.7%, 78.2%, respectively. At the last follow‐up, five patients developed cranial nerve injury, one patient developed mandibular bone necrosis, four patients developed temporal lobe injury, four patients developed nasopharyngeal massive hemorrhage (three cases after recurrence and one case without recurrence), and five patients developed second primary tumor.ConclusionThe survival outcomes of treating T4 NPC IMRT combined by induction chemotherapy deleting concurrent chemotherapy with or without adjuvant chemotherapy are encouraging. Moreover, mucosal reaction, nausea, and vomiting reaction were reduced during IMRT.

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“…Nasopharyngeal carcinoma (NPC) and the morbidity and mortality arising from it in Southern China, Southeastern Asia, and North Africa are the highest in the world, with poorly differentiated or undifferentiated squamous cell carcinoma being the main pathologic types [1,2]. NPC is a highly invasive tumor, with the majority (up to 70%) being locally advanced at the time of detection [3,4]. The standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) is induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), or CCRT followed by adjuvant chemotherapy (AC), or only CCRT is [5,6].…”

Section: Introductionmentioning

confidence: 99%

Improving effectiveness using nimotuzumab (NTZ) in patients with nasopharyngeal carcinoma based on the 18F-FDG PET/CT maximum standardized uptake value

Fei

et al. 2023

Preprint

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Background: This study was aimed towards improving the efficacy of nimotuzumab (NTZ) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) using the maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose positron emission tomography (18-FDG PET) as a predictive and prognostic indicator. Method: 248 patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) who met the inclusion criteria of our study were subjected to PET/CT scan in our hospital prior to chemoradiotherapy from January 2012 to June 2019. Survival differences and independent factors between groups were assessed by the Kaplan–Meier method, log-rank test, and Cox proportional hazards regression analysis. Outcome measures included analysis of the cost-effectiveness ratio (ICER). Result: The optimal cutoff value for the maximum standardized uptake value (SUVmax) was 12.92 while the area under concentration-time curve (AUC) for the SUVmax was 0.596. The prognostic significance for overall survival (OS) with NTZ treatment (P=0.023) and SUVmax (P=0.014) was indicated by multivariate analysis. Exploratory subgroup survival analysis revealed that NPC patients with SUVmax >12.92 treated with concurrent chemoradiotherapy (CCRT) plus NTZ had a significantly improved 3-year OS than those treated with CCRT alone (96.2% vs. 73.2%, P=0.047). However, in those with SUVmax ≤12.92 treated with CCRT plus NTZ there was no statistically significant difference from those treated with only CCRT (97.6% vs.94.3%, P=0.129). The treatment cost with nimotuzumab was $6317.61, this additional cost being only $274.68 extra for every 1% increase in the OS rate, as indicated by the cost-effectiveness analysis. Conclusion: In LA-NPC patients with SUVmax >12.92, adding NTZ to CCRT improves overall survival and is cost-effective. However, the addition of NTZ was not effective for patients with SUVmax ≤12.92.

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Comparing the 7th and 8th editions of UICC/AJCC staging system for nasopharyngeal carcinoma in the IMRT era

Cited by 15 publications

References 25 publications

Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma

Long-term Outcomes of Bevacizumab and Chemoradiation for Locoregionally Advanced Nasopharyngeal Carcinoma

Deletion of concurrent chemotherapy on the basis of sequential chemoradiotherapy for non‐metastatic stage T4 nasopharyngeal carcinoma in IMRT era

Improving effectiveness using nimotuzumab (NTZ) in patients with nasopharyngeal carcinoma based on the 18F-FDG PET/CT maximum standardized uptake value

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