Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy and intensity-modulated radiotherapy alone for stage II nasopharyngeal carcinoma

Chen, Kaihua; Zhu, Xiaodong; Li, Ling; Qu, Song; Zeng, Liang; Xia, Liang; Pan, Xin-Bin; Liang, Zhong‐Guo; Jiang, Yanming

doi:10.18632/oncotarget.11978

Cited by 25 publications

(35 citation statements)

References 27 publications

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“…Moreover, a multi-center study suggested that CCRT improved 5-year LRFS and progression-free survival [ 32 ]. However, several retrospective cohort studies showed that IMRT alone was a reasonable option for stage II NPC whereas, in line with the present results, chemotherapy use failed to improve survival [ 10 – 12 , 15 – 17 ].…”

Section: Discussionsupporting

confidence: 83%

“…Moreover, no differences were found between subgroups in 5-year LRFS and OS. Of note, several studies showed similar results [ 10 , 11 , 14 , 15 ]. Yet, despite much evidence that chemotherapy did not improve survival of stage II NPC, it was still widely used in clinical practices.…”

Section: Discussionsupporting

confidence: 55%

“…Concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy (AC) is superior to radiotherapy (RT) alone in the treatment of locoregionally advanced NPC [ 3 – 8 ]. Although CCRT with or without AC is recommended for stage II NPC by the National Comprehensive Cancer Network [ 9 ], several studies suggested that chemotherapy use does not improve survival compared with RT alone [ 10 – 17 ]. The Chinese Anti-Cancer Association recommends RT alone for the T2N0 subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Chemotherapy use and survival in stage II nasopharyngeal carcinoma

et al. 2017

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Although common, the use of chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We therefore conducted a retrospective cohort study to investigate whether chemotherapy confers survival gains to stage II NPC patients. A total of 251 stage II (2010 UICC/AJCC staging system) NPC patients treated between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity-score matching method. The primary endpoint was overall survival (OS). Secondary endpoints were locoregional-free survival (LRFS) and distant metastasis-free survival (DMFS). Our analyses revealed no significant differences in OS, LRFS, or DMFS for stage II NPC patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC). T2N1 (OR = 6.690; 95% CI, 3.091–14.481) and T1N1 (OR = 5.857; 95% CI, 2.278–15.061) patients were more likely to receive CCRT than T2N0 patients. Similarly, both T2N1 (OR = 10.513; 95% CI, 3.439–32.137) and T1N1 (OR = 7.321; 95% CI, 1.978–27.098) patients were more likely to receive CCRT + AC than T2N0 patients. The present matched survival analysis suggests potential overuse of chemotherapy in stage II NPC, as the addition of chemotherapy did not provide a survival benefit in this group of patients.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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Chemotherapy use and survival in stage II nasopharyngeal carcinoma

et al. 2017

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“…However, an accurate staging system helps clinicians not only predicting prognoses, but also making treatment decisions. Recently, several studies have demonstrated that no survival benefits are found from the additional concurrent chemotherapy to NPC with stage Ⅱ disease[17–19]. Therefore, after comparing the two schemes of the new T stage system, we recommend that it may be better to merge the current T2 and T1 categories into the new T1 stage.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

Liang¹,

Chen²,

Niu³

et al. 2016

PLoS ONE

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ObjectiveThe aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system.MethodsBetween January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).ResultsIn terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2.ConclusionsThe two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2.

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“…The Kaplan-Meier survival curves showed no significant difference in OS (P=0.200), LRFS (P=0.204), or DMFS (P=0.064) in patients treated with RT alone, CCRT, or CCRT + AC. And Chen et al 27 demonstrated a similar result.…”

Section: Adjuvant or Induction Chemotherapy Combined With Imrt For Stmentioning

confidence: 73%

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

Wu¹,

Zhao²,

Li³

et al. 2020

CMAR

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Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensitymodulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.

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Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy and intensity-modulated radiotherapy alone for stage II nasopharyngeal carcinoma

Cited by 25 publications

References 27 publications

Chemotherapy use and survival in stage II nasopharyngeal carcinoma

Chemotherapy use and survival in stage II nasopharyngeal carcinoma

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

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