Effects of locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: A real-world study

Zeng, Fujuan; Lu, Tianzhu; Xie, Fei; Chen, Lizhi; Lin, Zhongqiu; Su, Yong; Yu, Zhongren; Xiao, Yun; Fan, Ao; Li, Guoqing; Chen, Zhiping; Gong, Xiaomeng; Li, Jingao

doi:10.1016/j.tranon.2021.101187

Cited by 8 publications

(13 citation statements)

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“…Unlike previous studies, our model combined both anatomical and biological factors, and the optimal factors were selected to risk stratify patients accurately [ 16 , 17 ]. Based on our model, dmNPC patients were divided into three risk categories with significant differences in OS: the low-risk group (involved lesions ≤ 4 without liver involvement), the intermediate-risk group (involved lesions ≤ 4 with liver involvement or involved lesions > 4 with EBV-DNA < 62,000 copies/ml) and the high-risk group (involved lesions > 4 with EBV-DNA > 62,000 copies/ml).…”

Section: Discussionmentioning

confidence: 99%

Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis

et al. 2023

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Background The high heterogeneity of de novo metastatic nasopharyngeal carcinoma (dmNPC) makes its prognosis and treatment challenging. We aimed to accurately stage dmNPC and assess the patterns of treatment strategies for different risk groups. Methods The study enrolled a total of 562 patients, 264 from 2007 to 2013 in the training cohort and 298 from 2014 to 2017 in the validation cohort. Univariate and multivariate Cox regression analyses were conducted to determine the independent variables for overall survival (OS). Recursive partitioning analysis (RPA) was applied to establish a novel risk-stratifying model based on these variables. Results After pairwise comparisons of OS, three risk groups were generated: low-risk (involved lesions ≤ 4 without liver involvement), intermediate-risk (involved lesions ≤ 4 with liver involvement or involved lesions > 4 with Epstein–Barr virus (EBV)-DNA < 62,000 copies/ml), and high-risk (involved lesions > 4 with EBV-DNA > 62,000 copies/ml). The 3-year OS rate differed significantly between groups (80.4%, 42.0%, and 20.4%, respectively, all P < 0.05). Adding locoregional intensity-modulated radiotherapy (LRRT) followed by palliative chemotherapy (PCT) resulted in a significant OS benefit over PCT alone for the low- and intermediate-risk groups (P = 0.0032 and P = 0.0014, respectively). However, it provided no survival benefits for the high-risk group (P = 0.6). Patients did not benefit from concurrent chemotherapy during LRRT among the three subgroups (P = 0.12, P = 0.13, and P = 0.3, respectively). These results were confirmed with the validation cohort. Conclusions The novel RPA model revealed superior survival performance in subgroup stratification and could facilitate more effective treatment strategies for dmNPC.

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Section: Discussionmentioning

confidence: 99%

Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis

et al. 2023

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“…Recently, two retrospective studies from our center and other center found that the OMD model with ≤2 organs and ≤5 metastatic lesions could not only effectively evaluate the prognosis of patients with M1-NPC, but could also help to screen populations benefit from LR-RT. 4,13 Therefore, we believe that OMD (≤2 metastatic organs and ≤5 lesions) may be an appropriate definition in M1-NPC.…”

Section: Discussionmentioning

confidence: 99%

“…De novo metastatic nasopharyngeal carcinoma (M1‐NPC) accounts for 5%–10% of newly diagnosed NPC cases 1 . M1‐NPC generally has a poor long‐term survival, with 3‐year overall survival (OS) of 20%–30% 2–4 . However, heterogeneity exist.…”

Section: Introductionmentioning

confidence: 99%

“…Emerging data showed that M1‐NPC patients with different metastatic extent or site of metastasis may have different outcomes and may require different treatment approaches 8–12 . OMD is reported as an important prognostic indicator for M1‐NPC 4,6,7,13 . However, the definition of OMD remains unsettled.…”

Section: Introductionmentioning

confidence: 99%

“…Retrospective and prospective clinical studies have confirmed that locoregional radiotherapy (LR‐RT), that is, RT to primary tumor and cervical nodal areas, in M1‐NPC can significantly improve progression‐free survival (PFS) and OS 18,19 . However, previous retrospective studies have confirmed that not all patients with M1‐NPC benefit from LR‐RT and that OMD status may be an excellent way to differentiate the benefiting population 4,13,20 . In addition, systemic treatment of M1‐NPC has entered a new era of immunotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Anatomic prognostic factors and their potential roles in refining M1 classification for de novo metastatic nasopharyngeal carcinoma

Lu,

Zeng,

et al. 2023

Cancer Medicine

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Background and PurposeTo identify anatomic prognostic factors and their potential roles in refining M1 classification for de novo metastatic nasopharyngeal carcinoma (M1‐NPC).Materials and MethodsAll M1‐NPC treated with chemotherapy and/or radiotherapy between 2010 and 2019 from two centers (training and validation cohort) were included. The prognostic value of metastatic disease extent and involved organs for overall survival (OS) were assessed by several multivariable analyses (MVA) models. A new M1 classification was proposed and validated in a separate cohort who received immuno‐chemotherapy.ResultsA total of 197 M1‐NPC in the training and 307 in the validation cohorts were included for M1 subdivision study with median follow‐up of 46 and 57 months. MVA model with “≤2 organs/≤5 lesions” as the definition of oligometastasis had the highest C‐index (0.623) versus others (0.606–0.621). Patients with oligometastasis had better OS versus polymetastasis (hazard ratio [HR] 0.47/0.63) while liver metastases carried worse OS (HR 1.57/1.45) in MVA in the training/validation cohorts, respectively. We proposed to divide M1‐NPC into M1a (oligometastasis without liver metastases) and M1b (liver metastases or polymetastasis) with 3‐year OS of 66.5%/31.7% and 64.9%/35.0% in the training/validation cohorts, respectively. M1a subset had a better median progress‐free survival (not reach vs. 17 months, p < 0.001) in the immuno‐chemotherapy cohort (n = 163).ConclusionOligometastasis (≤2 organs/≤5 lesions) and liver metastasis are prognostic for M1‐NPC. Subdivision of M1‐NPC into M1a (oligometastasis without liver metastasis) and M1b (liver metastasis or polymetastasis) depicts the prognosis well in M1‐NPC patients who received immuno‐chemotherapy.

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Clinical observational study on the efficacy of induction chemotherapy sequential concurrent radiotherapy combined with targeted therapy in patients with locally advanced EGFR-positive nasopharyngeal carcinoma: prediction model construction and efficacy testing

Luo

Xiang

2023

Eur Arch Otorhinolaryngol

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Objective To establish a nomogram for prediction of prognosis in EGFR-positive advanced nasopharyngeal carcinoma (NPC) patients who were treated with induction chemotherapy (IC) and concurrent chemoradiotherapy (CCRT). The clinical data of 124 NPC patients who received IC sequential CCRT combined with targeted therapy at the Department of Oncology of the Affiliated Hospital of North Sichuan Medical College between June 2017 and September 2022 were retrospectively reviewed. Logistic regression analysis was used to identify the prognostic factors for building the nomogram. Results Multifactorial regression analysis showed that the use of targeted drugs and T stage were independent factors of prognosis (p < 0.05) and the equation Y = 0.476 + 2.733X1 + − 0.758 × 2 (Y = efficacy, X1 = targeted drug therapy, X2 = T stage) was obtained. Then, a prognostic nomogram prediction model was constructed. The prediction model was validated internally for 1000 times using the Bootstrap resampling method with an accuracy of 79.29%. The calibration curve suggests that the predicted values fit well with the true values. The clinical decision curve (DCA) shows that the model has good clinical predictive value. Conclusion The use of targeted therapy significantly improved the prognosis of patients with EGFR-positive advanced NPC. For advanced NPC patients with T1 and T2 stages, IC sequenced with CCRT is more effective, and the addition of targeted therapy can further improve patients’ prognosis. For advanced NPC patients with T3 and T4 stages, IC sequenced with CCRT is ineffective, and the addition of targeted therapy can significantly improve patient prognosis.

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Effects of locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: A real-world study

Abstract: Highlights Locoregional radiotherapy can prolong OS for patients with de novo metastatic nasopharyngeal carcinoma. Nasopharyngeal carcinoma patients with oligometastic disease can benefit from locoregional radiotherapy rather than polymetastatic disease.

Cited by 8 publications

References 38 publications

Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis

Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis

Anatomic prognostic factors and their potential roles in refining M1 classification for de novo metastatic nasopharyngeal carcinoma

Clinical observational study on the efficacy of induction chemotherapy sequential concurrent radiotherapy combined with targeted therapy in patients with locally advanced EGFR-positive nasopharyngeal carcinoma: prediction model construction and efficacy testing

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