Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials

Cheng, Skye Hongiun; Yen, Kuo‐Yang; Jian, James Jer-Min; Tsai, Shih Chang; Chu, Nai‐Shin; Leu, Szu-Yun; Chan, Kwan-Yee; Tan, Tran-Der; Cheng, J.C.Y.; Hsieh, Cheng-Yee; Huang, Andrew T.

doi:10.1016/s0360-3016(01)01509-7

Cited by 91 publications

(63 citation statements)

References 22 publications

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“…With the prospect of further improvement in local control with the increasing application of three-dimensional high-precision radiotherapy, distant failure is expected to become an even more outstanding problem. This point is well exemplified by recent studies that reported excellent local control in patients with advanced stage disease with the use of concomitant radiotherapy and chemotherapy 12 or intensity-modulated radiotherapy with or without chemotherapy. 1 Both studies had consistently demonstrated the increased burden of distant failure in NPC patients despite the achievement of excellent local control.…”

Section: Discussionmentioning

confidence: 79%

Lung metastasis alone in nasopharyngeal carcinoma: A relatively favorable prognostic group

Hui

Leung

et al. 2004

Cancer

177

114

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Section: Discussionmentioning

confidence: 79%

Lung metastasis alone in nasopharyngeal carcinoma: A relatively favorable prognostic group

Hui

Leung

et al. 2004

Cancer

177

114

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“…September 2009 distant metastases remains the major cause of treatment failure, and the outlook for stage IV patients remains poor (20).…”

Section: Molecular Cancer Therapeuticsmentioning

confidence: 99%

Recombinant adeno-associated virus encoding Epstein-Barr virus latent membrane proteins fused with heat shock protein as a potential vaccine for nasopharyngeal carcinoma

Pan

Zhang

Zhou

et al. 2009

Molecular Cancer Therapeutics

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Nasopharyngeal carcinoma (NPC) is a common cancer in Southern China and EBV is the most important pathogenesis. In this study, we explore the potential that a recombinant adeno-associated virus (rAAV) carrying a fusing gene containing heat shock protein as an adjuvant, EBV latent membrane proteins (LMP1 and LMP2) CTL epitope DNA as a vaccine prevents NPC. The tumor vaccine was devised by constructing a chimeric gene which contained EBV LMPs CTL epitope DNA fused with the heat shock protein gene as a tumor vaccine delivered via rAAV. Our results show that this vaccine can eliminate tumors in syngeneic animals and induce CTL activity in vitro. Taken together, the data suggest that this chimeric gene delivered by rAAV has potential as a NPC vaccine for prevention and therapy.

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“…Radical external radiotherapy (RT) has always been the mainstay of treatment for all-stage NPC (2). Currently, although patients with early-stage NPC may be cured by RT alone, the majority of NPC patients present with stage III or IV disease and have a poor prognosis (3). Numerous attempts have been made to improve the outcome of locoregionally advanced NPC (4).…”

Section: Introductionmentioning

confidence: 99%

“…cervix or non-melanoma cancers of the skin. The inclusion criteria were as follows: Karnofsky performance status ≥60%; WBC count ≥4,000̸mm 3 ; platelet count ≥100,000̸mm 3 ; serum creatinine level ≤1.6 mg̸dl; normal liver function with total bilirubin ≤2.5 mg̸dl; and no evidence of systemic metastasis. This study was performed following approval from the Institutional Ethics Committee.…”

Section: Introductionmentioning

confidence: 99%

Phase II trial of concurrent chemoradiotherapy with S-1 versus weekly cisplatin for locoregionally advanced nasopharyngeal carcinoma

Wen¹,

You²,

Lu³

et al. 2015

Molecular and Clinical Oncology

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Abstract. This is a prospective randomized trial performed to compare the efficacy of concurrent chemoradiotherapy (CCRT) + S-1 (oral fluoropyrimidine) with that of CCRT + cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma. A total of 105 eligible patients were randomly assigned to receive CCRT with S-1 (S-1 arm, n=50) or cisplatin weekly (control arm, n=55). Patients in the S-1 arm received CCRT plus S-1 (40-60 mg, twice daily for 4 consecutive weeks. Patients in the control arm received standard CCRT with weekly cisplatin. All the patients were included in an intention-to-treat survival analysis. Our results demonstrated that the S-1 and control arms did not differ significantly in terms of complete response, partial response, progression-free survival or overall survival (all P-values >0.05). However, the two arms varied significantly regarding certain grade 3-4 toxicities, including leukopenia, 5.5 vs. 22.0% (P= 0.013); mucositis, 20.0 vs. 46.0% (P= 0.004); dermatitis, 15.5 vs. 32.7% (P=0.011); and nausea, 9.1 vs. 41.6% (P<0.001) for the S-1 and control arms, respectively. In conclusion, CCRT with S-1 was found to be similar in efficacy but superior in terms of toxicity compared to the standard CCRT with weekly cisplatin. IntroductionNasopharyngeal carcinoma (NPC) is widespread in Southern China and Southeastern Asia, although it is less common in North America and Western Europe. Among head and neck carcinomas, NPC is characterized by clinical, pathological, phenotypic and biological heterogeneity (1). Radical external radiotherapy (RT) has always been the mainstay of treatment for all-stage NPC (2). Currently, although patients with early-stage NPC may be cured by RT alone, the majority of NPC patients present with stage III or IV disease and have a poor prognosis (3). Numerous attempts have been made to improve the outcome of locoregionally advanced NPC (4).As NPC has been found to be radiosensitive as well as chemosensitive and responds well to various chemotherapeutic agents, such as cisplatin, fluorouracil and paclitaxel (5-9), combined chemotherapy and RT have become the standard treatment strategy for locoregionally advanced NPC (10,11), particularly concurrent chemoradiotherapy (CCRT), on the basis of the INT 0099 trial (12). Randomized trials of induction chemotherapy followed by RT alone have resulted in encouraging response rates and improvement in disease-free survival (DFS), but not overall survival (OS) (13). The development of a sequential schedule of induction chemotherapy followed by chemoradiotherapy is a logical strategy to maximize the benefit from the two approaches, which has been widely used in Southern China. However, the high incidence of severe toxicity with this approach is the biggest obstacle to its wider application in the treatment of Asian patients with advanced NPC. The majority of the trials consistently demonstrated that CCRT increased acute toxicity by ~30%. Although most of these toxicities were recovered uneventfully, they were associated with 1...

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Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials

Cited by 91 publications

References 22 publications

Lung metastasis alone in nasopharyngeal carcinoma: A relatively favorable prognostic group

Lung metastasis alone in nasopharyngeal carcinoma: A relatively favorable prognostic group

Recombinant adeno-associated virus encoding Epstein-Barr virus latent membrane proteins fused with heat shock protein as a potential vaccine for nasopharyngeal carcinoma

Phase II trial of concurrent chemoradiotherapy with S-1 versus weekly cisplatin for locoregionally advanced nasopharyngeal carcinoma

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