Experience with combination of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

He, Xianghuo; Ou, Dan; Ying, Hongmei; Zhu, Guoding; Hu, Chaosu; Liu, Taifu

doi:10.1007/s00405-011-1669-9

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…Gemcitabine combined with cisplatin is an effective combination for the treatment of patients with locoregionally advanced NPC. Ou and coworkers13 reported that 70.3% of those with locally advanced NPC partially responded, whereas 29.7% achieved a complete response after two cycles of a GC regimen before RT. In two other retrospective studies, the overall response rates to the PF regimen, when used as induction chemotherapy, were 88.6 and 91.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The RT method used in our study was conventional. Recently, Xiayun et al 13. reported the use of a combination of GC chemotherapy and IMRT for locoregionally advanced NPC, with encouraging outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…analyzed a group of 40 patients with locally advanced NPC who received cisplatin–gemcitabine (GC) chemoradiotherapy and reported favorable toxicity profile and impressive antitumor activity. Recently, the same authors also reported favorable 3‐year survival rates in 54 patients treated with a combination of GC chemotherapy and intensity‐modulated RT (IMRT) 13. However, compared to cisplatin–fluorouracil (PF) chemoradiotherapy, the benefits of the GC regimen remain unclear.…”

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confidence: 99%

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Sequential chemoradiotherapy with gemcitabine and cisplatin for locoregionally advanced nasopharyngeal carcinoma

Liu

et al. 2012

Intl Journal of Cancer

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We investigated a new chemoradiotherapy (CRT) regimen for locoregionally advanced nasopharyngeal carcinoma (NPC). A total of 240 patients were randomly assigned to three different CRT regimens: sequential CRT [1 cycle chemotherapy 1 Phase I radiotherapy (RT) 1 1 cycle chemotherapy 1 Phase II RT 1 2 cycles chemotherapy] with a cisplatin-gemcitabine (GC) regimen weeks) (sPF-RT) and cisplatin-based concurrent chemoradiotherapy plus adjuvant PF chemotherapy (Con-RT 1 PF). The complete response rate was higher in the sGC 1 RT group than in the other two groups (98.75% vs. 92.50%, p < 0.01). The 3-year overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates in the sGC-RT group were significantly higher than those observed in the Con-RT group (OS, 95.0% vs. 76.3%, p < 0.001; DFS, 89.9% vs. 67.5%, p < 0.001; DMFS, 92.5% vs. 76.0%, p 5 0.004) and in the sPF 1 RT group (OS, 95.0% vs. 73.6%, p < 0.001; DFS, 89.9% vs. 63.3%, p < 0.001; DMFS, 92.5% vs. 74.7%, p 5 0.002). There were no significant differences in 3-year OS, DFS and MFS rates between the Con-RT and the sPF-RT groups. The GC-RT group experienced more hematologic toxicity, constipation and rash; however, there were no differences in late RT toxicity between the groups. These results demonstrate that a sGC-RT regimen is effective and well tolerated in patients with locoregionally advanced NPC. Nasopharyngeal carcinoma (NPC) is endemic in SoutheastAsia, especially in the southern provinces of China. 1 Furthermore, between 63.3 and 68.1% of patients with NPC present with Stage III or IV disease in southern China.2,3 Patients with locoregionally confined advanced NPC have a worse prognosis, with frequent local relapse and distant metastases. In recent years, local tumor control for NPC has been greatly improved by developments in radiotherapy (RT) techniques; however, the incidence of distant metastases remains high, and further research is needed to address this. 4 NPC is known for its high rates of response to RT and chemotherapy. The results from the Intergroup-0099 trial, which compared concurrent chemoradiotherapy (Con-RT) plus adjuvant chemotherapy with RT alone in patients to Stages III-IVB disease, suggest that the addition of chemotherapy to RT is beneficial.5 However, a randomized trial in endemic geographic areas showed that the Intergroup-0099 regimen only improved relapse-free survival and not overall survival (OS) or distant metastasis-free survival (DMFS). Additionally, the Intergroup-0099 regimen resulted in significantly increased toxicity rates.7 Therefore, an exploration of new therapies and regimens that improve outcome and decrease treatment-related toxicity in locoregionally confined advanced NPC is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sequential chemoradiotherapy with gemcitabine and cisplatin for locoregionally advanced nasopharyngeal carcinoma

Liu

et al. 2012

Intl Journal of Cancer

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“…The OS and DFS of the study group at 3 years was 76% and 63% respectively. With a median follow up of 30 months Xiayun et al (2012) also used gemcitabine and cisplatin both as IC and in adjuvant settings after intensity modulated radiation therapy (IMRT) (Xiayun et al, 2012). With 89% of the patients having stage III-IV, the 3 year OS of the group was 87.7%.…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine And Cisplatin Followed by Chemo-Radiation for Advanced Nasopharyngeal Carcinoma

Jamshed

Hussain²,

Iqbal³

2014

Asian Pacific Journal of Cancer Prevention

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Concurrent chemo-radiation (CRT) has been established as the standard of care for non-metastatic locoregionally advanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy in the already established regimen has presented an attractive multidisciplinary approach. This retrospective study was carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management of loco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatin based IC followed by CRT. Induction chemotherapy included a 2 drug combination; intravenous gemcitabine 1000 mg/m 2 on day 1 and 8 and cisplatin 75 mg/m 2 on day 1 only. Radiotherapy (RT) was given as a phase treatment to a total dose of 70 Gy in 35 fractions. Concurrent cisplatin (75 mg/m 2 ) was administered to all patients on days 1, 22 and 43. All patients were evaluated for tumor response and adverse effects after IC and 6 weeks after the completion of the treatment protocol. Statistical analysis was performed using SPSS version 17 and Kaplan Meier estimates were applied to project survival. Median follow-up duration was 20 months. The 5-year overall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 71%, 73% and 50%respectively. Acute grade 4 toxicity related to induction chemotherapy and concurrent chemo-radiation was 4% and 2% respectively, with only 3 toxicity-related hospital admissions. We conclude that induction gemcitabine and cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngeal carcinoma, meriting further investigation in randomized clinical trials.

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“…Based on a series of IMRT publications for NPC (Table 2), 13 studies have reported using treatment planning CT with 3 mm or less thickness [5,[20][21][22][23][27][28][29][30][31][32][33][34], one study used 3 to 5 mm which may have been as a result of available technology at the time given that it was the first reported experience [19], while three studies did not report slice thickness [35][36][37]. Therefore, given the available data, we recommend using treatment planning CT with 3 mm or less thickness in areas that contain disease.…”

Section: Treatment Planning and Target Volumesmentioning

confidence: 99%

Intensity-modulated radiation therapy for nasopharyngeal carcinoma: a review

et al. 2012

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Introduction Advances in radiation therapy, such as intensity-modulated radiation therapy (IMRT), have allowed high-dose delivery to tumors while sparing normal tissues. However, IMRT requires careful delineation of target volumes to prevent marginal recurrences. Results and discussion This review discusses the recent advances in the treatment of nasopharyngeal carcinoma with particular emphasis on IMRT. Multiple phase III trials that have relied on conventional radiotherapy have shown a survival benefit to concurrent chemoradiotherapy (CCRT) over radiotherapy (RT) alone. Two randomized trials using IMRT have demonstrated decreased xerostomia rates compared to conventional radiotherapy while still maintaining excellent local control rates, although follow-up was short. While modern locoregional results are excellent, 90 % or more, distant-metastasis-free rates are not as impressive, ranging from 66 to 93 % among studies. Conclusion IMRT is an advanced technique, its excellent treatment outcomes have been reproduced in many single institution studies. Perhaps IMRT-delivered RT can replace the benefit provided by chemotherapy when added to conventional RT. Future studies should focus on reducing target volumes to minimize toxicity while dose-escalating for high-risk patients.

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Experience with combination of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

Cited by 20 publications

References 24 publications

Sequential chemoradiotherapy with gemcitabine and cisplatin for locoregionally advanced nasopharyngeal carcinoma

Sequential chemoradiotherapy with gemcitabine and cisplatin for locoregionally advanced nasopharyngeal carcinoma

Gemcitabine And Cisplatin Followed by Chemo-Radiation for Advanced Nasopharyngeal Carcinoma

Intensity-modulated radiation therapy for nasopharyngeal carcinoma: a review

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