Identifying the optimal candidates for locoregional radiation therapy in patients with de novo metastatic nasopharyngeal carcinoma

Han, Xu; Lu, Longbin; Lu, Tianzhu; Xu, Yun; Zong, Jingfeng; Changming, Huang; Lin, Feng; Zheng, Yahan; Lin, Cheng; Lin, Sihao; Qiu, Sufang; Pan, Jianji; Guo, Qiaojuan

doi:10.1002/hed.26726

Cited by 12 publications

(13 citation statements)

References 26 publications

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“…Similar to that study, patients stratified into the low- and intermediate-risk groups benefited from additional LRRT, whereas patients in the high-risk group did not. Several studies have shown that dmNPC with a high tumor burden is unlikely to benefit from additional LRRT [ 21 – 23 ]. This could be explained that patients stratified in the low- and intermediate-risk group were in the low tumor burden status, and distant metastases could be better controlled under intensive PCT.…”

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%

“…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%

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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“…Local RT for mNPC is becoming a hot-button issue [13][14][15]. A phase 3 randomized clinical trial demonstrated that palliative chemotherapy (PCT) plus locoregional radiotherapy (LRRT) can significantly prolong OS in chemotherapy-sensitive patients with mNPC [5].…”

Section: Discussionmentioning

confidence: 99%

Optimizing the treatment mode for de novo metastatic nasopharyngeal carcinoma with bone-only metastasis

Lin

Lin²,

Zhu

et al. 2022

BMC Cancer

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Background No standard radiotherapy regimens have been established for the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LRRT) with or without local radiotherapy (RT) for metastatic bone lesions in mNPC. Methods We retrospectively analysed 131 de novo patients with mNPC who had bone-only metastasis and received at least two cycles of PCT with LRRT. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analyses were performed by Cox regression. Results The median overall survival (OS) and progression-free survival (PFS) were 33.0 months and 24.0 months, respectively. Patients with five or fewer metastatic bone lesions had significantly longer OS (72.0 months vs. 23.0 months, Hazard ratios (HR) = 0.45, p < 0.001) and PFS (48.0 months vs. 15.0 months, HR = 0.52, p = 0.004) than those who had more than five metastatic bone lesions. Patients who received four or more cycles of chemotherapy were associated with significantly longer OS (unreached vs. 19.0 months, HR = 0.27, p < 0.001) and PFS (66 months vs. 16.0 months, HR = 0.32, p < 0.001). Multivariate analysis confirmed that fewer bone metastases (≤ 5) and more chemotherapy cycles (≥ 4) were favourable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bone lesions tended to prolong OS (83.0 months vs. 45.0 months) and PFS (60 months vs. 36.5 months) in patients with five or fewer metastatic bone lesions than in those without RT to metastatic bone lesions (p > 0.05). Patients who received a RT dose > 30 Gy had neither better OS (63.5 months vs. 32.0 months, p = 0.299) nor PFS (48.0 months vs. 28.0 months, p = 0.615) than those who received a RT dose ≤30 Gy. Conclusions Local RT to bone metastases may not significantly improve survival in patients with de novo mNPC with bone-only metastasis who have already received PCT plus LRRT. Receiving four or more cycles of chemotherapy can significantly prolong survival and is a favourable independent protective factor.

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Identifying the optimal candidates for locoregional radiation therapy in patients with de novo metastatic nasopharyngeal carcinoma

Cited by 12 publications

References 26 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

Optimizing the treatment mode for de novo metastatic nasopharyngeal carcinoma with bone-only metastasis

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