Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease

Abstract

Background Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk nonendemic patients. Methods Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. Results On MVA, NAC‐improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046). Conclusions NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.

Computational Modeling of Interstitial Fluid Pressure and Velocity in Head and Neck Cancer Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging: Feasibility Analysis

“…Multimodal therapy in various combinations of surgery, radiation, or chemotherapy is used in the management of HN cancers, depending on the primary site and TNM stage (13)(14)(15). For nasopharyngeal carcinoma (NPC), treatment options include neoadjuvant chemotherapy (NAC), as it has high incidence of distant metastatic disease (16). Concurrent chemoradiation is the main approach for nonsurgical treatment of locoregionally advanced HN cancers (17)(18)(19).…”

A multicenter retrospective analysis of patients with nasopharyngeal carcinoma treated in IMRT era from a nonendemic population: Turkish Society for Radiation Oncology Head and Neck Cancer Group Study (TROD 01‐001)

“…34 Poor survival outcomes of stage N3 were also noted in a large nonendemic data. 35 A recent validation study reported better predictive models with 8th staging, although T2 and T3 survival curves were similar. 36 In parallel, a nonendemic cohort from China was reported to have better prognostic separation for 8th classification in global stage and N stage, but not T stage.…”

“…Also excellent regional control rates of more than 90% were reported for N0–N2 tumors, dropping to 76.4 and 81.8% for N3a‐b according to AJCC 7th 34 . Poor survival outcomes of stage N3 were also noted in a large nonendemic data 35 . A recent validation study reported better predictive models with 8th staging, although T2 and T3 survival curves were similar 36 .…”

Construction of Prognostic Nomogram in Patients with N3-Stage Nasopharyngeal Carcinoma

“…Nasopharyngeal carcinoma (NPC) is a malignant tumor that arises in the epithelial tissue of the head and neck. Approximately 87,000 new cases and 51,000 deaths of NPC are reported every year worldwide [1]. NPC shows a variant geographical distribution and is particularly endemic, prevailing in Southeast Asia and Southern China [2, 3].…”

“…In addition, a large scale of data are needed to identify the risk factors for metastases and therefore determine prognosis. T-classification and histological types of NPC are more likely to be correlated with metastasis because of the rich lymphatic network in and near the nasopharynx [1, 12, 13]. Both local recurrence and distant metastases are significant prognostic risk factors in NPC patients [14, 15].…”