Prognostic value of radiation interruption in different periods for nasopharyngeal carcinoma patients in the intensity‐modulated radiation therapy era

Abstract

We aimed to investigate the prognostic value of radiation interruptions at different times on the overall survival (OS) and disease‐free survival (DFS) of patients with nasopharyngeal carcinoma receiving intensity‐modulated radiation therapy. Totally, 4510 patients were identified from a well‐established big‐data intelligence platform. Optimal interruption thresholds were identified using Recursive partitioning analyses. Actuarial rates were plotted using the Kaplan–Meier method and were compared using the log‐rank test. Patients with preceding interruptions ≥1 d (5‐year OS, 89.6% vs. 85.7%, p < 0.001; 5‐year DFS, 81.4% vs. 76.4%, p < 0.001), or latter interruptions ≥4 d (88.4% vs. 82.3%, p < 0.001; 79.2% vs. 75.1%, p = 0.006) showed significant detrimental effects on OS and DFS than patients without those interruptions. However, no significant lower survival was identified in latter interruptions ≥1 d (5‐year OS: 89.0% vs. 86.7%, p = 0.053; 5‐year DFS, 80.2% vs. 77.8%, p = 0.080). Latter interruptions ≥4 d was an independent unfavorable prognostic factor for OS (HR, 1.404; 95% CI, 1.143–1.723, p = 0.001) and DFS (HR, 1.351; 95% CI, 1.105–1.652, p = 0.003) in multivariate analysis. Radiation interruptions longer than 3 days that occurred in the latter period of treatment with IMRT were independent factors in poorer survival. Efforts are needed to minimize radiation interruptions and improve the timely provision of treatment.

Tube feeding in patients with head and neck cancer undergoing chemoradiotherapy: A systematic review

“…31 The observation that the number of radiotherapy interruptions were similar in patients receiving NGT and PEG is of particular interest and significance considering their well-known detrimental effect on midrange and long-term survival. 32,33 The better swallow outcomes observed with the use of NGT in most of the studies are an important consideration in choosing the timing and method of providing nutrition support in patients with receiving CRT. In fact, long-term swallow function is a major factor influencing quality of life in survivors.…”

“…The observation that the number of radiotherapy interruptions were similar in patients receiving NGT and PEG is of particular interest and significance considering their well‐known detrimental effect on midrange and long‐term survival 32,33 …”

Effect of radiotherapy interruption on nasopharyngeal cancer

“…75.1%, p=0.006) were significantly detrimental to DFS and OS. In the further multifactorial analysis, interruptions longer than 3 or 4 days afterwards were both poor prognostic factors ( 57 ). Certainly, it has been reported that the prolongation of the treatment time has no effect on the prognosis of the patients ( 57 ).…”

Lack of association between XRCC1 SNPs and acute radiation‑induced injury or prognosis in patients with nasopharyngeal carcinoma

“…More specifically, ~20% of these patients suffer from acute severe radiation-induced injuries, which often cause uncontrollable pain, resulting in treatment interruptions (8,9). These interruptions eventually lead to failure of tumor control, thereby shortening the overall survival time (10,11). However, the lack of sensitive and specific biomarkers makes it difficult to predict the occurrence of acute severe radiation-induced injury in patients.…”