Propensity score matching analysis of cisplatin-based concurrent chemotherapy in low risk nasopharyngeal carcinoma in the intensity-modulated radiotherapy era

Zhang, Lu Ning; Gao, Yuanhong; Lan, Xiao Wen; Tang, Jie; Su, Zhen; Ma, Jun; Deng, Wuguo; Ou-Yang, Pu; Xie, Fang

doi:10.18632/oncotarget.5806

Cited by 23 publications

(25 citation statements)

References 39 publications

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“…Apart from a single randomized controlled trial[ 30 ], six of the seven trials were retrospective studies. All studies recruited stage II NPC patients except for two studies that also included a small fraction of stage III patients (T3N0M0, 18.0%)[ 27 ] and stage I patients (T1N0M0, 23.2%)[ 31 ]. The general quality of the seven studies was evaluated, and four were classified as high-quality.…”

Section: Resultsmentioning

confidence: 99%

“…A sensitivity analysis was performed to identify whether the survival results were sharply influenced by certain trials. As showed in Table 2 , the survival outcomes remained stable after separately excluding three trials that recruited less than 100 patients[ 29 – 31 ], three low-quality studies[ 25 , 30 , 31 ], one trial with the median follow-up time less than 36 months[ 31 ], and two trials that enrolled a small number of stage I or III NPC patients[ 27 , 31 ]. Considering that the weight of one study[ 26 ] was over 97% for the pooled result of LRRFS, we excluded this study and analyzed the residual trials.…”

Section: Resultsmentioning

confidence: 99%

“…With a median follow-up time of 42 months, the 5-year OS and local control rates were 79.6% and 90.5% for the IMRT group, and 67.1% and 84.7% for the 2D-RT group, respectively. In addition, in the study by Zhang et al[ 27 ], NPC patients who received IMRT alone had similar survival rates with patients who received concurrent chemotherapy and 2D-RT in the study by Chen et al[ 5 ] (4-year OS, 97.4% vs. 97.4%; 4-year DMFS, 96.5% vs. 97.3%; 4-year LRFS, 93.8% vs. 95.7%, respectively). We wonder that stage II NPC patients might not have a survival benefit from concurrent chemotherapy because IMRT is able to improve significantly the local control rate.…”

Section: Discussionmentioning

confidence: 99%

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The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis

et al. 2018

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ObjectivesTo compare clinical outcomes of concurrent chemoradiotherapy (CCRT) with those of radiotherapy alone for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy (IMRT) era.Materials and methodsWe comprehensively searched PubMed, Embase, and the Cochrane Library to identify eligible studies. Overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRRFS) with hazard ratios (HRs), and toxicities with odd ratios (ORs) were analyzed.ResultsA total of seven studies met the criteria, with 1302 patients who were treated with IMRT alone or IMRT plus concurrent chemotherapy. No significant survival benefit was shown by CCRT regardless of OS (HR = 1.17, 95% CI 0.73–1.89, P = 0.508), PFS (HR = 0.76, 95% CI 0.38–1.50, P = 0.430), DMFS (HR = 0.89, 95% CI 0.33–2.41, P = 0.816), or LRRFS (HR = 1.03, 95% CI 0.95–1.12, P = 0.498). Additionally, CCRT notably increased the risk of acute grade 3–4 leukopenia (OR = 4.432, 95% CI 2.195–8.952, P < 0.001), compared to IMRT alone.ConclusionAdding concurrent chemotherapy to IMRT led to no survival benefit and increased acute toxicity reactions for stage II nasopharyngeal carcinoma.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis

et al. 2018

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“…After PS matching, they found that additional concurrent chemotherapy did not improve the survival outcomes compared to those achieved IMRT alone, with no significant difference in failure-free survival (FFS) (91.2% versus 92.8%, P=0.801), LR-FFS (94.4% versus 95.2%, P=0.755), D-FFS (96.3% versus 96.4%, P=0.803), or OS (98.9% versus 98.2%, P=0.276) values. Zhang et al 19 also acquired a similar result with PS matching.…”

Section: Ccrt Versus Imrt Alonementioning

confidence: 60%

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

Wu¹,

Zhao²,

Li³

et al. 2020

CMAR

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Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensitymodulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.

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“…In the IMRT era, there have been several studies comparing the survival outcomes of patients with NPC who received RT alone to those who underwent CCRT . Owing to the diversity of conditions and comorbidities of patients included in these studies, the conclusions regarding the role of CCT varied.…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of two nomograms to predict the benefit of concurrent chemotherapy in stage II‐IVa nasopharyngeal carcinoma patients with different risk factors: Analysis based on a large cohort

et al. 2020

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Objective We aimed to establish and validate two nomograms that predict progression‐free survival (PFS) and overall survival (OS) in patients with stage II–IVa nasopharyngeal carcinoma (NPC) while evaluating the benefit of concurrent chemotherapy. Patients and Methods We randomly divided 3412 patients newly diagnosed with stage II‐IVa NPC between 2008 and 2013 into training and validation ‘A’ cohorts (n = 1706 each). Another set of patients diagnosed between 2014 and 2016 served as validation cohort ‘B’ (n = 1503). A Cox multivariate model using the backward stepwise approach was applied to develop the nomograms, which were assessed for accuracy (Harrel C index) and calibration. Results The 3‐ and 5‐year PFS rates in the training cohort were 86.8% (95% confidence interval [CI] 85.0%‐88.6%) and 82.3% (95% CI 80.1%‐84.5%), respectively. For the PFS nomogram, 5 variables were selected based on a backward procedure in the multivariate Cox model (gender, T stage, N stage, Epstein‐Barr virus DNA, and treatment method). The same variables plus patient age and diabetes mellitus were used for the OS nomogram. The Harrell C indices of the training, validation A, and validation B cohorts were 0.711, 0.700, and 0.703, respectively, for PFS, and 0.775, 0.743, and 0.727, respectively, for OS. Both nomograms performed well in terms of calibration in the training and validation cohorts. Conclusions Our nomograms are reliable prognostic predictors of PFS and OS in patients with stage II‐IVa NPC. These nomograms could robustly estimate an individual's benefit from concurrent chemotherapy, which assists in treatment decision‐making.

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Propensity score matching analysis of cisplatin-based concurrent chemotherapy in low risk nasopharyngeal carcinoma in the intensity-modulated radiotherapy era

Cited by 23 publications

References 39 publications

The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis

The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

Establishment and validation of two nomograms to predict the benefit of concurrent chemotherapy in stage II‐IVa nasopharyngeal carcinoma patients with different risk factors: Analysis based on a large cohort

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