The Association Between the Development of Radiation Therapy, Image Technology, and Chemotherapy, and the Survival of Patients With Nasopharyngeal Carcinoma: A Cohort Study From 1990 to 2012

Sun, Xiang; Liu, Sai-Lan; Luo, Min; Li, Xiaoyun; Chen, Qiuyan; Guo, Shan-Shan; Wen, Yihui; Liu, Liting; Xie, Haojun; Tang, Qing-Nan; Liang, Yu-Jing; Yan, Jin-Jie; Lin, Dafeng; Bi, Mingmin; Liu, Ying; Liang, Yu-fan; Ma, Jingfei; Tang, Lin‐Quan; Mai, Hai-Qiang

doi:10.1016/j.ijrobp.2019.06.2549

Cited by 96 publications

(86 citation statements)

References 29 publications

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“…1 The local control rate of NPC was quite satisfactory with the introduction of intensive modulated radiation therapy (IMRT) and concurrent chemo-radiotherapy (CCRT). 2 However, development of distant metastasis remains now the most common failure pattern in patients with NPC. 3,4 While over 20% locally advanced NPC developed post-treatment distant metastases, 5 4-10% of newly diagnosed NPC patients exhibit distant metastasis, so-called "synchronous metastatic" NPC (smNPC).…”

Section: Introductionmentioning

confidence: 99%

<p>Synchronous Metastatic Nasopharyngeal Carcinoma: Characteristics and Survival of Patients Adding Definitive Nasopharyngeal-Neck Radiotherapy to Systematic Chemotherapy</p>

Liao

Duan

et al. 2020

CMAR

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To determine the M1 sub-staging in synchronous metastatic nasopharyngeal carcinoma (smNPC) and to examine the effect of nasopharyngeal-neck radiotherapy (RT) and local treatment of metastases on overall survival (OS) of smNPC patients. Patients and Methods: A total of 150 patients with smNPC were included. Metastatic characteristics associated with their potential prognostic significance were analyzed. Then, a stratification system of the M1 sub-staging in smNPC was provided according to metastatic features. Moreover, the OS of patients with or without nasopharyngeal-neck RT was compared by Log rank test. The OS of patients who received or did not receive local treatment of metastases was also analyzed. Results: We successfully divided the M1 stage into three sub-staging: M1a (a single site with a single lesion), M1b (a single site with multiple lesions), and M1c (multiple sites with multiple lesions). The median OS was 53.2, 25.8, and 18.9 months for M1a, M1b, and M1c, respectively (p < 0.001). Nasopharyngeal-neck RT plus systematic chemotherapy (CT) significantly improved OS compared to systematic CT (median OS, 34.0 vs 15.2 months, p = 0.002). However, incorporation of local treatment of metastases did not bring survival benefit to smNPC patients who received nasopharyngeal-neck RT plus systematic CT (median OS, 25.8 vs 35.1 months, p = 0.374). Conclusion: The sub-staging of the M1 stage in smNPC had promising prognostic value. Adding nasopharyngeal-neck RT on the basis of systematic CT markedly improved the survival of smNPC patients, while addition of local treatment of metastases to nasopharyngeal-neck RT plus systematic CT for smNPC needed further exploration.

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Section: Introductionmentioning

confidence: 99%

<p>Synchronous Metastatic Nasopharyngeal Carcinoma: Characteristics and Survival of Patients Adding Definitive Nasopharyngeal-Neck Radiotherapy to Systematic Chemotherapy</p>

Liao

Duan

et al. 2020

CMAR

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“…In recent years, with the continuous improvement of local radiotherapy technology and comprehensive treatment methods, the overall survival rate of NPC patients has greatly increased. According to the current data, the 3-year overall survival rate of NPC patients is 82.3%; 5-year survival ranges from 59-76.1%; and the 10-year survival is 43% [1][2][3][4].…”

Section: Introductionmentioning

confidence: 96%

Clinicopathological Factors and Prognosis of Massive Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

Wang

Chen²,

Gong³

et al. 2020

Preprint

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Background: To investigate the clinicopathological factors and prognosis of nasopharyngeal hemorrhage after radiotherapy for nasopharyngeal carcinoma (NPC). Methods: The clinicopathological data of 539 NPC patients who received radiotherapy were analyzed retrospectively, including gender; age; T-stage; N-stage; pathological type; type of radiotherapy; synchronous chemotherapy; secondary-course radiotherapy; radioactive skull base osteonecrosis; diabetes, hypertension, or other systemic diseases; results of nasopharyngeal bacterial culture. Univariate and multivariate analyses were performed using the c2 test and logistic regression. The Kaplan-Meier method was applied to analyze the survival of patients with nasopharyngeal hemorrhage. Results: Among all patients, 64 (11.9%) had nasopharyngeal hemorrhage after radiotherapy. Results from the univariate analysis showed that T-stage (p<0.01), secondary-course radiotherapy (p<0.01), radioactive skull base osteonecrosis (p<0.01), nasopharyngeal bacterial culture results (p<0.01), and nasopharyngeal tumor recurrence (p<0.01) were associated with nasopharyngeal hemorrhage. Multivariate analysis showed that only radioactive skull base osteonecrosis was significantly associated with nasopharyngeal hemorrhage after radiotherapy (OR=41.83, p=0.0001). In patients with internal carotid artery hemorrhage, the survival rate was 60.9% in one year, 15.1% in3 years, and 0% in 5 years. In patients with external carotid artery bleeding, the 5-year survival rate was 50%. The main cause of death during follow-up was rebleeding. Conclusion: The rate of mortality in patients with nasopharyngeal hemorrhage after radiotherapy is high. The presence of radioactive skull base osteonecrosis is the decisive factor in patients with nasopharyngeal hemorrhage after radiotherapy. Influencing and synergistic factors include T-stage, secondary-course radiotherapy, results of nasopharyngeal bacterial culture, and nasopharyngeal tumor recurrence. After successful rescue,arterial embolization or stent implantation may prolong survival.

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“…Because of its radiosensitivity, radiotherapy (RT) with or without chemotherapy is the standard treatment method for non-metastatic NPC (2,3). Nowadays, distant metastases have become the main treatment failure and cause of death in NPC (4). Besides, approximately 15% of patients are detected to have distant metastases at the point of primary diagnosis (5).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Gemcitabine Plus Cisplatin vs. Docetaxel Plus Fluorouracil Plus Cisplatin Palliative Chemotherapy for Metastatic Nasopharyngeal Carcinoma

et al. 2020

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Objective: Our study aimed to compare the efficacy and toxicity of two chemotherapy regimens, gemcitabine plus cisplatin (GP) vs. docetaxel plus, fluorouracil plus cisplatin (TPF), in metastatic nasopharyngeal carcinoma (NPC) patients. Methods: We retrospectively enrolled metastatic NPC patients between July 2006 and December 2016 who were treated with TPF or GP palliative chemotherapy (PCT). The association between the PCT regimens and survival conditions was evaluated by log-rank tests and the Cox proportional hazards model. A cohort was created using propensity score matching with the ratio of 1:1 to clarify the results of the multivariable Cox regression analyses. Overall survival (OS) was the primary endpoint. Results: Of 266 eligible patients, 186 and 80 patients, respectively, received TPF and GP regimen. No significant difference was demonstrated in the survival rate between the GP and TPF groups (3-year OS: 52.6 vs. 50.3%; P = 0.929). However, multivariable analysis suggested receiving GP as an independent protective factor (hazard ratio, 0.864; 95% confidence interval, 0.753-0.992; P = 0.042). In the matched cohort, treatment with GP was also associated with a significantly higher OS (3-year OS: 52.6 vs. 35.6%, P = 0.042). Subgroup analysis indicated that the superiority of GP reflected in patients with secondary metastases rather than primary metastases. The incidence of grade 3 to 4 treatment-related toxicity was more common in the TPF group than in the GP group. Conclusion: Our study suggested that GP might be superior to TPF for metastatic NPC patients, especially those with secondary distant metastases. Further studies are necessary to validate our results.

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The Association Between the Development of Radiation Therapy, Image Technology, and Chemotherapy, and the Survival of Patients With Nasopharyngeal Carcinoma: A Cohort Study From 1990 to 2012

Cited by 96 publications

References 29 publications

<p>Synchronous Metastatic Nasopharyngeal Carcinoma: Characteristics and Survival of Patients Adding Definitive Nasopharyngeal-Neck Radiotherapy to Systematic Chemotherapy</p>

<p>Synchronous Metastatic Nasopharyngeal Carcinoma: Characteristics and Survival of Patients Adding Definitive Nasopharyngeal-Neck Radiotherapy to Systematic Chemotherapy</p>

Clinicopathological Factors and Prognosis of Massive Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

Comparison of Gemcitabine Plus Cisplatin vs. Docetaxel Plus Fluorouracil Plus Cisplatin Palliative Chemotherapy for Metastatic Nasopharyngeal Carcinoma

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