The effect of adding concurrent chemotherapy to radiotherapy for stage II nasopharyngeal carcinoma with undetectable pretreatment Epstein-Barr virus DNA: Retrospective analysis with a large institutional-based cohort

Jin, Yong; Tang, Qing-Nan; Yao, Ji‐Jin; Xu, Xiwei; He, Weiling; Wang, Lei; You, Yafei; Peng, Kangqiang; Jiang, Chang; Xia, Liangping

doi:10.1016/j.tranon.2020.100990

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…IMRT has become a daily choice for NPC. Several studies (8,11,(32)(33)(34)(35)(36) have investigated whether concurrent chemotherapy can further improve the efficacy of stage II NPC patients receiving IMRT. However, the results of these studies are not completely consistent.…”

Section: Discussionmentioning

confidence: 99%

“…Among the remaining 22 studies, six studies (19)(20)(21)(22)(23)(24) involving patients with adjuvant or neoadjuvant chemotherapy were excluded, another six studies (25)(26)(27)(28)(29)(30) involving patients with stage I or III were eliminated, and one study (31) with insufficient data was also eliminated (Figure 1). Nine studies were finally included, two of which were RCTs (8,9), and the rest were retrospective studies (10,11,(32)(33)(34)(35)(36). A total of 4,092 patients were enrolled, 2,462 received CCRT, and 1,632 received RT alone.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…A total of 4,092 patients were enrolled, 2,462 received CCRT, and 1,632 received RT alone. There are four studies (9,10,32,34) with a total of 2,490 patients that investigated 2DRT combined with concurrent chemotherapy, and 7 studies (8,11,(32)(33)(34)(35)(36) with 1,602 patients that explored IMRT plus concurrent chemotherapy (Table 1). According to RoB2 assessment criteria, the overall risk of bias was low for the two included RCTs (Figure 2).…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

Chen

Liang

et al. 2022

Front. Oncol.

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PurposeThe role of concurrent chemoradiotherapy (CCRT) in stage II nasopharyngeal carcinoma (NPC) is still controversial. Our objective is to evaluate the value of concurrent chemotherapy in stage II NPC receiving radiotherapy (RT).MethodsWe searched the PubMed, Embase, and Scopus databases for studies comparing CCRT versus RT alone in stage II NPC with survival outcomes and toxicities, including locoregional recurrence-free survival (LRFS), metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and grade 3–4 acute toxicities. The hazard ratios (HRs) of survival outcomes and risk ratios (RRs) of toxicities were extracted for meta-analysis. Subgroup analysis for stage N1 patients was performed to further explore whether these populations can earn benefits from concurrent chemotherapy.ResultsNine eligible studies with a total of 4,092 patients were included. CCRT was associated with a better OS (HR = 0.61, 95% CI 0.44–0.82), LRFS (HR = 0.62, 95% CI 0.50–0.78), and PFS (HR = 0.65, 95% CI 0.54–0.79), but with similar DMFS (HR = 0.81, 95% CI = 0.46–1.45) compared with two-dimensional RT (2DRT) alone. However, CCRT showed no survival benefit in terms of OS (HR = 0.84, 95% CI 0.62–1.15), LRFS (HR = 0.85, 95% CI 0.54–1.34), DMFS (HR = 0.96, 95% CI 0.60–1.54), and PFS (HR = 0.96, 95% CI 0.66–1.37) compared with intensity-modulated RT (IMRT) alone. Subgroup analyses indicated that CCRT had similar OS (HR = 1.04, 95% CI 0.37–2.96), LRFS (HR = 0.70, 95% CI 0.34–1.45), DMFS (HR = 1.03, 95% CI 0.53–2.00), and PFS (HR = 1.04, 95% CI 0.58–1.88) in the stage N1 populations. Meanwhile, compared to RT alone, CCRT significantly increased the incidence of grade 3–4 leukopenia (RR = 4.00, 95% CI 2.29–6.97), mucositis (RR = 1.43, 95% CI 1.16–1.77), and gastrointestinal reactions (RR = 8.76, 95% CI 2.63–29.12). No significant differences of grade 3–4 toxicity in thrombocytopenia (RR = 3.45, 95% CI 0.85–13.94) was found between the two groups.ConclusionFor unselected patients with stage II NPC, CCRT was superior to 2DRT alone with better LRFS, PFS, and OS, while adding concurrent chemotherapy to IMRT did not significantly improve survival but exacerbated acute toxicities.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022318253.

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Section: Discussionmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

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A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

Chen

Liang

et al. 2022

Front. Oncol.

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“…Since intensity‐modulated radiotherapy dramatically improved survival outcomes of nasopharyngeal carcinoma, omitting chemotherapy was considered for stage II patients in intensity‐modulated radiotherapy era. Several retrospective studies reported that concurrent chemoradiotherapy had comparable survival to intensity‐modulated radiotherapy alone for patients with stage II nasopharyngeal carcinoma, 4–6 and a prospective study enrolling 84 patients also confirmed this conclusion 7 . Intriguingly, a retrospective study based on National Cancer Database from the United States reported concurrent chemoradiotherapy improved survival of stage II nasopharyngeal carcinoma compared with intensity‐modulated radiotherapy alone 8 .…”

Section: Introductionmentioning

confidence: 90%

Development and prospective validation of a risk score model in guiding individualized concurrent chemoradiotherapy in stage II nasopharyngeal carcinoma in intensity‐modulated radiotherapy era

et al. 2021

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Purpose We aimed to develop and prospectively validate a risk score model to guide individualized concurrent chemoradiotherapy (CCRT) for patients with stage II nasopharyngeal carcinoma (NPC) in intensity‐modulated radiotherapy (IMRT) era. Materials and Methods In total, 1220 patients who received CCRT or IMRT alone were enrolled in this study, including a training cohort (n = 719), a validation cohort (n = 307), and a prospective test cohort (n = 194). Patients were stratified into different risk groups by a risk score model based on independent prognostic factors, which were developed in the training cohort. Survival rates were compared by the log‐rank test. The validation and prospective test cohorts were used for validation. Results Total tumor volume, Epstein–Barr virus DNA, and lactate dehydrogenase were independent risk factors for failure‐free survival (FFS, all p < 0.05). A risk score model based on these three risk factors was developed to classify patients into low‐risk group (no risk factor, n = 337) and high‐risk group (one or more factors, n = 382) in the training cohort. In the high‐risk group, CCRT had better survival rates than IMRT alone (5‐year FFS: 82.6% vs. 74.0%, p = 0.028). However, there was no survival difference between CCRT and IMRT alone either in the whole training cohort (p = 0.15) or in the low‐risk group (p = 0.15). The results were verified in the validation and prospective test cohorts. Conclusion A risk score model was developed and prospectively validated to precisely select high‐risk stage II NPC patients who can benefit from CCRT, and thus guided individualized treatment in IMRT era.

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Intensity-modulated radiotherapy alone compared with intensity-modulated radiotherapy plus concurrent chemotherapy in intermediate-risk nasopharyngeal carcinoma

Liao,

Zhang,

et al. 2024

Strahlenther Onkol

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The effect of adding concurrent chemotherapy to radiotherapy for stage II nasopharyngeal carcinoma with undetectable pretreatment Epstein-Barr virus DNA: Retrospective analysis with a large institutional-based cohort

Cited by 6 publications

References 24 publications

A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

Development and prospective validation of a risk score model in guiding individualized concurrent chemoradiotherapy in stage II nasopharyngeal carcinoma in intensity‐modulated radiotherapy era

Intensity-modulated radiotherapy alone compared with intensity-modulated radiotherapy plus concurrent chemotherapy in intermediate-risk nasopharyngeal carcinoma

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