The Impact of the Overall Radiotherapy Time on Clinical Outcome of Patients with Nasopharyngeal Carcinoma; A Retrospective Study

Abstract

PurposeIn Yogyakarta, nasopharyngeal carcinoma (NPC) shows a poor response to radiotherapy treatment. Previous study showed a prolonged overall treatment time (OTT), due to interruptions during treatment. This study explores the association between clinical outcome and OTT. Secondary, the relation between clinical outcome and disease stage, waiting time to radiation (WT) and chemotherapy schedule was explored.MethodsIn this retrospective cohort, 142 patients who started curative intent radiotherapy for NPC between March 2009 and May 2014, with or without chemotherapy, were included. The median follow up time was 1.9 years. Data was collected on WT, OTT, disease stage, and chemotherapy schedule. Time factors were log-transformed. Clinical outcome was defined as therapy response, loco-regional control (LRC), disease free survival (DFS) and overall survival (OS).ResultsThe median WT was 117 days (range 12–581) and OTT was 58 days (43–142). OTT and disease stage were not associated to any of the clinical outcome parameters. The log- WT was associated to poor therapy outcome (HR 1.68; 95% ci: 1.09–2.61), LRC (HR 1.66; 95% ci: 1.15–2.39), and DFS (HR 1.4; 95% ci: 1.09–1.81). In the multivariable analysis, significant hazard risk for poor therapy response, LRC, DFS and OS were seen for patients who didn’t received concurrent chemotherapy.ConclusionNot receiving concurrent chemotherapy showed the strongest risk for poor outcome. Since the choice of chemotherapy is related to a variety of factors, like the WT and patient’s physical condition when radiation can start, careful interpretation is needed. Reason for not finding a relation between OTT and clinical outcome might be the low number of patients who finished radiotherapy within 7 weeks, or by a stronger detrimental effect of other factors.

Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy

“…Univariate Cox analysis showed a significant hazard for poor local regional control and disease-free survival when the waiting time increased to >130 days. There was no association between long waiting time and OS (29).…”

RBBP6 increases radioresistance and serves as a therapeutic target for preoperative radiotherapy in colorectal cancer

“…Preoperative chemoradiotherapy results in fewer than 50% of rectal cancer patients achieving complete pathological response . Response to radiation is considered to be a key factor in the success of radiotherapy, but the response to radiation is determined by multifactorial etiologies (tumor pathologic type, tumor volume, tumor hypoxia, clinical stage, radiation dose and radiation modes) . Until now, no valid radiosensitizing target has been unambiguously identified to have prognostic or predictive value for colorectal cancer radiotherapy, although a few potential molecular markers, including EGFR, KRAS/NRAS, BRAF, PTEN and PIK3CA, have been investigated; the role they played in radiotherapy remains to be elucidated.…”

Patterns of Care and Outcome Analysis of Nasopharyngeal Carcinoma: An Indonesian Single Institution Study

“…Several studies reported the treatment outcomes of patients with nasopharyngeal cancer in Indonesia (Adham et al, 2014;Stoker et al, 2016;Wildeman et al, 2013). Stoker et al, (2016) retrospectively investigated the outcomes of 142 nasopharyngeal cancer patients treated with radiotherapy with or without chemotherapy with curative intent. The 2 year OS was 58% for this cohort that predominantly contained stages III-IVB patients.…”

“…Therefore, defining the patterns of care and treatment outcomes of patients with nasopharyngeal cancer in Indonesia is important to improve the outcome of this disease worldwide. However, there are few reports on the outcomes of patients with nasopharyngeal cancer treated in Indonesia (Adham et al, 2014;Stoker et al, 2016;Wildeman et al, 2013). Furthermore, the available studies are based on a small sample size, and they may not reflect the actual clinical situation in the country.…”