Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy: new insight into the value of total dose of cisplatin and radiation boost

Abstract

This study was to report the long-term outcomes and toxicities of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). From 2009 to 2010, 869 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. With a median follow-up of 54.3 months, the 5-year estimated local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 89.7%, 94.5%, 85.6%, 76.3%, 84.0%, respectively. In locally advanced NPC, gender, T, N, total dose of cisplatin more than 300 mg/m2 and radiation boost were independent prognostic factors for DMFS and DFS. Age, T, N and total dose of cisplatin were independent prognostic factors for OS. Radiation boost was an adverse factor for LRFS, RRFS, DMFS and DFS. Concurrent chemotherapy was not an independent prognostic factor for survival, despite marginally significant for DMFS in univariate analysis. Concurrent chemotherapy increased xerostomia and trismus, while higher total dose of cisplatin increased xerostomia and otologic toxicities. In conclusion, IMRT provided satisfactory long-term outcome for NPC, with acceptable late toxicities. Total dose of cisplatin was a prognostic factor for distant metastasis and overall survival. The role of concurrent chemotherapy and radiation boost in the setting of IMRT warrants further investigation.

The Incidence and Prognosis of Nasopharyngeal Carcinoma Patients With Family History

“…However we compared with the prognosis of 869 NPC patients with IMRT during the same period in our hospital [25]. The 5-year OS, LRFS, and DMFS rates were 84.0%, 89.7%, and 85.6%, which were similar to our study.…”

A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

“…But the courses were always interrupted or postponed in many patients as a result of adverse effects, especially for mucosal toxicity [20]. Similarly, our meta-analysis showed that patients in weekly cisplatin group had significant difficulty in achieving targeted dose of 200 mg/m 2 (RR=0.82, p=0.009) (Supplementary Figure S6), eventually, resulting in a worse survival benefit due to more treatment delay/interrupt and inadequate dose of cisplatin [21–22]. There is an urgent need that a longer follow-up work and higher quality of clinical trials were performed to test the ideas.…”

Effects of induction docetaxel, platinum, and fluorouracil chemotherapy in patients with stage III or IVA/B nasopharyngeal cancer treated with concurrent chemoradiation therapy: Final results of 2 parallel phase 2 clinical trials

“…In 370 consecutive cases of locally advanced NPC treated with IMRT with or without concurrent chemotherapy, Lin et al demonstrated that patients who received TPF induction chemotherapy achieved an OS rate of 89% at 3 years. Similarly, Ou et al reported that the 5‐year OS rate was 80.7% for a subgroup of locally advanced NPC patients who received induction chemotherapy (mostly with TP/TPF but a few with gemcitabine‐based chemotherapy) followed by IMRT versus 71.4% for those who did not ( P = .057). The numbers of induction chemotherapy cycles used in these 2 retrospective studies were not standardized, but most patients received 2 or 3 cycles.…”