A Multicentre UK Study of Outcomes of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy ± Chemotherapy

Published on Apr 1, 2020in Clinical Oncology3.113
· DOI :10.1016/J.CLON.2019.11.009
Finbar Slevin2
Estimated H-index: 2
(Leeds Teaching Hospitals NHS Trust),
Shermaine Pan1
Estimated H-index: 1
+ 6 AuthorsRobin Prestwich28
Estimated H-index: 28
(Leeds Teaching Hospitals NHS Trust)
Sources
Abstract
Abstract Aims To report the outcomes of nasopharyngeal carcinoma in adults across three large centres in a non-endemic region in the era of intensity-modulated radiotherapy (IMRT). Materials and methods Adult patients with nasopharyngeal carcinoma treated in three large cancer centres with IMRT ± chemotherapy with curative intent between 2009 and 2016 were identified from institutional databases. Radiotherapy was delivered with 70 Gy in 33–35 daily fractions. A univariable analysis was carried out to evaluate the relationship of patient, tumour and treatment factors with progression-free survival (PFS) and overall survival. Results In total, 151 patients were identified with a median follow-up of 5.2 years. The median age was 52 years (range 18–85). Seventy-five per cent were of Caucasian origin; 75% had non-keratinising tumours; Epstein Barr virus status was only available in 23% of patients; 74% of patients had stage III or IV disease; 54% of patients received induction chemotherapy; 86% of patients received concurrent chemotherapy. Five-year overall survival, PFS, local disease-free survival, regional disease-free survival and distant disease-free survival were 70%, 65%, 91%, 94% and 82%, respectively. Keratinising squamous cell carcinoma, older age, worse performance status, smoking and alcohol intake were associated with inferior overall survival and PFS. Conclusions Local, regional and distant disease control are relatively high following IMRT ± chemotherapy in a non-endemic population. There was considerable heterogeneity in terms of radiotherapy treatment and the use of chemotherapy, encouraging the development of treatment protocols and expert peer review in non-endemic regions.
📖 Papers frequently viewed together
5 Authors (Don Yee, ..., Stefan Glück)
13 Citations
3 Citations
9 Authors (Rovel J Colaco, ..., Lip W Lee)
51 Citations
References43
Newest
#1Wen Fei Li (SYSU: Sun Yat-sen University)H-Index: 25
#2Nian Yong Chen (Sichuan University)H-Index: 5
Last. Ying Sun (SYSU: Sun Yat-sen University)H-Index: 54
view all 35 authors...
: To report long-term results of a randomized controlled trial that compared cisplatin/fluorouracil/docetaxel (TPF) induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma (NPC). Patients with stage III-IVB (except T3-4 N0) NPC were randomly assigned to receive IC plus CCRT (n = 241) or CCRT alone (n = 239). IC included three cycles of docetaxel (60 mg/m2 d1), cisplatin (60 mg/m2 d1), and fluorouracil (600 mg/m2 /d ...
52 CitationsSource
#1S. RamasamyH-Index: 6
#2Louise MurrayH-Index: 18
Last. Robin PrestwichH-Index: 28
view all 7 authors...
Abstract Aims To assess the impact of weekly scheduled peer review of head and neck contours for definitive and adjuvant radiotherapy cases based on rates of recommended changes. Materials and methods Retrospective analysis of a prospective database. Recommended changes were prospectively classified as ‘major’ (change in gross tumour volume and/or high-dose clinical target volume, dose/fractionation) or ‘minor’ (change in intermediate or elective dose clinical target volumes or organs at risk). ...
3 CitationsSource
#1Yuan ZhangH-Index: 21
#2Lei ChenH-Index: 66
Last. Jun MaH-Index: 13
view all 47 authors...
Abstract Background Platinum-based concurrent chemoradiotherapy is the standard of care for patients with locoregionally advanced nasopharyngeal carcinoma. Additional gemcitabine and cisplatin indu...
162 CitationsSource
#1Ying lin Peng (SYSU: Sun Yat-sen University)H-Index: 2
#2Li Chen (SYSU: Sun Yat-sen University)H-Index: 104
Last. Xiaowu Deng (SYSU: Sun Yat-sen University)H-Index: 10
view all 15 authors...
Abstract Objective This study aimed to (a) assess the differences in the delineation of target volumes and organs-at-risk (OARs) by different physicians designing an intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and (b) analyze the impact of these differences on the treatment plan optimization. Materials and methods The planning target volumes (PTVs) and OARs for radiotherapy were manually delineated from computed tomography images of a patient with NPC, and a s...
10 CitationsSource
#1Imran Petkar (ICR: Institute of Cancer Research)H-Index: 6
#2Shreerang A. Bhide (ICR: Institute of Cancer Research)H-Index: 22
Last. Christopher M. Nutting (The Royal Marsden NHS Foundation Trust)H-Index: 69
view all 5 authors...
Objective:Advances in radiation delivery, imaging techniques, and chemotherapy have significantly improved treatment options for non-metastatic nasopharyngeal cancers (NPC). However, their impact on the practice in the United Kingdom (UK), where this tumour is rare, is unknown. This study examined the current attitudes of UK head and neck oncologists to the treatment of NPC.Methods:UK head and neck oncologists representing 19/23 cancer networks were sent an invitation email with a personalised l...
1 CitationsSource
#1Kwok-Hung AuH-Index: 6
#1Kwok-Hung AuH-Index: 5
Last. Anthony H.P. Tam (Hospital Authority)H-Index: 2
view all 14 authors...
Abstract Purpose To evaluate treatment outcomes, failure patterns and late toxicities in patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) in 6 public hospitals in Hong Kong over a 10-year period from 2001 to 2010. Material and methods Eligible patients were identified through the Hong Kong Cancer Registry data base. Clinical information was retrieved and verified by oncologists working in the individual centers. Treatment details, survival outcomes ...
66 CitationsSource
#1Anne W.M. Lee (HKU: University of Hong Kong)H-Index: 58
#1Anne W. Lee (HKU: University of Hong Kong)H-Index: 3
Last. Joseph Wee (NUS: National University of Singapore)H-Index: 36
view all 26 authors...
Purpose: Target delineation in nasopharyngeal carcinoma (NPC) often proves challenging because of the notoriously narrow therapeutic margin. High doses are needed to achieve optimal levels of tumour control, and dosimetric inadequacy remains one of the most important independent factors affecting treatment outcome. Method: A review of the available literature addressing the natural behaviour of NPC and correlation between clinical and pathological aspects of the disease was conducted. Existing i...
67 CitationsSource
#1Ellen T. Chang (Exponent)H-Index: 63
#2Zhiwei Liu (KI: Karolinska Institutet)H-Index: 14
Last. Weimin Ye (Exponent)H-Index: 88
view all 22 authors...
: The magnitude and patterns of associations between smoking and risk of nasopharyngeal carcinoma (NPC) in high-incidence regions remain uncertain. Associations with active and passive tobacco smoking were estimated using multivariate logistic regression in a population-based case-control study of 2,530 NPC cases and 2,595 controls in Guangdong and Guangxi, southern China, in 2010-2014. Among men, risk of NPC was significantly higher in current smokers compared with never smokers (odds ratio (OR...
23 CitationsSource
#1Laureen Ribassin-Majed (Université Paris-Saclay)H-Index: 2
#2Sophie Marguet (Université Paris-Saclay)H-Index: 9
Last. Pierre Blanchard (Université Paris-Saclay)H-Index: 31
view all 20 authors...
PurposeThe role of adjuvant chemotherapy (AC) or induction chemotherapy (IC) in the treatment of locally advanced nasopharyngeal carcinoma is controversial. The individual patient data from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma database were used to compare all available treatments.MethodsAll randomized trials of radiotherapy (RT) with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma were considered. Overall, 20 trials and 5,144 patients were included. Treat...
123 CitationsSource
3 CitationsSource
Cited By3
Newest
#1Guoqiang Xu (Kunming Medical University)H-Index: 1
#2Qiaoli Wang (Kunming Medical University)H-Index: 1
Last. Qin Huang (Kunming Medical University)
view all 10 authors...
PURPOSE Induction chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy alone are both standard treatment regimens for managing locally advanced nasopharyngeal carcinoma. However, the results of comparisons between them in clinical trials vary. Therefore, we designed this meta-analysis to illustrate their advantages and disadvantages in patients with locally advanced nasopharyngeal carcinoma. METHODS We thoroughly searched the PubMed, EMBASE, and Cochrane Library databa...
Source
#1Qiaoli Wang (Kunming Medical University)H-Index: 1
#2Guoqiang Xu (Kunming Medical University)H-Index: 1
Last. Wenhui Li (Kunming Medical University)H-Index: 10
view all 9 authors...
Abstract Background Induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) is a standard treatment regimen for locally advanced nasopharyngeal carcinoma (LA-NPC). However, the increased acute toxicity of this intensified chemotherapy may counteract its efficacy. The results of studies focusing on the omission of concurrent chemotherapy (CC) regimens are controversial. Therefore, we carried out a meta-analysis to elucidate the efficacy and toxicity of IC + CCRT versus IC plus radiot...
3 CitationsSource
#1Khodayar Goshtasbi (UCI: University of California, Irvine)H-Index: 8
#2Brandon M. Lehrich (CMU: Carnegie Mellon University)H-Index: 6
Last. Edward C. Kuan (UCI: University of California, Irvine)H-Index: 14
view all 6 authors...
ObjectivesTo comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome.Study DesignRetrospective...
Source