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Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study

Authors: Linger Liu, Zhenghua Fei, Mengfeng Chen, Lihao Zhao, Huafang Su, Dianna Gu, Baochai Lin, Xiaona Cai, Lihuai Lu, Mengdan Gao, Xuxue Ye, Xiance Jin, Congying Xie

Published in: Radiation Oncology | Issue 1/2018

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Abstract

Background

In the era of intensity-modulated radiotherapy (IMRT), the role of additional concurrent chemotherapy (CC) to radiotherapy (RT) after induction chemotherapy (IC) compared to IC followed by RT alone remains unclear for stage II-IVB nasopharyngeal carcinoma (NPC) patients. The aim of this study was to evaluate the efficacy and toxicities of IC/RT and IC/CCRT in the treatment of NPC with volumetric modulated arc therapy (VMAT).

Methods

From January 2012 to March 2016, a total of 217 NPC patients were retrospectively assessed. Of the 217 patients, 139 patients received IC followed by VMAT alone and 78 patients received IC plus CCRT. Overall survival (OS), progression-free survival (PFS) and toxicities were assessed.

Results

The 5-year OS, PFS rates were 57.5%, 41.8% and 47.8%, 38.4% for the IC/RT and IC/CCRT arms, respectively, without significant difference in survival between the two groups (both p > 0.05). Multivariate analysis indicated that treatment modality (IC/RT vs. IC/CCRT) was not an independent prognostic factor for OS or PFS. Grade 3–4 leukopenia/neutropenia (3.60% vs. 20.51%, p < 0.001), gastrointestinal disorder (nausea/vomiting/diarrhea, 2.16% vs. 41.03%, p < 0.001), mucositis (29.50% vs. 47.44%, p = 0.01) and xerostomia (34.53% vs. 48.72%, p = 0.04) were more frequent in the IC/ CCRT arm than in the IC/RT arm during VMAT.

Conclusions

No significant difference in OS and PFS was observed between IC plus VMAT alone and IC/CCRT in the treatment of stage II-IVB NPC patients, however, more side effects were observed in the IC/CCRT arm.
Literature
1.
Liang SB, Wang Y, Hu XF, He SS, Yang XL, Liu LZ, et al. Survival and toxicities of IMRT based on the RTOG protocols in patients with nasopharyngeal carcinoma from the endemic regions of China. J Cancer. 2017;8:3718–24.CrossRefPubMedPubMedCentral
2.
3.
Blanchard P, Lee A, Marguet S, Leclercq J, Ng WT, Ma J, et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Lancet Oncol. 2018;16:645–55.CrossRef
4.
Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016;17:1509–20.CrossRefPubMed
5.
Peng H, Chen L, Zhang J, Li WF, Mao YP, Zhang Y, et al. Induction chemotherapy improved long-term outcomes of patients with locoregionally advanced nasopharyngeal carcinoma: a propensity matched analysis of 5-year survival outcomes in the era of intensity-modulated radiotherapy. J Cancer. 2017;8(3):371–7.CrossRefPubMedPubMedCentral
6.
Hui EP, Ma BB, Leung SF, King AD, Mo F, Kam MK, et al. Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol. 2009;27:242–9.CrossRefPubMed
7.
Qiu WZ, Huang PY, Shi JL, Xia HQ, Zhao C, Cao KJ. Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma: a retrospective controlled study. Chin J Cancer. 2016;35:2.CrossRefPubMedPubMedCentral
8.
Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099. J Clin Oncol. 1998;16(4):1310–7.CrossRefPubMed
9.
Huang PY, Cao KJ, Guo X, Mo HY, Guo L, Xiang YQ, et al. A randomized trial of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy for locoregionally advanced nasopharyngeal carcinoma. Oral Oncol. 2012;48:1038–44.CrossRefPubMed
10.
Dilruba S, Kalayda GV. Platinum-based drugs: past, present and future. Cancer Chemother Pharmacol. 2016;77:1103–24.CrossRefPubMed
11.
Toumi N, Ben Kridis W, Mnejja W, Bouzguenda R, Khanfir A, Ghorbel A, et al. TPF induction chemotherapy followed by concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: long term results of a Tunisian series. Cancer Radiother. 2018;22(3):216–21.CrossRefPubMed
12.
Li WF, Li YQ, Chen L, Zhang Y, Guo R, Zhang F, et al. Propensity-matched analysis of three different chemotherapy sequences in patients with locoregionally advanced nasopharyngeal carcinoma treated using intensity-modulated radiotherapy. BMC Cancer. 2015;15:810.CrossRefPubMedPubMedCentral
13.
Zhang B, Hu Y, Xiong RH, Pan YF, Xu QL, Kong XY, et al. Matched analysis of induction chemotherapy plus chemoradiotherapy versus induction chemotherapy plus radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a multicenter study. Oncotarget. 2017; https://​doi.​org/​10.​18632/​oncotarget.​13285.
14.
Ma J, Mai HQ, Hong MH, Min HQ, Mao ZD, Cui NJ, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol. 2001;19:1350–7.CrossRefPubMed
15.
International Nasopharynx Cancer Study Group. Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV (N or = N2, M0) undifferentiated nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 1996;35:463–9.
16.
Jin X, Yi J, Zhou Y, Yan H, Han C, Xie C. Comparison of whole-field simultaneous integrated boost VMAT and IMRT in the treatment of nasopharyngeal cancer. Med Dosim. 2013;38:418–23.CrossRefPubMed
17.
18.
Tang C, Wu F, Wang R, Lu H, Li G, Liu M, et al. Comparison between nedaplatin and cisplatin plus docetaxel combined with intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma: a multicenter randomized phase II clinical trial. Am J Cancer Res. 2006;6:2064–75.
19.
Wu SX, Xie CY, Jin XC, Zhang P. Simultaneous modulated accelerated radiation therapy in the treatment of nasopharyngeal cancer: a local center’s experience. Int J Radiat Oncol Biol Phys. 2006;87:s40–6.CrossRef
20.
Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol. 2006;22:4604–12.CrossRef
21.
OuYang PY, Xie C, Mao YP, Zhang Y, Liang XX, Su Z, et al. Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials. Ann Oncol. 2013;24:2136–46.CrossRefPubMed
22.
Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005;23:6730–8.CrossRefPubMed
23.
Lin S, Lu JJ, Han L, Chen Q, Pan J. Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: experience of 370 consecutive cases. BMC Cancer. 2010;10:39.CrossRefPubMedPubMedCentral
24.
Tan T, Lim WT, Fong KW, Cheah SL, Soong YL, Ang MK, et al. Concurrent chemo-radiation with or without induction gemcitabine, carboplatin, and paclitaxel: a randomized, phase 2/3 trial in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2015;91:952–60.CrossRefPubMed
25.
Su SF, Han F, Zhao C, Huang Y, Chen CY, Xiao WW, et al. Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Chin J Cancer. 2011;30:565–73.CrossRefPubMedPubMedCentral
26.
Lee N, Harris J, Garden AS, Straube W, Glisson B, Xia P, et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol. 2009;27:3684–90.CrossRefPubMedPubMedCentral
27.
Peng G, Wang T, Yang KY, Zhang S, Zhang T, Li Q, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol. 2012;104:286–93.CrossRefPubMed
28.
Sun X, Su S, Chen C, Han F, Zhao C, Xiao W, et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiother Oncol. 2014;110:398–403.CrossRefPubMed
29.
30.
Chua DT, Ma J, Sham JS, Mai HQ, Choy DT, Hong MH, et al. Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials. J Clin Oncol. 2005;23:1118–24.CrossRefPubMed
31.
Lee AW, Tung SY, Ngan RK, Chappell R, Chua DT, Lu TX, et al. Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: combined analyses of NPC-9901 and NPC-9902 trials. Eur J Cancer. 2011;47:656–66.CrossRefPubMed
32.
33.
Wu LR, Jiang XS, Song X, Yu HL, Fan YX, Wang FJ, et al. Comparing the efficacy of induction-concurrent with concurrent-adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis. Oncotarget. 2017; https://​doi.​org/​10.​18632/​oncotarget.​20389.
34.
Golden DW, Rudra S, Witt ME, Nwizu T, Cohen EE, Blair E, et al. Outcomes of induction chemotherapy followed by concurrent chemoradiation for nasopharyngeal carcinoma. Oral Oncol. 2013;49:277–82.CrossRefPubMed
35.
Frikha M, Auperin A, Tao Y, Elloumi F, Toumi N, Blanchard P, et al. A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02). Ann Oncol. 2018;29(3):731–6.CrossRefPubMed
36.
Fountzilas G, Ciuleanu E, Bobos M, Kalogera-Fountzila A, Eleftheraki AG, Karayannopoulou G, et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma: a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation. Ann Oncol. 2012;23:427–35.CrossRefPubMed
37.
Al-Amro A, Al-Rajhi N, Khafaga Y, Memon M, Al-Hebshi A, El-Enbabi A, et al. Neoadjuvant chemotherapy followed by concurrent chemo-radiation therapy in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2005;62:508–13.CrossRefPubMed
38.
Johnson FM, Garden AS, Palmer JL, Shin DM, Morrison W, Papadimitrakopoulou V, et al. A phase I/II study of neoadjuvant chemotherapy followed by radiation with boost chemotherapy for advanced T-stage nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2005;63:717–24.CrossRefPubMed
39.
Oh JL, Vokes EE, Kies MS, Mittal BB, Witt ME, Weichselbaum RR, Haraf DJ, et al. Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal cancer. Ann Oncol. 2003;14:564–9.CrossRefPubMed
40.
Kwong DL, Pow EH, Sham JS, McMillan AS, Leung LH, Leung WK, et al. Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function. Cancer. 2004;101(7):1584–93.CrossRefPubMed
41.
Laskar S, Bahl G, Muckaden M, Pai SK, Gupta T, Banavali S, et al. Nasopharyngeal carcinoma in children: comparison of conventional and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:728–36.CrossRefPubMed
42.
Lai SZ, Li WF, Chen L, Luo W, Chen YY, Liu LZ, et al. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys. 2011;80:661–8.CrossRefPubMed
43.
Xue F, Hu C, He X. Induction chemotherapy followed by intensity-modulated radiotherapy with reduced gross tumor volume delineation for stage T3-4 nasopharyngeal carcinoma. Oncotargets Ther. 2017;10:3329–36.CrossRef
44.
Cheng SH, Jian JJ, Tsai SY, Yen KL, Chu NM, et al. Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys. 2000;48:1323–30.CrossRefPubMed
45.
Ke LR, Xia WX, Qiu WZ, Huang XJ, Yang J, Yu YH, et al. Safety and efficacy of lobaplatin combined with 5-fluorouracil as first-line induction chemotherapy followed by lobaplatin-radiotherapy in locally advanced nasopharyngeal carcinoma: preliminary results of a prospective phase II trial. BMC Cancer. 2017;17:134.CrossRefPubMedPubMedCentral
Metadata
Title
Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study
Authors
Linger Liu
Zhenghua Fei
Mengfeng Chen
Lihao Zhao
Huafang Su
Dianna Gu
Baochai Lin
Xiaona Cai
Lihuai Lu
Mengdan Gao
Xuxue Ye
Xiance Jin
Congying Xie
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-1092-0

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