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Radiation Oncology

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Open Access 01-12-2019 | Metastasis | Research

The prolonged interval between induction chemotherapy and radiotherapy is associated with poor prognosis in patients with nasopharyngeal carcinoma

Authors: Liang Peng, Jin-Qi Liu, Cheng Xu, Xiao-Dan Huang, Ling-Long Tang, Yu-Pei Chen, Ying Sun, Jun Ma

Published in: Radiation Oncology | Issue 1/2019

Abstract

Objectives

Induction chemotherapy (IC) now is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). The current study was conducted to examine the association between prognosis and the interval between IC and radiotherapy (RT) in NPC patients.

Methods

Patients with newly diagnosed, non-metastatic NPC who were treated with IC followed by RT from 2009 to 2012 were identified from an inpatient database. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were compared between those with interval ≤ 30 and > 30 days by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis.

Results

A total of 668 patients met inclusion criteria with median follow-up of 64.4 months. Patients were categorized by interval: 608 patients with interval ≤ 30 days, and 60 with interval > 30 days. The 5-year OS, DFS, DMFS and LRFS rates were 86.6, 78.2, 88.0 and 89.8% for patients with interval ≤ 30 days, respectively, and 69.2, 64.5, 71.2 and 85.1% for patients with interval > 30 days, respectively. The prolonged interval was a risk factor for OS, DFS and DMFS with adjusted hazard ratios (95% confidence intervals) were 2.44 (1.48–4.01), 1.99 (1.27–3.11) and 2.62 (1.54–4.47), respectively.

Conclusions

Prolonged interval > 30 days was associated with a significantly higher risk of distant metastasis and death in NPC patients. Efforts should be made to avoid prolonged interval between IC and RT to minimize the risk of treatment failure.

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Wei KR, Zheng RS, Zhang SW, Liang ZH, Li ZM, Chen WQ. Nasopharyngeal carcinoma incidence and mortality in China, 2013. Chin J Cancer. 2017;36(1):90. https://doi.org/10.1186/s40880-017-0257-9.CrossRefPubMedPubMedCentral

Lee AW, Sze WM, Au JS, Leung SF, Leung TW, Chua DT, et al. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2005;61(4):1107–16. https://doi.org/10.1016/j.ijrobp.2004.07.702.CrossRef

Mao YP, Xie FY, Liu LZ, Sun Y, Li L, Tang LL, et al. Re-evaluation of 6th edition of AJCC staging system for nasopharyngeal carcinoma and proposed improvement based on magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2009;73(5):1326–34. https://doi.org/10.1016/j.ijrobp.2008.07.062 Epub 9 Jan 17.CrossRefPubMed

Chan AT, Gregoire V, Lefebvre JL, Licitra L, Hui EP, Leung SF, et al. Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii83–5. https://doi.org/10.1093/annonc/mds266.CrossRefPubMed

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(3):661–8. https://doi.org/10.1016/j.ijrobp.2010.03.024 Epub Jul 17.CrossRefPubMed

Chen YP, Tang LL, Yang Q, Poh SS, Hui EP, Chan ATC, et al. Induction chemotherapy plus concurrent chemoradiotherapy in endemic nasopharyngeal carcinoma: individual patient data pooled analysis of four randomized trials. Clin Cancer Res. 2018;24(8):1824–33. https://doi.org/10.1158/078-0432.CCR-17-2656 Epub 018 Feb 5.CrossRefPubMed

Lefevre JH, Mineur L, Kotti S, Rullier E, Rouanet P, de Chaisemartin C, et al. Effect of interval (7 or 11 weeks) between neoadjuvant Radiochemotherapy and surgery on complete pathologic response in rectal Cancer: a multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol. 2016;34(31):3773–80. https://doi.org/10.1200/JCO.2016.67.6049.CrossRefPubMed

Omarini C, Guaitoli G, Noventa S, Andreotti A, Gambini A, Palma E, et al. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol. 2017;43(4):613–8. https://doi.org/10.1016/j.ejso.2016.09.020 Epub Oct 20.CrossRefPubMed

Gao SJ, Corso CD, Wang EH, Blasberg JD, Detterbeck FC, Boffa DJ, et al. Timing of surgery after neoadjuvant Chemoradiation in locally advanced non-small cell lung Cancer. J Thorac Oncol. 2017;12(2):314–22. https://doi.org/10.1016/j.jtho.2016.09.122 Epub Oct 5.CrossRefPubMed

10.

Chen YP, Mao YP, Zhang WN, Chen L, Tang LL, Li WF, et al. Prognostic value of wait time in nasopharyngeal carcinoma treated with intensity modulated radiotherapy: a propensity matched analysis. Oncotarget. 2016;7(12):14973–82. https://doi.org/10.8632/oncotarget.7789.CrossRefPubMedPubMedCentral

11.

Li WF, Sun Y, Chen M, Tang LL, Liu LZ, Mao YP, et al. Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation. Chin J Cancer. 2012;31(12):579–87. https://doi.org/10.5732/cjc.012.10095 Epub 2012 Aug 2.CrossRefPubMedPubMedCentral

12.

Shao JY, Zhang Y, Li YH, Gao HY, Feng HX, Wu QL, et al. Comparison of Epstein-Barr virus DNA level in plasma, peripheral blood cell and tumor tissue in nasopharyngeal carcinoma. Anticancer Res. 2004;24(6):4059–66.PubMed

13.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef

14.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.CrossRefPubMedPubMedCentral

15.

Altman DG, McShane LM, Sauerbrei W, Taube SE. Reporting recommendations for tumor marker prognostic studies (REMARK): explanation and elaboration. PLoS Med. 2012;9(5):e1001216. https://doi.org/10.1371/journal.pmed Epub 2012 May 29.CrossRefPubMedPubMedCentral

16.

Zhang W, Chen Y, Chen L, Guo R, Zhou G, Tang L, et al. The clinical utility of plasma Epstein-Barr virus DNA assays in nasopharyngeal carcinoma: the dawn of a new era?: a systematic review and meta-analysis of 7836 cases. Medicine (Baltimore). 2015;94(20):e845. https://doi.org/10.1097/MD.0000000000000845.CrossRef

17.

Chen PC, Yang CC, Wu CJ, Liu WS, Huang WL, Lee CC. Factors predict prolonged wait time and longer duration of radiotherapy in patients with nasopharyngeal carcinoma: a multilevel analysis. PLoS One. 2014;9(10):e109930. https://doi.org/10.1371/journal.pone.0109930 eCollection 2014.CrossRefPubMedPubMedCentral

18.

Guo R, Chen XZ, Chen L, Jiang F, Tang LL, Mao YP, et al. Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: development and validation of a predictive score model. Radiother Oncol. 2015;114(2):249–56. https://doi.org/10.1016/j.radonc.2014.12.002 Epub 5 Jan 21.CrossRefPubMed

19.

Peng H, Chen L, Zhang Y, Li WF, Mao YP, Liu X, et al. The Tumour Response to Induction Chemotherapy has Prognostic Value for Long-Term Survival Outcomes after Intensity-Modulated Radiation Therapy in Nasopharyngeal Carcinoma. Sci Rep. 2016;6:24835. https://doi.org/10.1038/srep24835.CrossRefPubMedPubMedCentral

20.

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(11):1509–20. https://doi.org/10.1016/S470-2045(16)30410-7 Epub 2016 Sep 27.CrossRefPubMed

21.

Ma BB, Hui EP, Chan AT. Systemic approach to improving treatment outcome in nasopharyngeal carcinoma: current and future directions. Cancer Sci. 2008;99(7):1311–8. https://doi.org/10.1111/j.49-7006.2008.00836.x Epub 2008 May 21.CrossRefPubMed

22.

Vasey PA. “Dose dense” chemotherapy in ovarian cancer. Int J Gynecol Cancer. 2005;15(Suppl 3):226–32. https://doi.org/10.1111/j.525-438.2005.00438.x.CrossRefPubMed

23.

Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228–37. https://doi.org/10.1002/cncr.11882.CrossRefPubMed

24.

Orlandi E, Alfieri S, Simon C, Trama A, Licitra L. Treatment challenges in and outside a network setting: head and neck cancers. Eur J Surg Oncol. 2018;14(18):30417.

25.

Peng H, Chen L, Li WF, Zhang Y, Liu LZ, Tian L, et al. Optimize the cycle of neoadjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: A propensity score matching analysis. Oral Oncol. 2016;62:78–84. https://doi.org/10.1016/j.oraloncology.2016.10.014 Epub Oct 19.CrossRefPubMed

Title: The prolonged interval between induction chemotherapy and radiotherapy is associated with poor prognosis in patients with nasopharyngeal carcinoma
Authors: Liang Peng
Jin-Qi Liu
Cheng Xu
Xiao-Dan Huang
Ling-Long Tang
Yu-Pei Chen
Ying Sun
Jun Ma
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Metastasis
Epstein-Barr Virus
Radiotherapy
Cytostatic Therapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1213-4

At a glance: The STEP trials

Springer Medicine

The prolonged interval between induction chemotherapy and radiotherapy is associated with poor prognosis in patients with nasopharyngeal carcinoma

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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