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Published in: Radiation Oncology 1/2020

Open Access 01-12-2020 | Radiotherapy | Research

Efficacy and safety of intensity-modulated radiotherapy alone versus intensity-modulated radiotherapy plus chemotherapy for treatment of intermediate-risk nasopharyngeal carcinoma

Authors: Omer Aftab, Shufang Liao, Rongjun Zhang, Nan Tang, Meiqing Luo, Bin Zhang, Sanjeev Shahi, Raju Rai, Jazib Ali, Wei Jiang

Published in: Radiation Oncology | Issue 1/2020

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Abstract

Background

This study directs to evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy in intermediate-risk NPC (stage II and T3N0M0).

Methods

A total of 124 patients with stage II and T3N0M0 NPC were pair-matched (1:1 ratio) to form two groups: an IMRT-alone group and an IMRT/chemotherapy group. Survival outcomes (overall survival [OS], disease–free survival [DFS], locoregional relapse–free survival [LRRFS], distant metastasis–free survival [DMFS]) and treatment-related grade 3–4 acute toxicity events were compared between the groups.

Results

Survival outcomes for patients with stage II and T3N0M0 NPC were quiet comparable between patients treated with IMRT alone versus patients treated with IMRT/chemotherapy: 5-year OS was 91.9% vs. 90.3%, respectively (P = 0.727); DFS was 87.1% vs. 88.7%, respectively (P = 0.821); LRFFS was 96.8% vs. 95.2%, respectively (P = 0.646), and DMFS was 91.9% vs. 91.5%, respectively (P = 0.955). Grade 3 acute toxicities were significantly higher with IMRT/chemotherapy than with IMRT alone: mucositis, 15% vs. 5% (P = 0.004); leukopenia/neutropenia, 8% vs. 1% (P <  0.015); and nausea/vomiting, 22% vs. 3% (P <  0.001).

Conclusion

For intermediate-risk (stage II and T3N0M0) NPC patients, the addition of chemotherapy to IMRT does not appear to provide any survival benefit. Moreover, grade 3 acute toxicities are also more common in patients receiving IMRT plus chemotherapy.
Literature
1.
2.
go back to reference Lee AW, Ma BB, Ng WT, Chan AT. Management of nasopharyngeal carcinoma: current practice and future perspective. J Clin Oncol. 2015;33(29):3356–64.CrossRef Lee AW, Ma BB, Ng WT, Chan AT. Management of nasopharyngeal carcinoma: current practice and future perspective. J Clin Oncol. 2015;33(29):3356–64.CrossRef
3.
go back to reference Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005;97(7):536–9.CrossRef Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005;97(7):536–9.CrossRef
4.
go back to reference Chen QY, Wen YF, Guo L, et al. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011;103(23):1761–70.CrossRef Chen QY, Wen YF, Guo L, et al. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011;103(23):1761–70.CrossRef
5.
go back to reference Chen L, Mao YP, Xie FY, et al. The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity-modulated radiotherapy from an endemic area in China. Radiother Oncol. 2012;104(3):331–7.CrossRef Chen L, Mao YP, Xie FY, et al. The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity-modulated radiotherapy from an endemic area in China. Radiother Oncol. 2012;104(3):331–7.CrossRef
6.
go back to reference You R, Cao YS, Huang PY, et al. The changing therapeutic role of chemo-radiotherapy for loco-regionally advanced nasopharyngeal carcinoma from two/three-dimensional radiotherapy to intensity-modulated radiotherapy: a network meta-analysis. Theranostics. 2017;7(19):4825–35.CrossRef You R, Cao YS, Huang PY, et al. The changing therapeutic role of chemo-radiotherapy for loco-regionally advanced nasopharyngeal carcinoma from two/three-dimensional radiotherapy to intensity-modulated radiotherapy: a network meta-analysis. Theranostics. 2017;7(19):4825–35.CrossRef
7.
go back to reference Xu T, Zhou X, Shen C, Hu C. Suggestions for surveillance and radiation strategy in nasopharyngeal carcinoma treated with IMRT: based on hazard-rate and patterns of recurrence. Oral Oncol. 2018;76(undefined):61–7.CrossRef Xu T, Zhou X, Shen C, Hu C. Suggestions for surveillance and radiation strategy in nasopharyngeal carcinoma treated with IMRT: based on hazard-rate and patterns of recurrence. Oral Oncol. 2018;76(undefined):61–7.CrossRef
8.
go back to reference Sun Y, Tang LL, Chen L, et al. Promising treatment outcomes of intensity-modulated radiation therapy for nasopharyngeal carcinoma patients with N0 disease according to the seventh edition of the AJCC staging system. BMC Cancer. 2012;12:68.CrossRef Sun Y, Tang LL, Chen L, et al. Promising treatment outcomes of intensity-modulated radiation therapy for nasopharyngeal carcinoma patients with N0 disease according to the seventh edition of the AJCC staging system. BMC Cancer. 2012;12:68.CrossRef
9.
go back to reference Zhang MX, Li J, Shen GP, et al. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: a 10-year experience with a large cohort and long follow-up. Eur J Cancer. 2015;51(17):2587–95.CrossRef Zhang MX, Li J, Shen GP, et al. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: a 10-year experience with a large cohort and long follow-up. Eur J Cancer. 2015;51(17):2587–95.CrossRef
10.
go back to reference Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.CrossRef Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.CrossRef
11.
go back to reference Guo Q, Lu T, Lin S, et al. Long-term survival of nasopharyngeal carcinoma patients with stage II in intensity-modulated radiation therapy era. Jpn J Clin Oncol. 2016;46(3):241–7.CrossRef Guo Q, Lu T, Lin S, et al. Long-term survival of nasopharyngeal carcinoma patients with stage II in intensity-modulated radiation therapy era. Jpn J Clin Oncol. 2016;46(3):241–7.CrossRef
12.
go back to reference Xu C, Zhang LH, Chen YP, et al. Chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma: a systemic review and meta-analysis of 2138 patients. J Cancer. 2017;8(2):287–97.CrossRef Xu C, Zhang LH, Chen YP, et al. Chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma: a systemic review and meta-analysis of 2138 patients. J Cancer. 2017;8(2):287–97.CrossRef
13.
go back to reference Lan XW, Xiao Y, Zou XB, et al. Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0–1 nasopharyngeal carcinoma: a propensity-matched study. Onco Targets Ther. 2017;10(undefined):3853–60.CrossRef Lan XW, Xiao Y, Zou XB, et al. Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0–1 nasopharyngeal carcinoma: a propensity-matched study. Onco Targets Ther. 2017;10(undefined):3853–60.CrossRef
14.
go back to reference Lai SZ, Li WF, Chen L, 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.CrossRef Lai SZ, Li WF, Chen L, 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.CrossRef
15.
go back to reference Wolden SL, Chen WC, Pfister DG, et al. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys. 2006;64(1):57–62.CrossRef Wolden SL, Chen WC, Pfister DG, et al. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys. 2006;64(1):57–62.CrossRef
16.
go back to reference Carman J, Strojan P. Nasopharyngeal carcinoma in Slovenia, 1990-2003 (results of treatment with conventional two-dimensional radiotherapy). Rep Pract Oncol Radiother. 2012;17(2):71–8.CrossRef Carman J, Strojan P. Nasopharyngeal carcinoma in Slovenia, 1990-2003 (results of treatment with conventional two-dimensional radiotherapy). Rep Pract Oncol Radiother. 2012;17(2):71–8.CrossRef
17.
go back to reference Ouyang PY, Zhang LN, Lan XW, et al. The significant survival advantage of female sex in nasopharyngeal carcinoma: a propensity-matched analysis. Br J Cancer. 2015;112(9):1554–61.CrossRef Ouyang PY, Zhang LN, Lan XW, et al. The significant survival advantage of female sex in nasopharyngeal carcinoma: a propensity-matched analysis. Br J Cancer. 2015;112(9):1554–61.CrossRef
Metadata
Title
Efficacy and safety of intensity-modulated radiotherapy alone versus intensity-modulated radiotherapy plus chemotherapy for treatment of intermediate-risk nasopharyngeal carcinoma
Authors
Omer Aftab
Shufang Liao
Rongjun Zhang
Nan Tang
Meiqing Luo
Bin Zhang
Sanjeev Shahi
Raju Rai
Jazib Ali
Wei Jiang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-020-01508-4

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