Carcinoma rinofaringeo. Un tumore della testa e collo “diverso”. Parte B: trattamento, fattori prognostici e risultati a distanza

The efficacy and safety of TPF-induced chemotherapy(IC) combined with concurrent chemoradiotherapy(CCRT) compared to CCRT and sequential PF-adjuvant chemotherapy(AC) lack randomized controlled clinical trials for evaluation, so the comparative efficacy and safety between the two approaches remain unclear. In this phase III trial(NCT03574324), 266 patients were enrolled and randomly assigned to either the IC group or the AC group. The IC group received TPF followed by CCRT, while the AC group received CCRT followed by PF. We are reporting on the primary outcome of progression-free survival (PFS) and secondary endpoints of overall survival(OS), locoregional relapse-free survival(LRFS), distant metastasis-free survival(DMFS), and toxicity profile. The 3-year PFS was similar between the two groups, with 79% for the IC group and 74.5% for the AC group (P = 0.454) at a median follow-up of 39 months. Similar findings were observed with no significant disparities in terms of OS, LRFS, and DMFS between the two treatment cohorts. Both groups had similar compliance rates for radiotherapy and chemotherapy, but the IC group experienced fewer toxic effects during CCRT, such as swallowing and dryness (40 [30.53%] vs 56 [43.75%] patients and 58 [44.27%] vs 86 [67.19%] patients, respectively).In this randomized clinical trial, IC did not improve 3-year PFS for LA-NPC patients but it did reduce the incidence rates of swallowing and dry mouth during radiotherapy.

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Predicting Teeth Extraction after Concurrent Chemoradiotherapy in Locally Advanced Nasopharyngeal Cancer Patients Using the Novel GLUCAR Index

Somay,

Topkan,

Yilmaz

et al. 2023

Diagnostics

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To evaluate the value of the newly created GLUCAR index in predicting tooth extraction rates after concurrent chemoradiotherapy (C-CRT) in locally advanced nasopharyngeal carcinomas (LA-NPCs). Methods: A total of 187 LA-NPC patients who received C-CRT were retrospectively analyzed. The GLUCAR index was defined as ′GLUCAR = (Fasting Glucose × CRP/Albumin Ratio) by utilizing measures of glucose, C-reactive protein (CRP), and albumin obtained on the first day of C-CRT. Results: The optimal GLUCAR cutoff was 31.8 (area under the curve: 78.1%; sensitivity: 70.5%; specificity: 70.7%, Youden: 0.412), dividing the study cohort into two groups: GLUCAR ˂ 1.8 (N = 78) and GLUCAR ≥ 31.8 (N = 109) groups. A comparison between the two groups found that the tooth extraction rate was significantly higher in the group with a GLUCAR ≥ 31.8 (84.4% vs. 47.4% for GLUCAR ˂ 31.8; odds ratio (OR):1.82; p < 0.001). In the univariate analysis, the mean mandibular dose ≥ 38.5 Gy group (76.5% vs. 54.9% for <38.5 Gy; OR: 1.45; p = 0.008), mandibular V55.2 Gy group ≥ 40.5% (80.3 vs. 63.5 for <40.5%, p = 0.004, OR; 1.30), and being diabetic (71.8% vs. 57.9% for nondiabetics; OR: 1.23; p = 0.007) appeared as the additional factors significantly associated with higher tooth extraction rates. All four characteristics remained independent predictors of higher tooth extraction rates after C-CRT in the multivariate analysis (p < 0.05 for each). Conclusions: The GLUCAR index, first introduced here, may serve as a robust new biomarker for predicting post-C-CRT tooth extraction rates and stratifying patients according to their tooth loss risk after treatment.

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Carcinoma rinofaringeo. Un tumore della testa e collo “diverso”. Parte B: trattamento, fattori prognostici e risultati a distanza

Cited by 4 publications

References 96 publications

Conundrum of 3N: nasopharyngeal nonkeratinizing non-viral carcinoma—reappraisal of fusions and report of two consecutive cases with unusual molecular findings

Conundrum of 3N: nasopharyngeal nonkeratinizing non-viral carcinoma—reappraisal of fusions and report of two consecutive cases with unusual molecular findings

TPF induction chemotherapy versus PF adjuvant chemotherapy plus concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: a multicenter, randomized controlled phase III trial

Predicting Teeth Extraction after Concurrent Chemoradiotherapy in Locally Advanced Nasopharyngeal Cancer Patients Using the Novel GLUCAR Index

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