Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099.

Al‐Sarraf, Muhyi; LeBlanc, Michael; Giri, Padmini; Fu, Karen K.; Cooper, Jay S.; Vuong, T.; Forastiere, Arlene A.; Adams, Grenfell; Sakr, Wael; Schuller, David E.; Ensley, John F.

doi:10.1200/jco.1998.16.4.1310

Cited by 2,049 publications

(1,555 citation statements)

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“…One of the main reasons for the increase in survival rates for NPC patients was the introduction of concomitant chemo-radiotherapy and the use of intensity-modulated radiotherapy. In 1998 Al-Sarraf et al found improvement in survival for patients with advanced NPC receiving chemo-radiotherapy compared to radiotherapy alone [19] and later this was verified in a Cochrane review [20]. Although the overall survival in Greenland has improved significantly, it is still not comparable to Denmark or the United States.…”

Section: Discussionmentioning

confidence: 99%

Improved survival of head and neck cancer patients in Greenland

Lawaetz

Jensen

Friborg

et al. 2018

International Journal of Circumpolar Health

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Previously, head and neck cancer (HNC) patients in Greenland have had significant diagnostic delay and poor survival rates. From 2005-2009 several initiatives have been made to ensure faster diagnosis and better survival. The aim of this study was to compare the prognosis before and after these initiatives were introduced.All Greenlandic patients diagnosed with HNC between 2005 and 2012 were included. Data were retrieved from medical records and national databases and compared with the period 1994-2003. A total of 98 patients were identified. Diagnostic delay was significantly lower compared to the period 1994–2004 (p=0.048). The 3-year overall survival was 56% for all HNC and 47% for nasopharyngeal carcinomas. We found that patients with HNC between 1994 and 2003 had a higher risk of death from all reasons compared with the period 2005–2012 (HR 2.17; CI 1.46–3.23) after adjustments for stage and diagnostic delay.Patients with head HNC in Greenland from 2005-2012 were diagnosed earlier and had a better overall survival compared to the period 1994–2003. The change in survival is more likely to be due to improvement in treatment rather than the initiated interventions. Although survival has improved in Greenland, demographic problems and lack of specialists remain a challenge.

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Section: Discussionmentioning

confidence: 99%

Improved survival of head and neck cancer patients in Greenland

Lawaetz

Jensen

Friborg

et al. 2018

International Journal of Circumpolar Health

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“…( Al-Sarraf et al, 1998;Lin et al, 2003;Wee et al, 2004). Thus, with reanalysis, we have eliminated the bias with the use of chemotherapy and make the two cohorts more comparable.…”

Section: Discussionmentioning

confidence: 99%

“…In view of the high rate of systemic relapse, chemotherapy has been incorporated into the primary treatment of locally advanced disease in order to improve the outcome. Concurrent chemoradiotherapy was shown to improve overall and progression-free survival for locally advanced NPC in the Intergroup study (Al-Sarraf et al, 1998) and this was replicated in studies carried out in the endemic areas of Singapore (Wee et al, 2004), Hong Kong and Taiwan (Lin et al, 2003). However, a significant proportion of patients would still relapse systemically despite combined modality therapy and many of these patients would ultimately succumb to disseminated disease.…”

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confidence: 87%

Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma

Toh

Heng

et al. 2005

Br J Cancer

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Patients with metastatic nasopharyngeal carcinoma have variable survival outcomes. We previously designed a scoring system to better prognosticate these patients. Here, we report results on validation of this new prognostic index score in a separate cohort of patients. Clinical features and laboratory parameters were examined in 172 patients with univariate and multivariate analyses and a numerical score was derived for each independent prognostic variable. Significant independent prognostic variables and their scores assigned included poor performance status (score 5), haemoglobin o12 g dl À1 (score 4) and disease-free interval (DFI) (DFIp6 months (score 10) or metastases at initial diagnosis (score 1)). Maximum score was 19 and patients stratified into three prognostic groups: good, 0 -3; intermediate, 4 -8; poor, X9. When applied to a separate cohort of 120 patients, 59 patients were good, 43 intermediate and 18 poor prognosis, with median survivals of 19.6 (95% CI 16.1, 23.1), 14.3 (95% CI 12.3, 16.2) and 7.9 (95% CI 6.6, 9.2) months, respectively. (logrank test: P ¼ 0.003). We have validated a new prognostic score with factors readily available in the clinics. This simple score will prove useful as a method to prognosticate and stratify patients as well as to promote consistent reporting among clinical trials.

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“…Given its anatomical location and the proximity to critical organs, radiation therapy (RT) is the primary local modality in contrast to other head and neck malignancies where surgery may still play a major role. As such, prior to the advent of megavoltage RT, NPC had a poor prognosis; however, modern RT technology, especially Intensity Modulated RT, and concurrent chemotherapy has resulted in >70% 5‐year overall survival 2, 3, 4, 5…”

Section: Introductionmentioning

confidence: 99%

“…Several studies in the early 1990s and 2000s demonstrated that concurrent chemoradiation (CRT) followed by adjuvant cisplatin improved survival compared to RT alone and established this as the standard of care for newly diagnosed NPC 2, 5. Furthermore, the use of 3‐dimensional imaging (CT and MRI) along with improvement in RT technology has resulted in excellent local control rates 6.…”

Section: Introductionmentioning

confidence: 99%

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

et al. 2018

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The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T‐ and N‐stage had a higher likelihood of being treated with induction chemotherapy. The 5‐year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3‐T4N1 or TanyN2‐3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3‐T4N1 or TanyN2‐3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.

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Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099.

Abstract: We conclude that chemoradiotherapy is superior to radiotherapy alone for patients with advanced nasopharyngeal cancers with respect to PFS and overall survival.

Cited by 2,049 publications

References 30 publications

Improved survival of head and neck cancer patients in Greenland

Improved survival of head and neck cancer patients in Greenland

Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

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