Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis

Blanchard, Pierre; Lee, Anne; Marguet, Sophie; Leclercq, Julie; Ng, Wai Tong; Ma, Jingfei; Chan, Anthony T.C.; Huang, Pei‐Yu; Benhamou, E; Zhu, Guoding; Chua, Daniel T.T.; Chen, Yong; Mai, Hai‐Qiang; Kwong, Dora Lai Wan; Cheah, Shie Lee; Moon, James; Tung, Yuk; Chi, Kwan‐Hwa; Fountzilas, George; Zhang, Li; Hui, Edwin P.; Lu, Tai‐Xiang; Bourhis, Jean; Pignon, Jean-Pierre

doi:10.1016/s1470-2045(15)70126-9

Cited by 609 publications

(512 citation statements)

References 31 publications

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“…A recent meta‐analysis based on individual patient data showed a survival benefit associated with concurrent CRT, however, it failed to show a survival benefit of induction chemotherapy 5, 11. Here, we show that induction chemotherapy is not an independent predictor of OS.…”

Section: Discussioncontrasting

confidence: 50%

“…However, this has been controversial as several studies have found a survival benefit with this approach, while others have not 8, 9, 10. A meta‐analysis based on individual patient data has showed no benefit with induction chemotherapy 11. In this study, we aim to use the National Cancer Database (NCDB) to study the patterns of care in the use of induction chemotherapy and evaluate the survival benefit of induction chemotherapy in NPC.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 50%

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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“…Therefore, compared with leukocytes and monocytes, neutrophils may have an increased predictive value for NPC. Although the majority of previous studies have focused on the prediction of poor prognosis, with the goal of identifying patients who may benefit from adjuvant chemotherapy, it is equally important that prognostic classifiers can identify patients with good prognosis who may not require further radical treatment, as the benefit of adjuvant chemotherapy in patients with NPC remains unclear (41,42). The present data demonstrated that prognostic stratification was greatly improved following the combination of SUVmax-N and neutrophils in NPC.…”

Section: Discussionmentioning

confidence: 71%

Prognostic value of 18F-fluorodeoxyglucose PET parameters and inflammation in patients with nasopharyngeal carcinoma

Zhong

Ren

et al. 2017

Oncology Letters

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Abstract. The aim of the present study was to investigate the association between positron emission tomography (PET) parameters and peripheral inflammatory markers, and assess their prognostic value in nasopharyngeal carcinoma (NPC). A total of 121 patients with non-disseminated NPC were recruited. Pretreatment maximum standardized uptake values (SUVmax) of PET and peripheral inflammatory factors (leukocyte, neutrophil and monocyte counts) were recorded. Kaplan-Meier and multivariate analyses were used to identify predictors for progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS). The results of the present study revealed that SUVmax at the primary tumor was positively correlated with leukocytes (P= 0.025), neutrophils (P= 0.009) and monocytes (P= 0.043). SUVmax at regional lymph nodes (SUVmax-N) was significantly associated with monocytes (P= 0.024). Kaplan-Meier analysis demonstrated that SUVmax-N (>10.15) significantly predicted PFS (P=0.004) and DMFS (P= 0.003). In addition, neutrophils (>5.18) were significantly associated with PFS (P= 0.001), DMFS (P= 0.013) and LRFS (P<0.001). Multivariate analysis revealed that SUVmax-N and neutrophils retained independent prognostic significance for PFS (SUVmax-N, P= 0.026; and neutrophils, P=0.033) and DMFS (SUVmax-N, P=0.026; and neutrophils, P= 0.032). Furthermore, patients with SUVmax-N ≤10.15 and neutrophils ≤5.18 had significantly improved prognosis in PFS (96.4 vs. 58.5%, P<0.001), OS (95.7 vs. 81.1%, P=0.044), DMFS (96.4 vs. 67.0%, P<0.001) and LRFS (100 vs. 90.2%, P= 0.036) compared with those with SUVmax-N >10.15 or neutrophils >5.18. In conclusion, SUVmax may be significantly associated with cancer-associated inflammation. SUVmax-N and neutrophils were independent prognostic indicators for PFS and DMFS. Combined assessment of SUVmax-N and neutrophils may lead to refinement of risk stratification in NPC.

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“…A previous meta-analysis had also confirmed concurrent chemo-radiotherapy as the most effective way of improving survival with a 20% improvement in overall survival at 5 years [8]. This finding was again replicated in a recent update to meta-analysis of chemotherapy in nasopharyngeal carcinoma collaborative group study (MAC-NPC) which showed no added benefit of adjuvant chemotherapy when concomitant chemoradiotherapy is used [9]. Induction chemotherapy followed by radiotherapy alone on the other hand has failed to demonstrate significant benefit [10].…”

Section: Introductionmentioning

confidence: 82%

Does concurrent chemoradiotherapy preceded by chemotherapy improve survival in locally advanced nasopharyngeal cancer patients? Experience from Ghana

et al. 2017

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Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis

Cited by 609 publications

References 31 publications

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

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

Prognostic value of 18F-fluorodeoxyglucose PET parameters and inflammation in patients with nasopharyngeal carcinoma

Does concurrent chemoradiotherapy preceded by chemotherapy improve survival in locally advanced nasopharyngeal cancer patients? Experience from Ghana

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