Chemotherapy in locally advanced nasopharyngeal carcinoma: An individual patient data meta-analysis of eight randomized trials and 1753 patients

Baujat, B.; Audry, Hélène; Bourhis, Jean; Chan, Anthony T.C.; Onat, Haluk; Chua, Daniel T.T.; Kwong, Dora Lai Wan; Al‐Sarraf, Muhyi; Hwa, Kwan; Hareyama, Masato; Leung, Sing-fai; Thephamongkhol, Kullathorn; Pignon, Jean-Pierre

doi:10.1016/j.ijrobp.2005.06.037

Cited by 573 publications

(321 citation statements)

References 23 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%

“…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%

“…There have been several studies that have evaluated additional cycles of chemotherapy in the adjuvant setting without finding significant survival benefit 5, 7. The primary limitation of the preceding trials has been a low compliance rate of adjuvant chemotherapy with approximately 40‐50% patients not completing the prescribed chemotherapy regimen 7.…”

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%

Section: Introductionmentioning

confidence: 99%

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 results of the last meta-analysis [15] confirm the role of concurrent chemoradiotherapy as a standard treatment for locoregionally advanced NPC.…”

Section: Discussionmentioning

confidence: 66%

Induction chemotherapy with carboplatin and taxol followed by radiotherapy and concurrent weekly carboplatin + taxol in locally advanced nasopharyngeal carcinoma

Airoldi

Gabriele

et al. 2010

Cancer Chemother Pharmacol

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Methods: Thirty patients were treated with three cycles of carboplatin (AUC6) plus taxol (175mg/m 2 ) on day 1 every 3 weeks, followed by weekly carboplatin (AUC1) plus Taxol (60mg/m2) and concomitant radiotherapy (70Gy). Results:We observed the objective complete response rates of 33% (after chemotherapy) and 87%(after chemo-radiotherapy). Treatment tolerability and toxicity were controllable. Three and five years progression free survival were 80% and 75% respectively and 3 and 5 years overall survival were 85% and 80% (follow-up 49.5 months). Five years loco-regional control was 90.3% and five years distant metastases free survival was 85%.Conclusions: Neoadjuvant-chemotherapy with such protocol represents a feasible, efficient treatment for patients with A-NPC, ensuring excellent locoregional disease control and overall survival with low incidence of distant metastases.

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Effect of Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy on Survival Without Disease Relapse in Patients With Low-risk Nasopharyngeal Carcinoma

Tang

Guo

Zhang

et al. 2022

JAMA

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IMPORTANCE Concurrent chemoradiotherapy has been the standard treatment for stage II nasopharyngeal carcinoma (NPC) based on data using 2-dimensional conventional radiotherapy. There is limited evidence for the role of chemotherapy with use of intensity-modulated radiation therapy (IMRT).OBJECTIVE To assess whether concurrent chemotherapy can be safely omitted for patients with low-risk stage II/T3N0 NPC treated with IMRT. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, open-label, randomized, phase 3, noninferiority clinical trial was conducted at 5 Chinese hospitals, including 341 adult patients with low-risk NPC, defined as stage II/T3N0M0 without adverse features (all nodes <3 cm, no level IV/Vb nodes; no extranodal extension; Epstein-Barr virus DNA <4000 copies/mL), with enrollment between November 2015 and August 2020. The final date of follow-up was March 15, 2022.INTERVENTIONS Patients were randomly assigned to receive IMRT alone (n = 172) or concurrent chemoradiotherapy (IMRT with cisplatin, 100 mg/m 2 every 3 weeks for 3 cycles [n = 169]). MAIN OUTCOMES AND MEASURESThe primary end point was 3-year failure-free survival (time from randomization to any disease relapse or death), with a noninferiority margin of 10%. Secondary end points comprised overall survival, locoregional relapse-free survival, distant metastasis-free survival, adverse events, and health-related quality of life (QOL) measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference Ն10 for physical function, symptom control, or health-related QOL; higher score indicates better functioning and global health status or worse symptoms). RESULTS Among 341 randomized patients (mean [SD] age, 48 [10] years; 30% women), 334 (98.0%) completed the trial. Median follow-up was 46 months (IQR,. Three-year failure-free survival was 90.5% for the IMRT-alone group vs 91.9% for the concurrent chemoradiotherapy group (difference, −1.4%; 1-sided 95% CI, −7.4% to ϱ; P value for noninferiority, <.001). No significant differences were observed between groups in overall survival, locoregional relapse, or distant metastasis. The IMRT-alone group experienced a significantly lower incidence of grade 3 to 4 adverse events (17% vs 46%; difference, −29% [95% CI, −39% to −20%]), including hematologic toxicities (leukopenia, neutropenia) and nonhematologic toxicities (nausea, vomiting, anorexia, weight loss, mucositis). The IMRT-alone group had significantly better QOL scores during radiotherapy including the domains of global health status, social functioning, fatigue, nausea and vomiting, pain, insomnia, appetite loss, and constipation.CONCLUSIONS AND RELEVANCE Among patients with low-risk NPC, treatment with IMRT alone resulted in 3-year failure-free survival that was not inferior to concurrent chemoradiotherapy.

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Chemotherapy in locally advanced nasopharyngeal carcinoma: An individual patient data meta-analysis of eight randomized trials and 1753 patients

Cited by 573 publications

References 23 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

Induction chemotherapy with carboplatin and taxol followed by radiotherapy and concurrent weekly carboplatin + taxol in locally advanced nasopharyngeal carcinoma

Effect of Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy on Survival Without Disease Relapse in Patients With Low-risk Nasopharyngeal Carcinoma

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