Combined High-dose Radiation Therapy and Systemic Chemotherapy Improves Survival in Patients With Newly Diagnosed Metastatic Nasopharyngeal Cancer

Shen, Lin; Tham, Ivan; Pan, Jianji; Han, Lu; Chen, Qisong; Lu, Jiade J.

doi:10.1097/coc.0b013e31821a9452

Cited by 70 publications

(73 citation statements)

References 19 publications

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“…Since 2011, concurrent chemo/radiotherapy has been another choice for selected patients (patients with distant metastasis in limited site or with small tumor burden, or patients with symptoms in the primary or any nodal site) in the guideline, emphasizing the importance of multidisciplinary therapy in newly diagnosed metastatic NPC. Concurred closely with other studies (Cao et al, 2011;Lin et al, 2012), we found a combination of radiotherapy for nasopharynx improved the OS. But the prognosis did not significantly relate to different radiation doses and techniques.…”

Section: Discussionmentioning

confidence: 59%

“…Our data indicated that early T-stage and N-stage, single organ with solitary metastasis were significant predictors for favorable survival, which concurred closely with other studies. In a study (Lin et al, 2012) of 170 NPC patients with lung metastasis alone, it was found that the disease-free internal was longer in patients with early T-stage (p=0.001) or N-stage (p=0.002). Another study suggested patients with metastasis to the lung and/or solitary lesions have a more favorable prognosis compared with those patients with multiple metastases located in other anatomic sites.…”

Section: Discussionmentioning

confidence: 99%

“…Cao et al (2011) found no significant better overall survival in patients received more than 6 circles of chemotherapy. Lin et al (2012) chose 4 circles as the cut-off point, and the result was negative, too. Our data showed the prognosis of patients with more than 6 courses was better in univariate analysis (p=0.046), but no statistical significance in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The median survival time ranges between 12.9-26.8 months (Toh et al, 2005;Cao et al, 2011;Lin et al, 2012). But a variable survival outcome is frequently observed in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

Li¹,

Huang²,

Wen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The median survival time ranges between 12.9-26.8 months (Toh et al, 2005;Cao et al, 2011;Lin et al, 2012). But a variable survival outcome is frequently observed in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

Li¹,

Huang²,

Wen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Recently, several retrospective studies demonstrated a survival benefit with the addition of locoregional definitive radiotherapy to systemic chemotherapy in patients with initially metastatic NPC [9][10][11]. However, in these studies, there were different combinations with respect to the timing of chemotherapy in relation to radiotherapy (i.e., induction, concurrent, adjuvant or other combination), which may have differential impact on treatment outcome.…”

Section: Introductionmentioning

confidence: 96%

Systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy yields prolonged survival in nasopharyngeal carcinoma patients with distant metastasis at initial diagnosis

Dong

et al. 2015

Med Oncol

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Chemotherapy is the current mainstay of treatment for patients with newly diagnosed metastatic nasopharyngeal carcinoma (NPC), whereas the role of locoregional radiotherapy remains to be defined. In this study, we retrospectively evaluated the outcome of systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy (IMRT) as first-line treatment for these patients. Forty-one patients with pathologically confirmed NPC with distant metastasis at initial diagnosis seen between March 2005 and February 2014 were included. All the patients were treated with platinum-based systemic chemotherapy followed by definitive IMRT to the primary head and neck region with or without concurrent chemotherapy. In addition, local treatment to metastatic lesions was given in 19 patients. With a median follow-up time of 25 months, 24 patients had died, and the estimated median overall survival time was 31.2 months. The 1-, 2-, 3- and 5-year estimated OS rates were 89.9, 67.4, 41.1 and 22.5%, respectively. Prognostic analyses showed that serum lactate dehydrogenase level (P = 0.021) and number of metastatic sites (single vs. multiple; P = 0.016) were significant prognostic factors. Five patients are still alive without evidence of disease after 52 to >101 months. All of them had a single metastatic lesion and received local treatment to metastatic sites. These results suggest that the use of definitive IMRT to treat the locoregional tumor in combination with systemic chemotherapy may prolong survival in patients with newly diagnosed metastatic NPC, making curability a possible consideration in selected patients with single metastasis. Further prospective clinical trials are warranted.

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The Importance of Locoregional Therapy in Metastatic Nasopharyngeal Cancer

2020

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Historically, patients with metastatic disease may undergo palliative low-dose radiotherapy for bleeding, pain, or other symptom control from localized progression of disease. However, the advent of increasingly effective systemic therapies has led to interest in exploring how consolidative high-dose locoregional therapies can prolong beneficial effects from systemic therapy in metastatic disease. Investigators have explored local therapy directed at metastatic foci in addition to treatment of in situ primary tumors. In oligometastatic cancers, for patients who did not progress with systemic therapy, the addition of local therapy directed at metastasis has demonstrated an improvement to overall survival (OS) compared with systemic therapy alone in early randomized studies. 1,2 In low-volume metastatic prostate cancer, the addition of primary-directed radiotherapy has also improved OS. 3 Prior retrospective series have demonstrated that patients with metastatic nasopharyngeal cancer (NPC) who receive radiotherapy to their primary and nodal disease have superior outcomes than those who receive systemic therapy alone, and that higher doses of radiotherapy may be associated with superior outcome. 4,5 In an analysis of 718 patients with metastatic NPC in the national cancer database, the 437 patients who received RT had an improved 5-year OS of 28% compared with 10% for those who did not. 4 A review of 105 patients treated at a single institution with metastatic NPC revealed higher doses of radiotherapy (>65 Gy) delivered to the primary site were associated with improved outcomes. 5 Although, to our knowledge, no level I evidence exists to date, based on the aforementioned data and other similar series, the National Comprehensive Cancer Network offers chemoradiotherapy to the primary disease in the head and neck as one of the possible treatment paradigms for metastatic NPC. 6 In this issue of JAMA Oncology, You et al 6 report results from a multicenter randomized clinical trial of patients with metastatic NPC to directly address the benefit of chemoradiotherapy to the primary tumor and nodal disease in this setting. Following the studies in oligometastatic cancer, patients who had a partial response or complete response to 3 cycles of cisplatin and fluorouracil were eligible to be randomized to an additional 3 cycles of chemotherapy alone, or radiotherapy to 70 Gy with concurrent cisplatin/fluorouracil (PF). Of the 173 patients who were assessed for eligibility, 126 had a CR or PR after 3 cycles of chemotherapy and were randomized. The 2-year OS improved by an absolute difference of more than 20%, from 76.4% in the radiotherapy arm vs 54.5% in the chemotherapy-alone group, which led to a hazard ratio of 0.42 for death (P = .004). Not surprisingly, there was a significant decrease in patients who had local or regional recurrence as part of their first recurrence from 70% in the chemotherapy-

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Combined High-dose Radiation Therapy and Systemic Chemotherapy Improves Survival in Patients With Newly Diagnosed Metastatic Nasopharyngeal Cancer

Cited by 70 publications

References 19 publications

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

Systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy yields prolonged survival in nasopharyngeal carcinoma patients with distant metastasis at initial diagnosis

The Importance of Locoregional Therapy in Metastatic Nasopharyngeal Cancer

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