Concurrent chemoradiotherapy degrades the quality of life of patients with stage II nasopharyngeal carcinoma as compared to radiotherapy

Pan, Xin-Bin; Huang, Shan; Chen, Kaihua; Jiang, Yanming; Ma, Jialin; Qu, Song; Li, Ling; Chen, Long; Zhu, Xiaodong

doi:10.18632/oncotarget.14932

Cited by 19 publications

(30 citation statements)

References 27 publications

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“…In the study reported by Cengiz et al for NPC patients treated by 2D‐RT, they observed that neoadjuvant or adjuvant chemotherapy did not have any effect on QOL, whereas concurrent chemotherapy adversely affected some symptom scales (insomnia, social eating, feeling ill, weight gain, and the need of nutritional supplement) . In the other study by Pan et al, they also observed that the combination of chemotherapy in patients whatever treated by 2D‐RT or IMRT had worse effect in QOL scales, including global QOL, functional scales, symptom scales of fatigue and insomnia, financial problems, and weight gain …”

Section: Discussionmentioning

confidence: 93%

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

et al. 2018

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Background To investigate the toxicity, changes of quality of life (QOL), and survival for patients with nasopharyngeal cancer (NPC) treated by concurrent chemoradiotherapy (CCRT) with simultaneously integrated boost volumetric‐modulated arc therapy (SIB‐VMAT). Methods A total of 68 NPC patients treated by CCRT with SIB‐VMAT technique were collected. QOL was longitudinally assessed by the EORTC QLQ‐C30 and HN35 questionnaires at the 4 time points: baseline, 42.4 Gy (20 fractions), and 3, 12 months after CCRT. Results The 4‐year locoregional relapse free, distant metastasis free, failure free, and overall survival rates were 97.0%, 86.4%, 82.0%, and 88.1%, respectively. The 4‐year cumulative incidence rate of late toxicities with grade 3 or more was 3.0%. One year after CCRT, most QOL scales, except some oral related symptoms, recovered to baseline level. Conclusion CCRT with SIB‐VMAT produces excellent locoregional control, few severe late toxicity, and good general health status for NPC patients.

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Section: Discussionmentioning

confidence: 93%

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

et al. 2018

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“…First, patients who received CCRT or CCRT+AC showed more acute and late toxicity reactions without a substantial survival benefit [ 8 – 10 ]. Second, compared to RT alone, CCRT impaired the quality of life of stage II NPC patients [ 39 ]. Third, because the cost of chemotherapy for NPC is high, overuse of chemotherapy imposes a considerable economic burden on society, especially in developing countries such as China [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, compared to RT alone, CCRT impaired the quality of life of stage II NPC patients [ 39 ]. Third, because the cost of chemotherapy for NPC is high, overuse of chemotherapy imposes a considerable economic burden on society, especially in developing countries such as China [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy use and survival in stage II nasopharyngeal carcinoma

et al. 2017

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Although common, the use of chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We therefore conducted a retrospective cohort study to investigate whether chemotherapy confers survival gains to stage II NPC patients. A total of 251 stage II (2010 UICC/AJCC staging system) NPC patients treated between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity-score matching method. The primary endpoint was overall survival (OS). Secondary endpoints were locoregional-free survival (LRFS) and distant metastasis-free survival (DMFS). Our analyses revealed no significant differences in OS, LRFS, or DMFS for stage II NPC patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC). T2N1 (OR = 6.690; 95% CI, 3.091–14.481) and T1N1 (OR = 5.857; 95% CI, 2.278–15.061) patients were more likely to receive CCRT than T2N0 patients. Similarly, both T2N1 (OR = 10.513; 95% CI, 3.439–32.137) and T1N1 (OR = 7.321; 95% CI, 1.978–27.098) patients were more likely to receive CCRT + AC than T2N0 patients. The present matched survival analysis suggests potential overuse of chemotherapy in stage II NPC, as the addition of chemotherapy did not provide a survival benefit in this group of patients.

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“…9 A wealth of studies have shown that IMRT could improve OS mainly by reducing local and regional recurrence rates compared to conventional RT, in addition to resulting in a better quality of life (QOL) and having a more acceptable toxicity for NPC patients. [10][11][12][13] Given these findings, some researchers have attempted to explore the effect of IMRT alone for stage II patients with an aim to achieve survival outcomes comparable to those obtained with CCRT but with less associated toxicity.…”

Section: Treatment Patterns For Stage II Npc Imrt Alonementioning

confidence: 99%

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

Wu¹,

Zhao²,

Li³

et al. 2020

CMAR

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Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensitymodulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.

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Concurrent chemoradiotherapy degrades the quality of life of patients with stage II nasopharyngeal carcinoma as compared to radiotherapy

Cited by 19 publications

References 27 publications

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

Chemotherapy use and survival in stage II nasopharyngeal carcinoma

<p>Management of Chemotherapy for Stage II Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era: A Review</p>

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