Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma

Zeng, Lei; Tian, Yun; Sun, Xue Ming; Huang, Ying; Chen, Chun Yan; Han, Fei; Liu, Shuai; Lan, Mei; Guan, Ying; Deng, Xiao Wu; Lu, Tai Xiang

doi:10.1007/s00066-014-0680-7

Cited by 20 publications

(12 citation statements)

References 32 publications

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“…In addition, with the development of conformal radiotherapy technology, such as IMRT, and the use of chemotherapy, the 5-year overall survival rate for stage III NPC is reported to have reached almost 90%, but remains around 60%-70% for stage IVA/B disease. [3, 21, 22] To some extent, these survival differences may reflect inherent biological variations that affect the value of such prognostic factors in patients with stage III and stage IVA/B NPC.…”

Section: Discussionmentioning

confidence: 99%

“…The details of the radiotherapy technique used at our cancer center have previously been reported. [3, 20] Most patients (723/755; 95.8%) received platinum-based chemotherapy: neoadjuvant (546/755; 72.3%), concurrent (548/755; 72.5%) and adjuvant chemotherapy (33/755; 4.4%).…”

Section: Methodsmentioning

confidence: 99%

“…The prognosis of stage IVA/B disease is much poorer than stage III disease and the 5-year overall survival rate is still around 60% to 70%, even though intensity-modulated radiotherapy (IMRT) has been widely used. [1–3] Therefore, it is important to identify effective prognostic factors for this subgroup of patients.…”

Section: Introductionmentioning

confidence: 99%

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Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

et al. 2016

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PurposeEffective prognostic factors for patients with stage IVA/B nasopharyngeal carcinoma (NPC) who are susceptible to distant metastases are limited. We aim to investigate the prognostic value of pretreatment plasma fibrinogen (FIB) level and Epstein–Barr virus DNA (EBV-DNA) load in these patients in the era of intensity-modulated radiotherapy (IMRT).ResultsThe 5-year DSS, DFS and DMFS rates of the entire cohort were 72.7%, 66.8%, 80.0%, respectively. High FIB level was identified as a negative prognostic factor for survival: the 5-year DSS, DFS and DMFS rates for patients with high FIB (> 4.0 g/L) and normal FIB (≤ 4.0 g/L) were 60.3% vs. 76.0%, 56.0% vs. 69.9%, and 59.4% vs. 85.5%, respectively (all P < 0.001). Subgroup analysis demonstrated that DSS, DFS and DMFS decreased as FIB gradually increased, even within the normal range. The risk of distant metastasis in patients with high FIB was over 3-fold than patients with normal FIB. EBV-DNA was not an independent prognostic factor for any survival outcomes in multivariate analysis.ConclusionHigh pretreatment FIB level shows superior prognostic value than EBV-DNA load for stage IVA/B NPC patients in the era of IMRT.Materials and MethodsA total of 755 patients with newly-diagnosed stage IVA/B NPC treated with definitive IMRT between January 2007 and December 2011 were enrolled. Plasma FIB and EBV-DNA were measured before treatment. Disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method; differences were compared using the log-rank test.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

et al. 2016

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“…Recurrence and metastasis are commonly seen after the initial treatment of LANPC, which can lead to the failure rate of first-cycle radiotherapy up to 25%. Moreover, distant metastasis is the primary failure model, accounting for 53.6%~63.1% of the whole recurrence, followed by the locoregional recurrence and regional lymph node metastasis (Chen et al, 2013;Zeng et al, 2014). At present, radiochemotherapy is still the major protocol for the treatment of LANPC patients, and in order to further improve its therapeutic efficacy, the independent prognostic factors influencing the therapeutic failure models should be firstly explored.…”

Section: Introductionmentioning

confidence: 99%

Analysis on Clinical Characteristics and Influencing Factors of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

Zheng

Xu²,

Qiu³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: To explore the independent prognostic factors for the recurrence/metastasis of patients with locoregionally advanced nasopharyngeal carcinoma (LANPC). Materials and Methods: A total of 604 patients initially diagnosed as LANPC by pathohistology in Fujian Provincial Cancer Hospital were selected to analyze the relationship between the clinical pathological patterns, therapeutic protocols and clinical stages with the recurrence/metastasis of LANPC. Results: The 1-, 3-and 5-year locoregionally recurrent rates of LANPC patients were 2.0%, 9.5% and 12.9% respectively, with average recurrent period being 78 months. Univariate analysis results indicated that clinical stages had certain influence on the recurrent period of LANPC patients. However, COX regression models showed that ages, genders and clinical stages were not the independent prognostic factors influencing the recurrence. The 1-, 3-and 5-year metastatic rates of LANPC patients were 6.6%, 17.5% and 18.8% respectively, with average metastatic period of 73 months. Univariate analysis results demonstrated that ages, N stages, clinical stages, locations of lymph node, retropharyngeal lymph node and extracapsular invasion of lymph node had certain influence on the metastatic period of LANPC patients. Additionally, further COX regression analysis results suggested that T stages, reduction protocols and extracapsular invasion of lymph node were the independent prognostic factors influencing the metastasis of patients with LANPC, in which T stages and extracapsular invasion of lymph node were the pestilent factors while reduction protocols the protective factor. Conclusions: Induction chemotherapy is beneficial to LANPC patients with initial treatment, and the metastatic rate decreases greatly after the application of reduction chemotherapy.

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“…In comparison to 2DRT, IMRT can make highly conformal isodose lines and prevent target volume from being underdosed. This improved dose distributions potentially lead to improved tumor control and better survival outcomes [ 31 32 ]. The results of IMRT treated by Lee et al [ 33 ] showed 97% local progression-free survival and 88% OS with 4-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea

et al. 2015

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PurposeTo investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea.Materials and MethodsA multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions.ResultsOf the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose.ConclusionAssessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.

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Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma

Abstract: The results of treating stage IVA NPC with IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for patients with stage IVA and IVB NPC, and more effective systemic chemotherapy should be explored.

Cited by 20 publications

References 32 publications

Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

Elevated plasma fibrinogen level shows superior prognostic value than Epstein-Barr virus DNA load for stage IVA/B nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

Analysis on Clinical Characteristics and Influencing Factors of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea

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