Overall Survival After Concurrent Cisplatin-Radiotherapy Compared With Radiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma

Abstract

This phase III randomized study compared concurrent cisplatin-radiotherapy (CRT) versus radiotherapy (RT) alone in patients with locoregionally advanced nasopharyngeal carcinoma. A total of 350 patients were randomly assigned to receive external RT alone or concurrently with cisplatin at a dosage of 40 mg/m(2) weekly. The primary endpoint was overall survival, and the median follow-up was 5.5 years. The 5-year overall survival was 58.6% (95% confidence interval [CI] = 50.9% to 66.2%) for the RT arm and 70.3% (95% CI = 63.4% to 77.3%) for the CRT arm. In Cox regression analysis adjusted for T stage, age, and overall stage, the difference in overall survival was statistically significantly in favor of concurrent CRT (P = .049, hazard ratio [HR] = 0.71 [95% CI = 0.5 to 1.0]). Subgroup analysis demonstrated that there was no difference between overall survival in the arms for T1/T2 stage (P = .74, HR = 0.93 [95% CI = 0.59 to 1.4]), whereas there was a difference between the arms for T3/T4 stage (P = .013, HR = 0.51 [95% CI = 0.3 to 0.88]), favoring the CRT arm. The regimen of weekly concurrent CRT is a promising standard treatment strategy for locoregionally advanced nasopharyngeal carcinoma patients.

High expression of excision repair cross-complementation group1 protein predicts poor outcome in patients with nasopharyngeal cancer

“…1,2 In several phase III studies including the Intergroup 0099 trial and meta-analysis, concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy showed improved survival compared with radiotherapy alone. [3][4][5][6][7][8] Based on these results, cisplatin-based CCRT is now considered as a standard treatment of locally advanced NPC. 9 Therefore, determining parameters to identify patients who would benefit from cisplatin-based CCRT and who would not has strong clinical implications.…”

Dose intensity comparison between weekly and 3-weekly Cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: A retrospective comparison from New Cross Hospital, Wolverhampton, UK

“…The largest head and neck study delivering weekly Cisplatin 40 mg/m 2 randomized 350 patients with nasopharyngeal carcinoma to concurrent chemoradiation or radiotherapy alone. Concurrent chemoradiation was found to be well tolerated despite the large radiotherapy fields employed in the treatment of nasopharyngeal carcinoma with an acceptable 4.6% of these patients having grade 4 mucositis and 12.6% grade 3 leukopenia [8].…”

The Role of Chemotherapy in the Management of Patients with Head and Neck Cancer

“…Outcomes remain comparable when trials including adjuvant chemotherapy after CRT are compared with trials with CRT alone. [88][89][90][91][92][93] Furthermore, meta-analyses evaluating the role of adjuvant chemotherapy after CRT have not been able to demonstrate improved outcomes such as improved locoregional control, decreased risk of distant metastases, or improved OS with the addition of adjuvant chemotherapy. 94,95 However, given the lack of randomized data, recommendations on administration of adjuvant chemotherapy after CRT should be individualized based on the characteristics and preferences of individual patients.…”