Patterns of nodal failure after intensity modulated radiotherapy for nasopharyngeal carcinoma

Li, Jingao; Venigalla, Praveen; Leeman, Jonathan E.; LaPlant, Quincey; Setton, J.; Sherman, Eric J.; Tsai, C. Jillian; McBride, Sean; Riaz, Nadeem; Lee, Nancy

doi:10.1002/lary.26139

Cited by 19 publications

(21 citation statements)

References 34 publications

(47 reference statements)

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“…Kong et al 21 analyzed 370 non-metastatic NPC patients treated with IMRT (with or without chemotherapy) and found regional relapses in 11 patients, of which 81.8% (9/11) were in-field. With a median follow-up of 70.4 months, 6.0% (10/165) of patients with NPC who had been treated with IMRT developed nodal relapse, and in-field failures accounted for 60% of all nodal failures, as reported by Li et al 18 . The authors also demonstrated agreement between the phenomenon that most in-field failures occurred in level II and the distribution of pretreatment nodes in patients with NPC, as level II was the most frequently involved nodal group.…”

Section: Discussionmentioning

confidence: 64%

“…Therefore, regional control is a major concern in NPC treatment. Li et al 18 reported that 75% of their NPC patients had involved lymph nodes, and 7.7% eventually underwent recurrence after treatment. A total of 84.7% (233/275) of the patients in our study presented with lymphadenopathy at the time of diagnosis, and only 6.2% (17/275) of the patients developed regional failure at a median follow-up time of 71 months.…”

Section: Discussionmentioning

confidence: 99%

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Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Xue

2017

J. Cancer

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Purpose: To analyze the long-term patterns of regional failure following intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods: From January 2005 to December 2010, 275 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. Patients staged as II (lymph nodes measuring 4 or more cm in diameter), III or IV also received chemotherapy. Failures were assessed as in-field or out-field relative to the pretreatment planning computed tomography data sets. Univariate and multivariate analyses were performed with Cox proportional hazards model to analyze the effect of various prognostic factors on regional failure-free survival (RFFS) and overall survival (OS).Results: During a median follow-up of 71 months, the RFFS and OS rates were 94.3% and 83.9%, respectively. Seventeen patients developed regional failures, of which 16 were in-field; one patient showed an out-field failure in the parotid gland, and no recurrences were seen for level Ib. Failures in level II and in the retropharyngeal area accounted for 70.6% (12/17) and 52.9% (9/17) of all failures, respectively. The 5-year RFFS rates for patients with classifications of N0-1 and N2-3 were 98.5% and 90.2%, respectively (p = 0.001). Multivariate analysis showed that N stage was the only independent prognostic predictor of RFFS (HR 7.363, 95% CI 1.516-35.756, p = 0.013).Conclusions: The regional failure of NPC after treatment with IMRT is uncommon but is significantly higher in N2-3 patients than in N0-1 patients. In-field failures represent the main pattern of regional recurrence and are most often detected in level II and in the retropharyngeal area, while out-field failure is rare. Close attention should be directed to NPC patients with advanced N stages.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Xue

2017

J. Cancer

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“…IMRT produces more accurate dose homogeneity around targets and less toxicity to normal organs than CRT. [2] The advantages of IMRT to spare the parotid gland have been demonstrated repeatedly, and its use for NPC was more prevailed than CRT. [2,3] However, results showing that IMRT in terms of oncologic outcomes had limited success compared with CRT, and most results were only come from China or other Asian countries.…”

Section: Introductionmentioning

confidence: 99%

“…[2] The advantages of IMRT to spare the parotid gland have been demonstrated repeatedly, and its use for NPC was more prevailed than CRT. [2,3] However, results showing that IMRT in terms of oncologic outcomes had limited success compared with CRT, and most results were only come from China or other Asian countries. [4–6] For the time being, there is no undisputed evidence that IMRT is superior to CRT regarding overall survival, locoregional control, disease-free survival, and metastasis-free survival.…”

Section: Introductionmentioning

confidence: 99%

Oncologic outcomes of IMRT versus CRT for nasopharyngeal carcinoma

2019

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Background: Nasopharyngeal carcinoma (NPC) is a prevalent malignancy in Asia particularly southern China. Comparisons of outcomes of conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT) have been still debated. This meta-analysis was carried out to compare oncologic outcomes of CRT and IMRT in the treatment of NPC. Methods: A literature search was performed through PubMed, Embase, and the Cochrane library databases from their inceptions to November 10, 2018. Two authors assessed the included studies and extracted data independently. Relative studies that compared oncologic outcomes between CRT and IMRT for NPC were included. Results: A total of 13 eligible studies were included, which contained 1 RCT, 1 prospective study, and 11 retrospective studies. Our meta-analysis showed that IMRT has increased overall survival (OR = 0.51, 95% CI = 0.41–0.65, P < .00001), locoregional control rate (OR = 0.59, 95% CI = 0.52–0.67, P < .00001), disease-free survival (OR = 0.77, 95% CI = 0.65–0.91, P = .002), and metastasis-free survival (OR = 0.71, 95% CI = 0.54–0.94, P = .01) in comparison with CRT. Conclusion: The results of this meta-analysis indicate IMRT should be a better option for the treatment of NPC because patients who underwent IMRT may benefit from increased overall survival, locoregional control rate, disease-free survival, and metastasis-free survival compared with CRT.

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“…Local control rate of NPC has improved markedly in the past decade (3). However, local recurrence and metastasis remain the primary causes of mortality from this cancer, particularly in advanced stages (4), and management of local treatment failure remains a challenge in NPC treatment.…”

Section: Introductionmentioning

confidence: 99%

Salinomycin may inhibit the cancer stem‑like populations with increased chemoradioresistance that nasopharyngeal cancer tumorspheres contain

Zhang

Ren

et al. 2018

Oncol Lett

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Tumor recurrence and metastasis of nasopharyngeal cancer (NPC) often result in the failure of treatment due to chemoradioresistance. Cancer stem cells (CSCs) have been observed to drive tumor initiation and tumor chemoradioresistance. Therefore, the poor prognosis of advanced NPC is likely to result from the failure to kill CSCs. Sphere formation may be used as an experimental method to enrich potential CSC subpopulations. At present, there are few reports on NPC tumorspheres. The present study focused on examining the cancer stem-like properties of NPC tumorspheres from NPC cell lines. Western blot analysis revealed that NPC tumorspheres had a higher expression of stem cell markers Nanog homeobox and SRY-box 2, compared with parental cells. It was additionally verified that NPC tumorspheres contained a high aldehyde dehydrogenase (ALDH) enzymatic activity compared with parental cells. ALDH+ cells were amplified by 9- to 10-fold in tumorspheres, compared with parental cells (1.8 vs. 16.9%). The tumorsphere cells exhibited an increased half maximal inhibitory concentration value of >10-fold with cisplatin compared with the control parental cells. Compared with the parental cells, the percentage of side population cells in the tumorsphere cell population increased significantly (10.3 vs. 2.3%; P<0.05). NPC tumorsphere cells demonstrated enhanced resistance to radiation. Further investigation verified that salinomycin inhibited NPC CSCs by selectively targeting its stem cells. Altogether, the data revealed that NPC tumorspheres contain cancer stem-like populations with increased chemoradioresistance. It was suggested that the serum-free culture of NPC cells may provide an appropriate model for researching the sensitivity of CSCs to therapeutic agents. It was additionally revealed that salinomycin is an efficient inhibitor of NPC CSCs, supporting the hypothesis that salinomycin may eliminate CSCs and imply a need for further clinical evaluation.

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Patterns of nodal failure after intensity modulated radiotherapy for nasopharyngeal carcinoma

Abstract: 4. Laryngoscope, 2016 127:377-382, 2017.

Cited by 19 publications

References 34 publications

Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Oncologic outcomes of IMRT versus CRT for nasopharyngeal carcinoma

Salinomycin may inhibit the cancer stem‑like populations with increased chemoradioresistance that nasopharyngeal cancer tumorspheres contain

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