Prognostic factors in metastatic nasopharyngeal carcinoma

Khanfir, Afef; Frikha, M.; Ghorbel, Abdelmonem; Drira, M.; Daoud, J.

doi:10.1016/j.canrad.2007.06.006

Cited by 39 publications

(41 citation statements)

References 14 publications

(1 reference statement)

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“…In our study, only three (7.3 %) patients developed local or regional failure after IMRT, and the locoregional control rate was similar to those reported in previous studies [3][4][5][6][7][8]. Moreover, patients' median OS exceeded 31 months, substantially longer that those reported in the most previous literature [2,[16][17][18][19][20][23][24][25][26]. The prolonged survival in our patients may be attributed to several reasons.…”

Section: Discussionsupporting

confidence: 82%

“…Another prognosticator identified in our study was pre-treatment serum LDH level. In the previous literature, elevated levels of LDH were associated with large tumor burden, liver metastasis, multiple metastases, poor response to chemotherapy and poor survival [10,[24][25][26]. The prognostic significance of LDH appeared to be independent of treatment modalities [10].…”

Section: Discussionmentioning

confidence: 94%

“…A sizable body of literature has explored potential prognostic factors for metastatic NPC [23][24][25][26], yet few of these studies focused on the subset of patients with distant metastasis at initial diagnosis undergoing combined chemoradiotherapy. In the study conducted by Lin et al [9], radiation dose to the primary tumor-bearing region and number of metastatic organs were found to be independent predictors for OS in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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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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“…To date, several retrospective analyses have identified some unfavorable prognostic factors, including older age (4), anemia (5,6), poor performance status (5,6,14), short disease-free interval (4,5), prior chemotherapy (14), presence of liver metastasis (4-6, 14, 15), and multiple lesions (4,6,14). However, the application of these pretreatment markers into clinical practice with consequent adjustment of the treatment regimen has never been shown to be feasible.…”

Section: Discussionmentioning

confidence: 99%

Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma

Wang

Twu

Chen

et al. 2010

Clinical Cancer Research

149

111

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Purpose: To investigate the prognostic effect of the concentrations and clearance rates of plasma EBV DNA in metastatic/recurrent nasopharyngeal carcinoma (NPC).Experimental Design: Thirty relapsed and four previously nontreated metastatic NPC patients were treated according to the consensus guidelines of the head and neck cancer team in our hospital (i.v. chemotherapy first, followed by local irradiation boost and oral maintenance chemotherapy where applicable). Multiple plasma samples were collected during the first month of chemotherapy. Circulating EBV DNA concentrations were measured by a real-time quantitative PCR. The half-life values (t 1/2 ) of plasma EBV DNA clearance were calculated. The associations between clinical outcome and plasma EBV DNA assays were analyzed.Results: Tumor response evaluated after 12 weeks of treatment showed 14 complete responses (41.2%), 12 partial responses (35.3%), 7 stable diseases (20.6%), and 1 progression disease (2.9%). The plasma EBV DNA concentrations have no significant effects on outcome prediction. The t 1/2 of plasma EBV DNA clearance ranged from 1.85 to 28.29 days (median, 3.99). Patients with a short t 1/2 of plasma EBV DNA clearance have significantly higher complete response rate and overall survival than those with long t 1/2 . Multivariate analysis revealed a significant effect of the t 1/2 of plasma EBV DNA clearance on survival.Conclusions: The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival. Early change of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate. Clin Cancer Res; 16(3); 1016-24. ©2010 AACR.Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck by its epidemiology, histopathology, clinical characteristics, methods of treatment, and patterns of failure. Because of the inherent anatomic constraints and a high degree of radiosensitivity, radiotherapy has been the primary treatment for NPC patients without distant metastasis. Treatment failure in the past was due to a high rate of local recurrence and/or distant metastasis. However, advances in radiation oncology have improved the locoregional control, and treatment failure is now due mainly to distant metastasis. To date, the outcome of salvage treatment for relapse is still very poor, with the 5-year survival rates after local recurrence and distant metastasis being 9.4% to 30% and <5%, respectively (1-6). Because most metastatic/recurrent patients will succumb rapidly to the disease, the development of a quick and precise marker to predict treatment response is urgently needed.NPC has been proven as an EBV-associated cancer. EBV genome is present in the cells from almost every primary and metastatic NPC, regardless of the degree of tumor differentiation or the geographic origin of the patients. Recently, the quantification of plasma EBV DNA by the real-time quantitative PCR has been shown as a useful marker in the detection, monitoring, and prognos...

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“…Clinical studies have shown that patients with early stage of nasopharyngeal carcinoma had markedly improved survival compared with those diagnosed in later disease stages [Hsu et al, 1982;Khanfir et al, 2007]. These findings improve the efficacy of conventional treatments by chemo-radio therapies at the early stage of nasopharyngeal carcinoma development that is characterized by the absence or the unspecific nature of clinical signs.…”

Section: Introductionmentioning

confidence: 92%

IgA antibodies against the Epstein‐Barr nuclear antigen1 as a valuable biomarker for the diagnosis of nasopharyngeal carcinoma in Tunisian patients

Ayadi

Karray-Hakim

Feki

et al. 2009

Journal of Medical Virology

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Serological tests for Epstein-Barr virus (EBV) have been used for many years as diagnostic predictors of nasopharyngeal carcinoma. It has been shown previously that the conventional immunofluorescence assay has a limited diagnostic value, especially in young patients from North African area. In the search for more reliable immunoglobulin (Ig) G or IgA antibody markers for the diagnosis of nasopharyngeal carcinoma, immunoblot analysis was performed using a full spectrum of EBV proteins. Sera were collected from 108 patients with nasopharyngeal carcinoma and three control groups composed of 18 patients with lymphoma, 18 other patients with autoimmune diseases and 55 healthy EBV carriers. It was observed that the IgA Epstein-Barr nuclear antigen 1 (EBNA1), IgA early antigen (EA)-p138 and IgG EA-p138 antibodies represent the most specific anti-EBV responses in either young or older patients with nasopharyngeal carcinoma which yield higher positive rates compared to the three control groups. Since the IgA EBNA1 response showed the highest sensitivity value for the detection of nasopharyngeal carcinoma, a novel enzyme-linked immunosorbent assay (ELISA) was established using a GST-EBNA1 protein expressed in bacteria, containing the P-threonine EBNA1 subtype cloned from DNA EBV sequence of C15 xenograft cells. Detection rates were 85.7% and 94.9% in young and older patients with nasopharyngeal carcinoma respectively, while only 3.6%, 11.1%, and 16.6% in healthy EBV carriers, patients with lymphoma and patients with autoimmune diseases, respectively. Thus, IgA EBNA1 ELISA may be useful for early diagnosis and mass screening of nasopharyngeal carcinoma in Tunisia even in young patients.

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Prognostic factors in metastatic nasopharyngeal carcinoma

Cited by 39 publications

References 14 publications

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

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

Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma

IgA antibodies against the Epstein‐Barr nuclear antigen1 as a valuable biomarker for the diagnosis of nasopharyngeal carcinoma in Tunisian patients

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