Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

Loong, Herbert H.; B.Y., Brigette; Leung, Sing Fai; Mo, Frankie; Hui, Edwin P.; Kam, Michael K.M.; Chan, Stephen L.; Yu, Brian; Chan, Anthony T.C.

doi:10.1016/j.radonc.2011.12.022

Cited by 99 publications

(84 citation statements)

References 31 publications

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“…Based on the review of the results of clinical trials reported until the early 2000s, the study by Ang (10) suggested that a cumulative cisplatin dose of 200 mg/m 2 would be the threshold for patients to yield a beneficial antitumor effect from CCRT regardless of the schedule. Previous studies also suggest that a cumulative dose of 200 mg/m 2 is the threshold to experience a benefit from CCRT (11,12), and certain clinical trials set a total dose of 200 mg/m 2 in their control group (9,13). Based on these findings, the present study used the cumulative dose of 200 mg/m 2 as the target dose.…”

Section: Discussionmentioning

confidence: 92%

Predictive factors of head and neck squamous cell carcinoma patient tolerance to high-dose cisplatin in concurrent chemoradiotherapy

Nakano

Sato

Toshiyasu

et al. 2015

Molecular and Clinical Oncology

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Abstract. Although high-dose cisplatin is the standard regimen of concurrent chemoradiotherapy (CCRT) for locally advanced head and neck squamous cell carcinoma (HNSCC), varying levels of patient tolerance towards cisplatin have been reported, and the predictive factors of cisplatin tolerance remain to be elucidated. The present study retrospectively reviewed newly diagnosed HNSCC patients who received CCRT. Cisplatin ; OR, 2.21; P=0.032) were significantly predictive of high-dose cisplatin tolerance. The high-dose cisplatin-tolerant patients had a significantly higher complete response (CR) rate (82 vs. 67%, P=0.045); however, there were no significant between-group differences in the 3-year OS (79.5 vs. 81.2%, P=0.59) or PFS (70.4 vs. 44.6%, P=0.076) by cisplatin tolerance. In clinical practice, approximately one-half of the patients tolerated high-dose cisplatin in CCRT. Male gender and high BSA could be predictive of cisplatin tolerance.

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Section: Discussionmentioning

confidence: 92%

Predictive factors of head and neck squamous cell carcinoma patient tolerance to high-dose cisplatin in concurrent chemoradiotherapy

Nakano

Sato

Toshiyasu

et al. 2015

Molecular and Clinical Oncology

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“…Similarly, patients receiving induction therapy are also less likely to complete the full dose of concurrent cisplatin with RT 23. It has been shown that total dose of cisplatin administered with concurrent RT is associated with local control and OS 31. In the a recent phase III randomized trial of induction TPF and concurrent CRT alone, it was noted that only 30% in the induction group vs 56% in the concurrent CRT completed all three cycles of concurrent cisplatin 8.…”

Section: Discussionmentioning

confidence: 99%

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

et al. 2018

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The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T‐ and N‐stage had a higher likelihood of being treated with induction chemotherapy. The 5‐year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3‐T4N1 or TanyN2‐3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3‐T4N1 or TanyN2‐3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.

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“…In a prognostic analysis of NPC-9901 and NPC-9902, Lee et al [17] using multivariate analyses found that at least 2 cycles (100 mg/m 2 ) was an independent prognostic factor in LFS and OS. Loong et al [16] retrospectively analyzed the data from a Hong Kong phase III trial of CCRT with weekly cisplatin at 40 mg/m 2 and suggested that a dose intensity of > 5 cycles was significantly associated with OS in stage II-III patients. Our data showed that a cumulative dose > 200 mg/m 2 could improve the 5-year DFS and 5-year PFS.…”

Section: Discussionmentioning

confidence: 99%

“…It has been confirmed that the dose intensity of cisplatin during CCRT confers survival benefit in head and neck squamous cell cancer (HNSCC). However, data on the total cisplatin dose during CCRT for NPC are limited [16,17]. …”

Section: Introductionmentioning

confidence: 99%

Pretreatment Epstein-Barr Virus DNA Load and Cumulative Cisplatin Dose Intensity Affect Long-Term Outcome of Nasopharyngeal Carcinoma Treated with Concurrent Chemotherapy: Experience of an Institute in an Endemic Area

Wei

Huang

et al. 2014

Oncol Res Treat

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Background: We retrospectively compared the long-term efficacy of concurrent chemoradiotherapy (CCRT) regimens (docetaxel vs. cisplatin), total dose intensity of cisplatin (> 200 vs. ≤ 200 mg/m²) and pretreatment plasma levels of Epstein-Barr virus (EBV) DNA for nasopharyngeal carcinoma (NPC), and investigated the prognostic factors. Methods: We enrolled 214 patients diagnosed with NPC and treated with CCRT. 41 patients received weekly docetaxel and 173 weekly cisplatin. 62 received cumulative cisplatin of ≤ 200 mg/m² and 111, > 200 mg/m². Pretreatment levels of EBV DNA were available for 155 patients. Results: Patients receiving concurrent weekly docetaxel and cisplatin had similar 5-year rates for overall survival (OS) (p = 0.306), progression-free survival (PFS) (p = 0.133), distant failure-free survival (DFS) (p = 0.110), and locoregional failure-free survival (LFS) (p = 0.452). Cumulative cisplatin of > 200 mg/m² improved the 5-year rates of PFS (p = 0.018) and DFS (p = 0.042) significantly in comparison with cumulative cisplatin of ≤ 200 mg/m². EBV DNA levels of ≥ 1,500 copies/ml was closely associated with poor DFS (p = 0.011), PFS (p = 0.006), and OS (p = 0.004). Conclusions: Weekly cisplatin was well tolerated in CCRT, during which cumulative cisplatin of > 200 mg/m² improved PFS and DFS. The long-term efficacy of concurrent docetaxel was similar to that of concurrent cisplatin. The EBV DNA level was the most significant prognostic factor.

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Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

Cited by 99 publications

References 31 publications

Predictive factors of head and neck squamous cell carcinoma patient tolerance to high-dose cisplatin in concurrent chemoradiotherapy

Predictive factors of head and neck squamous cell carcinoma patient tolerance to high-dose cisplatin in concurrent chemoradiotherapy

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

Pretreatment Epstein-Barr Virus DNA Load and Cumulative Cisplatin Dose Intensity Affect Long-Term Outcome of Nasopharyngeal Carcinoma Treated with Concurrent Chemotherapy: Experience of an Institute in an Endemic Area

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