Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials

Abstract

Background The impact of radiotherapy interruption due to the Spring Festival holidays in China on the survival of patients with nasopharyngeal carcinoma (NPC) is unclear. Methods Nontrial patients with locoregionally advanced NPC receiving radiotherapy plus induction chemotherapy (IC) and/or concurrent chemotherapy (CC) were included (N = 5035) and divided into two groups based on the Spring Festival-induced radiotherapy interruption. Kaplan–Meier curves for overall survival (OS) and failure-free survival (FFS) were compared between rival groups. Impact of the timing of radiotherapy interruption (during or outside the Spring Festival) on survival was investigated in a propensity score-matched dataset. We adopted ordination correspondence analysis to determine the cut-off of radiotherapy prolongation for prognostic prediction, and accordingly performed subgroup analysis based on delayed days and chemotherapy details. Individual patient data of three phase III NPC trials (NCT00677118, NCT01245959, NCT01872962) were used for validation (N = 1465). Results Radiotherapy interruption was most frequently observed between December to January of the following year. Significantly lower OS and FFS were associated with the Spring Festival-induced interruption of radiotherapy (P = 0.009 and 0.033, respectively), but not that interruption of IC. In two matched comparison groups, the timing of radiotherapy interruption during the Spring Festival was more likely to lead to a decrease in FFS than outside the Spring Festival (P = 0.046), which was not observed in the validation using clinical trial data or in the subgroup analysis based on the 5-day delayed time. The absence of CC and the accumulated dose of cisplatin < 200 mg were related to the negative influences of the Spring Festival-induced radiotherapy interruption on FFS (P = 0.002) and OS (P = 0.010), respectively. Conclusions The poor survival of patients with NPC is associated with the Spring Festival-induced interruption of radiotherapy. We recommend that these patients receive adequate doses of cisplatin concurrently with radiotherapy.

Effects of CIK Cell Therapy Combined with Camrelizumab on the Quality of Life in Patients with Nasopharyngeal Carcinoma and Analysis of Prognostic Factors

“…Nasopharyngeal carcinoma, as a malignant tumor originating from the epithelium of the nasopharyngeal mucosa, mostly presents in the hanging wall and sidewall of the nasopharynx. Its incidence is 30/100,000–50/100,000, and it is most prevalent among the yellow race [ 1 , 2 ]. Therefore, deeper research on this disease can reduce the medical burden in China.…”

TPF induction chemotherapy versus PF adjuvant chemotherapy plus concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: a multicenter, randomized controlled phase III trial

“…Notably, the 3-year OS outcome in our study was superior to that reported in the Intergroup Study 0099 16 and other studies 46,49 , which applied a dual approach of CCRT combined with AC. Studies have reported that IC increases the waiting time for radiotherapy and interrupts the radiation treatment, resulting in accelerated tumor growth and reduced treatment e cacy [50][51][52][53] . However, another reason may be that our IC group has increased the interrupts the radiation and the low completion rate of 3-cycle CC for radiotherapy due to the lack of PFS and other outcomes bene ts.…”

Effect of radiotherapy interruption on nasopharyngeal cancer

“…In order to achieve better prognosis, an uninterrupted routine radiotherapy schedule is an essential necessity for precise radiotherapy of nasopharyngeal carcinoma ( 36 ). Disruptions in radiotherapy, however, are inevitable for several unavoidable factors, such as public holidays ( 37 ) (the largest share, about 39-46%), machine failures, patient compliance, and adverse effects of treatment ( 38 ). Similarly, because of the pandemic of Corona Virus Disease 2019, confirmed positive patients had longer treatment interruptions, which led to fewer patients completing radiotherapy, thus increasing local disease progression ( 39 ).…”