Randomized Trial of Radiotherapy Plus Concurrent-Adjuvant Chemotherapy vs Radiotherapy Alone for Regionally Advanced Nasopharyngeal Carcinoma

Lee, Anne W.M.; Tung, Stewart Y.; Chua, Daniel T.T.; Ngan, Roger K.C.; Chappell, Rick; Tung, Raymond; Siu, Lillian L.; Ng, Wai Tong; Au, Gordon K.H.; Law, Stephen C.K.; O’Sullivan, Brian; Yau, Tsz Kok; Leung, TW; Au, Joseph Siu Kie; Sze, W.M.; Choi, Cheuk-Wai; Fung, K. K.; Lau, Joseph T. F.; Lau, W.S.

doi:10.1093/jnci/djq258

Cited by 296 publications

(200 citation statements)

References 33 publications

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“…8,9 Both the SQNP01 trial and the current trial enrolled patients who had stage III to IVB patients according to the 5th edition of the AJCC cancer staging manual, whereas the HK99-01 trial focused on patients with N2 or N3 disease. Patients who have regionally advanced NPC have a higher distant tumor burden and, thus, poorer OS compared with patients who have locally advanced disease.…”

Section: Discussionmentioning

confidence: 99%

“…5 Surprisingly, 2 randomized trials that were conducted to verify the IGS regimen in endemic NPC patients resulted in opposite outcomes: results from the SQNP01 trial in Singapore indicated that the modified IGS regimen significantly improved 5-year OS compared with RT (67% vs 49%; P 5 .008), 6,7 whereas the HK99-01 trial in Hong Kong did not (68% vs 64%; P 5 .22). 8,9 Therefore, we carried out a randomized trial to verify a modified IGS regimen in patients with stage III to IVB NPC from endemic regions of China. The preliminary results have been published and demonstrate that concurrent adjuvant chemotherapy increases 2-year OS by 10% (P 5 .003).…”

Section: Introductionmentioning

confidence: 99%

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Progress report of a randomized trial comparing long‐term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China

Chen

Sun

Liang

et al. 2013

Cancer

150

117

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BACKGROUND:The objective of this study was to evaluate the long-term survival and late toxicities of concurrent-adjuvant chemotherapy in patients with stage III through IVB nasopharyngeal carcinoma (NPC) from endemic regions of China. METHODS: Patients with stage III to IVB NPC were assigned randomly to receive radiotherapy (RT) alone (the RT group) or RT plus concurrent adjuvant chemotherapy (the CRT group). CRT patients received concurrent cisplatin (40 mg/m 2 ) weekly during RT followed by cisplatin (80 mg/m 2 ) and fluorouracil (800 mg/m 2 daily for 5 days) every 4 weeks for 3 cycles. The primary endpoint was overall survival. RESULTS:In total, 316 patients underwent randomization, with 158 to each group. At a median follow-up of 70 months, the 5-year overall survival rate was 72% for the CRT group and 62% for the RT group (hazard ratio, 0.69; 95% confidence interval, 0.48-0.99; P 5.043). Failure-free survival was significantly higher in the CRT group (P 5.020). Most late toxicities were similar (33% vs 26%; P 5.089), except for cranial neuropathy (P 5.042), peripheral neuropathy (P 5.041), and ear damage (P 5.048), which were significantly increased in the CRT group. CONCLUSIONS: The addition of concurrent adjuvant chemotherapy to RT provides survival benefits to patients with stage III through IVB NPC in endemic regions of China, and it does not increase most late toxicities apart from cranial neuropathy, peripheral neuropathy, and ear damage. Cancer 2013;119:2230-8.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Progress report of a randomized trial comparing long‐term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China

Chen

Sun

Liang

et al. 2013

Cancer

150

117

View full text Add to dashboard Cite

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“…More and more evidence has supported the finding that combined chemoradiotherapy is the best choice of treatment modality for patients with advanced disease. [1][2][3][4][5][6][7][8][9][10][11] It is long established that NPC is an Epstein-Barr virus (EBV)-associated cancer. Modern molecular biologic techniques have revealed that the EBV genome is present in cells from almost every primary and metastatic NPC.…”

Section: Introductionmentioning

confidence: 99%

Long‐term survival analysis of nasopharyngeal carcinoma by plasma Epstein‐Barr virus DNA levels

Wang

Twu²,

Chen

et al. 2012

Cancer

129

111

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BACKGROUND:The objective of this study was to confirm the relation between plasma Epstein-Barr virus (EBV) DNA (pEBV DNA) load and treatment outcomes after long-term follow-up in patients with nasopharyngeal carcinoma (NPC). METHODS: In total, 210 patients with NPC were enrolled, including 99 previously reported patients and 111 new patients. They prospectively received treatment with induction chemotherapy plus radiotherapy and were followed for at least 6 years. In these patients, pEBV DNA levels were measured before treatment and 1 week after treatment. The plasma viral load was correlated with treatment outcomes in the group of new patients and in the entire group. RESULTS: By using previously defined pEBV DNA cutoff values (1500 copies/mL pretreatment and 0 copies/mL post-treatment), there was a significant correlation between the pEBV DNA value and relapse-free survival, overall survival, and subsequent relapse rates in the new, independent patient cohort. Outcome analyses for the entire group revealed a higher relapse rate (45.6% vs 21.5% [P ¼ .0037] or 76.7% vs 26.1% [P < .0001]), a worse relapse-free survival rate (56.5% vs 79.3% [P < .0001] or 23.3% vs 75.6% [P < .0001]), and poorer overall survival (59.2% vs 86% [P ¼ .0003] or 33.3% vs 79.4% [P < .0001]) in patients who had high pretreatment or persistently detectable post-treatment pEBV DNA levels, respectively, versus their respective counterparts. Multivariate Cox analysis also confirmed these results. CONCLUSIONS: In this expanded study, the prognostic significance of pEBV DNA was confirmed using predefined cutoff values in an independent patient group, and pEBV DNA was identified as an independent prognostic marker for NPC.

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“…Long term follow up data published in 2010 confirmed the trend toward improved DFS seen on the initial analysis (62% vs 53% favoring chemotherapy). However, while five-year analysis showed a clear reduction death due to disease progression in the chemotherapy arm (28% vs 38% favoring chemotherapy, p = 0.08), the five-year overall survival data revealed only a modest trend favoring chemotherapy (68% vs 64%, p = 0.22) 27 . The discrepancy between a clear decreased in disease-associated death and nearly identical five-year overall survival was attributed to an increase in non-cancer deaths among patients in the chemotherapy arm.…”

Section: Concurrent Plus Adjuvant Chemotherapymentioning

confidence: 84%

Nasopharyngeal Carcinoma: The Role for Chemotherapeutics and Targeted Agents

Knol¹,

King²,

Agulnik³

2012

Head and Neck Cancer

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Randomized Trial of Radiotherapy Plus Concurrent-Adjuvant Chemotherapy vs Radiotherapy Alone for Regionally Advanced Nasopharyngeal Carcinoma

Cited by 296 publications

References 33 publications

Progress report of a randomized trial comparing long‐term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China

Progress report of a randomized trial comparing long‐term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China

Long‐term survival analysis of nasopharyngeal carcinoma by plasma Epstein‐Barr virus DNA levels

Nasopharyngeal Carcinoma: The Role for Chemotherapeutics and Targeted Agents

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