Second primary cancer after intensity-modulated radiotherapy for nasopharyngeal carcinoma: A territory-wide study by HKNPCSG

Chow, J.C.H.; Tam, Anthony H.P.; Cheung, Ka Man; Lee, Victor; Chiang, Chi Leung; Tong, Macy; Wong, E.; Cheung, A.; Chan, Sunny P.C.; Lai, Jessica W.Y.; Ngan, Roger K.C.; Ng, Wai‐Tong; Lee, Anne W.M.; Au, Kwok‐Hung

doi:10.1016/j.oraloncology.2020.105012

Cited by 17 publications

(32 citation statements)

References 25 publications

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“…In general, the longer a life span is for primary malignancies after treatment, the more likely it is to develop a second primary cancer. The second primary cancer for NPC patients after radiotherapy was also reported by some previous studies ( 4 , 6 , 7 , 15 ). Survivors of NPC patients had a higher risk of cancer than the general population.…”

Section: Discussionsupporting

confidence: 76%

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Second Primary Lung Adenocarcinoma After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Xue

Niu

et al. 2022

Front. Oncol.

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ObjectiveThe improvement of the efficacy of intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer (NPC) has prolonged the survival of patients, and the incidence of the second tumor has gradually increased. Among them, second primary lung adenocarcinoma (SPLAC) attributes the highest incidence. This study aimed to determine the long-term risk of SPLAC in NPC patients after IMRT.MethodsFrom May 2005 to May 2018, a total of 1,102 non-metastatic NPC patients who received IMRT in our hospital were enrolled, and the incidence and efficacy of SPLAC were followed up in the long term.ResultsOver a median follow-up period of 66 months, a total of 22 cases of SPLAC were observed, with an incidence of 2.0%. The 1-, 2-, 3-, 4-, and 5-year cumulative risks of SPLAC were 0.4%, 0.7%, 0.8%, 1.1%, and 1.7%, respectively. During follow-up, 90.9% (20/22) of the SPLAC detected was in early stage, and the recurrence rate of surgery alone was 5.3% (1/19).ConclusionIn NPC patients, the proportion of SPLAC after IMRT was similar to that of the normal population, and most of them were found in early stage during follow-up, with good surgical efficacy.

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Section: Discussionsupporting

confidence: 76%

“…While the second tumor is also an important reason (1)(2)(3)(4)(5). The incidence of the second primary tumor after IMRT in NPC patients was 3.0%-9.2%, with second primary lung adenocarcinoma (SPLAC) contributing the highest incidence (6,7). With the prolongation of survival, the incidence of the second primary tumor gradually increased.…”

Section: Introductionmentioning

confidence: 99%

Second Primary Lung Adenocarcinoma After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Xue

Niu

et al. 2022

Front. Oncol.

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“…SPT is a dreadful complication and negatively impact of OS. It was observed that 290 cases SPT occurred with a crude incidence of 9.2% over a median follow-up period of 10.8 years after IMRT for NPC patients in Chow's study [29]. It mainly included oral cavity, sarcoma, oropharynx, paranasal sinus, salivary gland, thyroid, skin and lung cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Second primary tumor (SPT) is a serious late complication after IMRT for NPC. [29][30] The incidence and risk factors of SPT are poorly characterized. It can occur in-field or out-field anytime after RT and increases with long-term survivors of NPC.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of nasopharyngeal carcinoma patients with T1-2 stage in intensity-modulated radiotherapy era

Niu¹,

Xue²,

Liu³

et al. 2022

Int. J. Med. Sci.

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Objectives: To evaluate long-term outcomes and late toxicities of nasopharyngeal carcinoma (NPC) patients with T1-2N0-3M0 stage in intensity-modulated radiotherapy (IMRT) era. Materials and Methods: From June 2005 to October 2013, 276 patients confirmed T1-2N0-3M0 NPC treated with IMRT were reviewed, with 143 (51.8%) N0-1 disease and 133 (48.2%) N2-3 disease. Among them, 76.4% received chemotherapy. The prescribed doses given to the primary tumor and lymph nodes were 66Gy in 30 fractions. Results: After a median follow-up of 103 months, the 5-year and 10-year overall survival (OS) were 90.6% and 79.2%. The 5-year and 10-year local control (LC) rate, regional control (RC) rate and distant metastasis free survival (DMFS) were 97.0% and 91.9%, 94.1% and 92.2%, 89.4% and 87.0%, respectively. The 5-year and 10-year OS, RC rate and DMFS of N0-1 compared with those of N2-3 were 98.6% vs. 82.0% and 86.8% vs. 70.9% (P=0.000), 99.3% vs. 88.3% and 99.3% vs. 84.1% (P=0.000), 97.9% vs. 80.1% and 95.7% vs. 77.5% (P=0.000). The incidence of 3-4 late toxicities were low and mainly xerostomia and hearing deficit. The rates of radiation-induced cranial nerve palsy and temporal necrosis were 2.5% and 2.5%, respectively. Eighteen patients had the second primary tumor, of whom eight were lung cancer, six were head and neck cancer, four were others. Conclusions: Satisfactory locoregional control was achieved in T1-2N0-3M0 NPC treated with IMRT. Distant metastasis was the main failure cause and N2-3 was the main adverse prognostic factor. Second primary tumor occurred 6.5% and negatively impacted OS in NPC.

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“…Interestingly, elderly NPC patients even seemed to be less susceptible to develop post-radiation hypothyroidism (38,39). On the contrary, elderly NPC patients are more prone to develop post-radiation xerostomia and second malignancy (40,41). In a recent territory-wide study in Hong Kong, the risk of second cancer in post-IMRT NPC patients aged >60 was 40% higher compared with the demographic-matched general population.…”

Section: Radiotherapymentioning

confidence: 99%

Management of Nasopharyngeal Carcinoma in Elderly Patients

Chan

Chow

et al. 2022

Front. Oncol.

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Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%–15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients’ functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients’ preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.

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Second primary cancer after intensity-modulated radiotherapy for nasopharyngeal carcinoma: A territory-wide study by HKNPCSG

Cited by 17 publications

References 25 publications

Second Primary Lung Adenocarcinoma After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Second Primary Lung Adenocarcinoma After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

Long-term outcomes of nasopharyngeal carcinoma patients with T1-2 stage in intensity-modulated radiotherapy era

Management of Nasopharyngeal Carcinoma in Elderly Patients

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