The Tumour Response to Induction Chemotherapy has Prognostic Value for Long-Term Survival Outcomes after Intensity-Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Abstract

The prognostic value of the tumour response to induction chemotherapy (IC) for long-term survival outcomes after intensity-modulated radiation therapy in nasopharyngeal carcinoma (NPC) remains unknown. We retrospectively reviewed 1811 consecutive patients with newly diagnosed NPC treated using IMRT, and 399 eligible patients with pre- and post-induction chemotherapy magnetic resonance images were recruited. The clinicopathological features of patients with different tumour responses were compared using the Chi-square test or Fisher’s exact test. Prognostic value was assessed using a multivariate Cox proportional hazards model. After IC, 101/399 (25.3%) patients had a complete tumour response overall (CR), 262 (65.7%) had a partial response (PR) and 36 (9.0%) had stable disease (SD). The 4-year disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) rates for CR vs. PR vs. SD were 90.0% vs. 79.0% vs. 58.2% (CR vs. PR: P1 = 0.007; CR vs. SD: P2 < 0.001; PR vs. SD: P3 = 0.004), 95.7% vs. 88.7% vs. 70.2% (P1 = 0.017, P2 < 0.001, P3 = 0.005), 92.0% vs. 87.4% vs. 74.3% (P1 = 0.162, P2 = 0.005, P3 = 0.029) and 95.9% vs. 88.8% vs. 81.8% (P1 = 0.024, P2 = 0.006, P3 = 0.268), respectively. Multivariate analysis identified that the tumour response to IC was an independent prognostic factor for DFS, OS and LRRFS.

Tumor response to neoadjuvant chemotherapy predicts long‐term survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma: A secondary analysis of a randomized phase 3 clinical trial

“…This should be attributed to insufficient follow-up and the small sample in each group, which could result in a low testing power. The effective response rate (CR plus PR) to the TPF regimen in the current study was 90.9%, which was consistent with the results of our retrospective study (91%), 27 but was much higher than that in the study by Liu et al in which the PF regimen was used (67.6%). 22 The main purpose of using NACT in clinical practice was to eliminate micrometastasis before radical IMRT and therefore improve OS for patients with advanced NPC.…”

Complete Clinical Response after Induction Chemotherapy Followed by Chemoradiotherapy in Nasopharyngeal Carcinoma: Impact on Oncologic Outcomes

“…revealed that the unsatisfactory tumor response after induction chemotherapy (stable disease or disease progression) could predict poor prognosis for patients with advanced-stage NPC (locoregional relapse-free survival,PFS) [23]. However ;an another trial concluded that the overall tumor response after induction chemotherapy was an independent prognostic factor for disease-free-survival , OS and locoregional recurrence free survival [24].…”

Comparison of different images in gross target volume delineating on VX2 nasopharyngeal transplantation tumor models

“…Currently, radiotherapy has been widely accepted as a first-line and standard treatment for advanced NPC, by providing the superior dose of distributions and the better tolerated on NPC patients [25][26][27]. The more precise the radiation technique becomes the more rigid the requirements are to precisely delineate the tumor.…”