Radiation Oncology Journal

  • 제33권2호
  • /
  • Pages.98-108
  • /
  • 2015
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지
DOI QR코드

DOI QR Code

Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy

  • Wee, Chan Woo (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Keam, Bhumsuk (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Heo, Dae Seog (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Sung, Myung-Whun (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine) ;
  • Won, Tae-Bin (Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine) ;
  • Wu, Hong-Gyun (Department of Radiation Oncology, Seoul National University College of Medicine)
  • 투고 : 2015.03.24
  • 심사 : 2015.06.01
  • 발행 : 2015.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Materials and Methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

키워드

참고문헌

  1. Vokes EE, Liebowitz DN, Weichselbaum RR. Nasopharyngeal carcinoma. Lancet 1997;350:1087-91. https://doi.org/10.1016/S0140-6736(97)07269-3
  2. Ali H, Al-Sarraf M. Chemotherapy in advanced nasopharyngeal cancer. Oncology (Williston Park) 2000;14:1223-30.
  3. Geara FB, Sanguineti G, Tucker SL, et al. Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of distant metastasis and survival. Radiother Oncol 1997;43:53-61. https://doi.org/10.1016/S0167-8140(97)01914-2
  4. Hong S, Wu HG, Chie EK, et al. Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1999;45:901-5. https://doi.org/10.1016/S0360-3016(99)00287-4
  5. Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998;16:1310-7. https://doi.org/10.1200/JCO.1998.16.4.1310
  6. Wee J, Tan EH, Tai BC, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005;23:6730-8. https://doi.org/10.1200/JCO.2005.16.790
  7. Chen Y, Liu MZ, Liang SB, et al. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china. Int J Radiat Oncol Biol Phys 2008;71:1356-64. https://doi.org/10.1016/j.ijrobp.2007.12.028
  8. Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 2003;21:631-7. https://doi.org/10.1200/JCO.2003.06.158
  9. Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst 2005;97:536-9. https://doi.org/10.1093/jnci/dji084
  10. Zhang L, Zhao C, Peng PJ, et al. Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results. J Clin Oncol 2005;23:8461-8. https://doi.org/10.1200/JCO.2004.00.3863
  11. Chen L, Hu CS, Chen XZ, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 2012;13:163-71. https://doi.org/10.1016/S1470-2045(11)70320-5
  12. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): head and neck cancers v2.2014 [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2015 [cited 2015 Jan 8]. Available from: http://www.nccn.org/professionals/physician_ gls/pdf/head-and-neck.pdf.
  13. Chan AT, Teo PM, Leung TW, et al. A prospective randomized study of chemotherapy adjunctive to definitive radiotherapy in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1995;33:569-77. https://doi.org/10.1016/0360-3016(95)00218-N
  14. Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2001;19:1350-7. https://doi.org/10.1200/JCO.2001.19.5.1350
  15. Chua DT, Sham JS, Choy D, et al. Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Cancer 1998;83:2270-83. https://doi.org/10.1002/(SICI)1097-0142(19981201)83:11<2270::AID-CNCR6>3.0.CO;2-T
  16. Hareyama M, Sakata K, Shirato H, et al. A prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma. Cancer 2002;94:2217-23. https://doi.org/10.1002/cncr.10473
  17. Chua DT, Ma J, Sham JS, et al. Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials. J Clin Oncol 2005;23:1118-24. https://doi.org/10.1200/JCO.2005.12.081
  18. Hui EP, Ma BB, Leung SF, et al. Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol 2009;27:242-9. https://doi.org/10.1200/JCO.2008.18.1545
  19. Fountzilas G, Ciuleanu E, Bobos M, et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma: a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation. Ann Oncol 2012;23:427-35. https://doi.org/10.1093/annonc/mdr116
  20. Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 2004;22:4604-12. https://doi.org/10.1200/JCO.2004.10.074
  21. Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 2006;64:47-56. https://doi.org/10.1016/j.ijrobp.2005.06.037
  22. Lee AW, Ng WT, Chan OS, Sze HC. If concurrent-adjuvant chemoradiotherapy is beneficial for locoregionally advanced nasopharyngeal carcinoma, would changing the sequence to induction-concurrent achieve better outcome? J Radiat Oncol 2012;1:107-15. https://doi.org/10.1007/s13566-012-0032-0
  23. Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 2008;9:367-75. https://doi.org/10.1016/S1470-2045(08)70098-6
  24. Lin S, Pan J, Han L, Zhang X, Liao X, Lu JJ. Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys 2009;75:1071-8. https://doi.org/10.1016/j.ijrobp.2008.12.015
  25. Tham IW, Hee SW, Yeo RM, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the national cancer centre singapore experience. Int J Radiat Oncol Biol Phys 2009;75:1481-6. https://doi.org/10.1016/j.ijrobp.2009.01.018
  26. Wong FC, Ng AW, Lee VH, et al. Whole-field simultaneous integrated-boost intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2010;76:138-45. https://doi.org/10.1016/j.ijrobp.2009.01.084
  27. Lai SZ, Li WF, Chen L, et al. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys 2011;80:661-8. https://doi.org/10.1016/j.ijrobp.2010.03.024
  28. Lee NK, Park YJ, Yang DS, Yoon WS, Lee S, Kim CY. Long-term results of 2-dimensional radiation therapy in patients with nasopharyngeal cancer. J Korean Soc Ther Radiol Oncol 2010;28:193-204. https://doi.org/10.3857/jkstro.2010.28.4.193
  29. Yeh SA, Huang YJ. Dose escalation for patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone. Am J Clin Oncol 2007;30:401-5. https://doi.org/10.1097/COC.0b013e31803377b3

피인용 문헌

  1. The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis vol.48, pp.3, 2015, https://doi.org/10.4143/crt.2015.265
  2. Tumor regression patterns by follow-up duration in patients with nasopharyngeal carcinoma treated with concurrent chemoradiotherapy vol.58, pp.2, 2015, https://doi.org/10.1093/jrr/rrw100
  3. Induction chemotherapy for the treatment of non-endemic locally advanced nasopharyngeal carcinoma vol.8, pp.4, 2015, https://doi.org/10.18632/oncotarget.14279
  4. Chemoradiotherapy enhanced the efficacy of radiotherapy in nasopharyngeal carcinoma patients: a network meta-analysis vol.8, pp.24, 2015, https://doi.org/10.18632/oncotarget.16349
  5. Chemoradiotherapy enhanced the efficacy of radiotherapy in nasopharyngeal carcinoma patients: a network meta-analysis vol.8, pp.24, 2015, https://doi.org/10.18632/oncotarget.16349
  6. Long-term outcomes of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy (CCRT) vs CCRT alone for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy using prop vol.10, pp.None, 2015, https://doi.org/10.2147/ott.s135590
  7. 18 F-FLT and 18 F-FDG PET/CT in Predicting Response to Chemoradiotherapy in Nasopharyngeal Carcinoma: Preliminary Results vol.7, pp.None, 2017, https://doi.org/10.1038/srep40552
  8. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in nasopharyngeal carcinoma patients with cervical nodal necrosis vol.7, pp.None, 2015, https://doi.org/10.1038/srep42624
  9. Concurrent Chemoradiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma: Treatment Outcomes and Prognostic Factors vol.19, pp.6, 2015, https://doi.org/10.22034/apjcp.2018.19.6.1591
  10. Clinical outcome and prognostic analysis of young adults nasopharyngeal carcinoma patients of a nonendemic area in intensity-modulated radiotherapy era vol.15, pp.4, 2015, https://doi.org/10.2217/fon-2018-0547
  11. Value of early evaluation of treatment response using 18F-FDG PET/CT parameters and the Epstein-Barr virus DNA load for prediction of outcome in patients with primary nasopharyngeal carcinoma vol.46, pp.3, 2015, https://doi.org/10.1007/s00259-018-4172-3
  12. The Prognostic Value of Albumin-to-Alkaline Phosphatase Ratio before Radical Radiotherapy in Patients with Non-metastatic Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis vol.51, pp.4, 2015, https://doi.org/10.4143/crt.2018.503
  13. MRI-based radiomics nomogram may predict the response to induction chemotherapy and survival in locally advanced nasopharyngeal carcinoma vol.30, pp.1, 2015, https://doi.org/10.1007/s00330-019-06211-x
  14. Induktionschemotherapie mit Cisplatin und Gemcitabin, gefolgt von Radiochemotherapie bei Nasopharynxkarzinomen vol.196, pp.8, 2015, https://doi.org/10.1007/s00066-020-01644-6
  15. A network meta-analysis for efficacies and toxicities of different therapeutic regimens in the treatment of advanced nasopharyngeal carcinoma vol.278, pp.9, 2021, https://doi.org/10.1007/s00405-020-06593-5