Comparison of concurrent chemoradiotherapy versus induction chemotherapy followed by radiation in patients with nasopharyngeal carcinoma
The study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) with platinum-based chemotherapy as a primary treatment for nasopharyngeal carcinoma (NPC) and to further compare the results of CCRT with these of neoadjuvant chemotherapy (NAC) followed by radiotherapy (RT). Before 1998, 21 patients with NPC received NAC followed by RT (NAC-RT). Between 1999 and 2008, a total of 25 NPC patients received CCRT. The CCRT group received a regimen including docetaxel (50 mg/m(2), day1), cisplatin (CDDP, 60 mg/m(2), day4) and continuous 5-fluorouracil (5-FU) infusion (600 mg/m(2), day 1-5), the TPF regimen, or a regimen including CDDP (60 mg/m(2), day4), continuous 5-FU infusion (600 mg/m(2), day 1-5), methotrexate (MTX, 30 mg/m(2), day 1) and leucovorin (LV, 20 mg/m(2), day 1-5), PFML regimen. The CCRT group received 2 cycles of chemotherapy during definitive RT. The NAC group of patients received a PFML regimen. The overall response rate after CCRT was 96%. The 3-year and 5-year disease-specific survival rates were 75.6% and 60.1%, respectively. In patients receiving NAC-RT, the 3-year and 5-year disease-specific survival rates were 84.1% and 67.3%, respectively. There was no difference observed in terms of survival rates between the group receiving CCRT and that receiving NAC-RT. CCRT with the TPF or PFML regimen was tolerable, and the NPC patients receiving this treatment showed excellent survival rates. In comparison to the group receiving NAC-RT, CCRT had no advantage in terms of the survival rate. In the future, the control of distant metastasis might play an important role in improving the survival rate of patients with advanced NPC receiving CCRT.
[Show abstract] [Hide abstract] ABSTRACT: Background Combined radiotherapy and chemotherapy is considered the standard of care for locally advanced nasopharyngeal carcinoma (LA-NPC) in Epstein-Barr virus infection endemic area. This study compared the long-term outcomes between LA-NPC patients treated with neoadjuvant chemotherapy followed by radiotherapy (NACT) and those treated with concurrent chemoradiotherapy (CCRT). Methods From 2003 to 2007, a total of 128 histopathologically proven LA-NPC patients receiving either NACT or CCRT were consecutively enrolled at the National Cheng Kung University Hospital in Taiwan. NACT consisted of 3-week cycles of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL) or weekly alternated cisplatin on day 1 and fluorouracil and leucovorin on day 8 (P-FL). CCRT comprised 3-week cycles of cisplatin (Cis 100) or 4-week cycles of cisplatin and fluorouracil (PF4). The first failure site, disease free survival (DFS), overall survival (OS), and other prognostic factors were analyzed. Results Thirty-eight patients (30%) received NACT. Median follow-up duration was 53 months. More patients with advanced nodal disease (N2-N3) (86.8% vs 67.8%, p =0.029) and advanced clinical stage (stage IVA-IVB) enrolled in the NACT group (55.2% vs 26.7%, p =0.002). For NACT, both MEPFL and P-FL had similar 5-year DFS and OS (52.9% vs 50%, p =0.860 and 73.5% vs 62.5%, p =0.342, respectively). For CCRT, both PF4 and Cis 100 had similar 5-year DFS and OS (62.8% vs 69.6%, p =0.49 and 72.9% vs 73.9%, p =0.72, respectively). Compared to CCRT, NACT had similar 5-year DFS and OS (51.5% vs 65.1%, p =0.28 and 71.7% vs 74.3%, p =0.91, respectively). Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046). Conclusions For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability. Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.0Comments 4Citations
- "Because most NPC patients suffered from disease recurrence during the first 2-3 years while completing radical therapy for advanced disease control [13,18], we further analyzed patients who remained disease-free in the first two years after the completion of treatment, and found that patients who received NACT experienced poorer late locoregional control (HR =2.57, 95% CI: 1.02 to 6.47, p =0.046) compared to those who received CCRT (Figure 1C). Komatsu et al. reported a relatively small series (N =46) of advanced NPC patients receiving either CCRT or NACT with a long-term follow-up (median 51.7 months) . They reported that the 5-year disease specific survival in NACT and CCRT was 67.3% and 60.1%, respectively, which is similar to our finding (in our study, the 5-year rate was 71.7% vs. 74.3%). "
[Show abstract] [Hide abstract] ABSTRACT: In China, the incidence of nasopharyngeal carcinoma (NPC) and tuberculosis remains high. Additionally, there has been a marked increase in the prevalence of gout. In recent years, there has been an increase in the number of coexisting diseases. To the best of our knowledge, there have been no previous cases reported in the literature with regard to patients suffering from NPC complicated with pulmonary tuberculosis and gout. The present study describes the case of a 59yearold male with this condition. The patient received a combination of antitumor, antituberculosis and antigout therapies, and experienced no severe adverse reactions during treatment. At present, the patient's Eastern Cooperative Oncology Group performance status is good, there has been no local recurrence or distant metastasis of the NPC, and the pulmonary tuberculosis and gout are well controlled. The aim of this study was to provide insight into the treatment of patients suffering from coexisting conditions.0Comments 0Citations
- "Currently, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology recommend concurrent chemoradiotherapy for the treatment of locally advanced NPC (7,8,9). Studies of targeted therapies have been encouraging in recent years. "
[Show abstract] [Hide abstract] ABSTRACT: Heat shock protein 70, a stress protein, has been implicated in tumor progression. However, its role in nasopharyngeal carcinoma (NPC) progression has not yet been clearly investigated. Immunohistochemistry (IHC) was employed to examine the expression patterns of Hsp70, human leukocyte antigen -A (HLA-A) in NPC tissue samples. The expression of Hsp70 exhibited different spatial patterns among nuclear, membrane and cytoplasm in 507 NPC tumor tissues. Kaplan-Meier survival analysis demonstrated that different Hsp70 expression patterns are correlated with different patient outcomes. High membranal and cytoplasmic levels of Hsp70 predicted good survival of patients. In contrast, high nuclear abundance of Hsp70 correlated with poor survival. Moreover, the membranal and cytoplasmic levels of Hsp70 were positively correlated with levels of the MHC I molecule HLA-A. Different Hsp70 expression patterns had distinct predictive values. The different spatial abundance of Hsp70 may imply its important role in NPC development and provide insight for the development of novel therapeutic strategies involving immunotherapy for NPC.0Comments 3Citations
- "Therapeutic strategies have been studied aiming to improve the survival rate for advanced NPC. Recently, novel therapies based on molecular targets and neoadjuvant chemotherapy (NAC) followed by RT of NPC were promising for advanced lesions [7,8] , though need to be validated in more trials. Conventional TNM staging has a strong prognostic implication for NPC ; and patients at early-stage are almost curable under RT, however, the prognosis remains poor in a significant number of patients with late-stage NPC  . "