scholarly journals Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037150
Author(s):  
Si-Ting Lin ◽  
Dong-Fang Meng ◽  
Qi Yang ◽  
Wei Wang ◽  
Li-Xia Peng ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cohort Study ◽  
Nasopharyngeal Carcinoma ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Intensity Modulated ◽  
Kaplan Meier

ObjectivesGeographical disparities have been identified as a specific barrier to cancer screening and a cause of worse outcomes for patients with cancer. In the present study, our aim was to assess the influence of geographical disparities on the survival outcomes of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).DesignCohort study.SettingGuangzhou, China.ParticipantsA total of 1002 adult patients with NPC (724 males and 278 females) who were classified by area of residence (rural or urban) received IMRT from 1 January 2010 to 31 December 2014, at Sun Yat-sen University Cancer Center. Following propensity score matching (PSM), 812 patients remained in the analysis.Main outcome measuresWe used PSM to reduce the bias of variables associated with treatment effects and outcome prediction. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox regression was used to identify independent prognostic factors.ResultsIn the matched cohort, 812 patients remained in the analysis. Kaplan-Meier survival analysis revealed that the rural group was significantly associated with worse overall survival (OS, p<0.001), disease-free survival (DFS, p<0.001), locoregional relapse-free survival (LRRFS, p=0.003) and distant metastasis-free survival (DMFS, p<0.001). Multivariate Cox regression showed worse OS (HR=3.126; 95% CI 1.902 to 5.138; p<0.001), DFS (HR=2.579; 95% CI 1.815 to 3.665; p<0.001), LRRFS (HR=2.742; 95% CI 1.359 to 5.533; p=0.005) and DMFS (HR=2.461; 95% CI 1.574 to 3.850; p<0.001) for patients residing in rural areas.ConclusionsThe survival outcomes of patients with NPC who received the same standardised treatment were significantly better in urban regions than in rural regions. By analysing the geographic disparities in outcomes for NPC, we can guide the formulation of healthcare policies.

scholarly journals Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy in Saudi Arabia.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. e295-e295
Author(s):  
Ahmed M Maklad ◽  
Yasser Bayoumi ◽  
Mohamed Abdalaziz Senosy ◽  
AbuSaleh A. Elawadi ◽  
Hussain AlHussain ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Concurrent Chemotherapy ◽  
Patterns Of Failure ◽  
Intensity Modulated

e295 Background: We aimed to investigate the patterns of failure (locoregional and distant metastasis), associated factors, treatment outcomes in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT) combined with chemotherapy, results of reirradiation in recurrent cases and its toxicity. Methods: From April 2006 to December 2011, 68 NPC patients were treated with IMRT and chemotherapy at our hospital. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy/33-35fractions. For recurrent cases reirradiation was given by SRS 25 -30 Gy/5 fractions or IMRT 50-60 Gy/25-30 fractions according to volume of recurrence and surrounding critical structures. The clinical toxicities, patterns of failures, locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) were observed. Results: The median follow up time was 52.2 months (range: 11-87). EBV infection positive was 63.2%.There were 7 locoregional recurrences, 3 regional recurrences with distant metastases and 11 distant metastases. The median interval from the date of diagnosis to failure was 26.5 months (range, 16-50 months). 6/10 (60%) locoregional recurrences were treated with re-irradiation +/- concurrent chemotherapy. Acute grade 3 and 4 mucositis were observed in 2 patients (28.6%); however no significant late toxicities were seen after reirradiation. Nodal recurrences were salvaged by neck dissection. The 5-year LRC, DMC, DFS and OS rates of whole cohort were 81.1%, 74.3%, 60.1% and 73.4% respectively. Cox regression analyses revealed that neoadjuvant chemotherapy, age and Epstein-Barr virus (EBV) were independent predictors for DFS. Conclusions: Distant metastasis is the most common pattern of failure after IMRT with SIB technique with or without neoadjuvant and concurrent chemotherapy in Saudi patients with NPC. Early detection of local and locoregional recurrences is important as reirradiation with IMRT or SRT with or without chemotherapy is still feasible option with acceptable toxicity. However, efforts should be made for proper patient selection.

scholarly journals Prognostic value of hypertension in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy

2020 ◽  
Author(s):  
yin wen jing ◽  
liu jin quan ◽  
chen dong ping ◽  
qi bin ◽  
wang meng yao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Distant Metastasis ◽  
Prognostic Value ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Untreated Hypertension

Abstract Purpose To investigate the prognostic value of hypertension in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: A total of 1057 patients with nonmetastatic, histologically proven NPC who were treated with IMRT were retrospectively reviewed. Associations between hypertension and overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were estimated by Cox regression. Results Among 1057 patients, 94 (8.9%) had hypertension. Compared to normotensive patients, the hypertensive patients were generally older, had higher body fat, were more likely to be alcohol consumers, were more often in the early stage and usually received radiotherapy alone. Compared to normotension, hypertension was significantly associated with worse OS (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.41–3.42; P = 0.000), LRRFS (HR, 2.13; 95% CI, 1.12–4.03; P = 0.021) and DMFS (HR, 1.82; 95% CI, 1.09–3.05; P = 0.023) after adjusting for covariates. Moreover, the association with OS remained unchanged regardless of smoking, body mass index (BMI), N stage and chemotherapy, whereas it was limited in the subgroup of patients who were older than 50 years, male, not alcohol consumers, in advanced T stage and in advanced clinical stage. Compared with treated hypertension, untreated hypertension was associated with increased risks for death (P = 0.221; HR, 1.88; 95% CI, 0.69–5.15), locoregional recurrence (P = 0.073; HR, 3.29; 95% CI, 0.89–12.09) and distant metastasis (P = 0.640; HR, 1.30; 95% CI, 0.44–3.83). The patients with more severe levels of hypertension had worse survival and locoregional control, although there was no statistically significant difference (P > 0.05). Conclusions Hypertension is an independent adverse prognostic factor in NPC patients treated with IMRT. The NPC patients with untreated hypertension had similar survival as those with treated hypertension. The severity of hypertension did not influence the prognosis.

Overall and disease-free survival outcomes of patients receiving intensity-modulated radiation therapy (IMRT) with PET-CT-based planning for cancers of the head and neck

2015 ◽  
pp. 1-11
Author(s):  
Benjamin L. Franc ◽  
Christi DeLemos ◽  
Christopher Jones
Keyword(s):  
Overall Survival ◽  
Metastatic Disease ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Distant Metastatic Disease ◽  
Intensity Modulated ◽  
Pet Ct ◽  
Disease Free

AbstractIntroductionCombined modality treatment regimens have provided modest gains in locoregional control rates of cancers of the head and neck (HNC), and intensity-modulated radiation therapy (IMRT) has gained widespread use. The methodology for determining contours of the gross tumour volume (GTV) in the radiation treatment plan is often based on combined anatomic and metabolic data from positron emission tomography–computed tomography (PET-CT). This study aimed to retrospectively evaluate the overall survival and disease-free survival outcomes of patients with HNC who received definitive IMRT with or without chemotherapy, planned with PET-CT.Materials and MethodsA total of 1,200 patients underwent treatment for HNC during the study period, from 1 January 2002 to 31 December 2010. Of those, 261 cases had evaluable data that met the inclusion criteria for the study. The incidence and timing of locoregional recurrence, distant metastatic disease, new primary malignancies and death were evaluated retrospectively. Overall and disease-free survival (survival to time of first recurrence) were determined by the life table method. Incidence of distance metastatic disease and additional cancers were also studied.ResultsMedian follow-up from treatment initiation was 26·4 months (range 1·2–84·7 months). Overall survival and disease-free survival rates were 0·883 and 0·791, respectively, at 1 year; 0·793 and 0·688, respectively, at 2 years; and 0·732 and 0·619, respectively, at 3 years. The cumulative risk of recurrence was 22·6% at 3 years following definitive IMRT and the median time to recurrence was 345 days. There was an overall low incidence of distant metastatic disease (3·07%) and additional cancers (8·05%).ConclusionOverall and disease-free survival outcomes of a large cohort of HNC patients treated with definitive IMRT radiotherapy following treatment planning with PET-CT shows a similar high level of disease control and mortality rate as previously published outcome studies of shorter terms and/or smaller numbers of patients.

scholarly journals Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhouying Peng ◽  
Yumin Wang ◽  
Yaxuan Wang ◽  
Ruohao Fan ◽  
Kelei Gao ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Meta Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Intensity Modulated ◽  
T Stage ◽  
Recurrent Nasopharyngeal Carcinoma ◽  
Disease Free

BackgroundThis meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC).MethodsRelevant studies were retrieved in six databases from 02/28,2011 to 02/28,2021. The 2-year, 3-year, 5-year overall survival (OS) rates and 2-year disease-free survival (DFS) rates were calculated to compare the survival outcomes of the two treatments of IMRT and ES. Combined odds ratios (ORs) and 95% confidence interval (C Is) were measured as effect size on the association between high T-stage and 5-year OS rates.ResultsA total of 23 publications involving 2,578 patients with recurrent NPC were included in this study. Of these, 1611 patients with recurrent rT3-4 NPC were treated with ES and IMRT in 358 and 1,253 patients, respectively. The combined 2-year OS and 5-year OS rates for the two treatments were summarized separately, and the 2-year OS and 5-year OS rate for ES were 64% and 52%, respectively. The 2-year OS and 5-year OS rate for IMRT were 65% and 31%, respectively. The combined 2-year DFS rates of IMRT and ES were 60% and 50%, respectively. Combined ORs and 95% confidence intervals for 5-year survival suggest that ES may improve survival in recurrent NPC with rT3-4. In terms of complications, ES in the treatment of high T-stage recurrent NPC is potentially associated with fewer complications.ConclusionsThe results of our study suggest that ES for rT3-4 may be a better treatment than IMRT, but the conclusion still needs to be sought by designing more studies.

scholarly journals Adjuvant Chemotherapy Following Combined Induction Chemotherapy and Concurrent Chemoradiotherapy Improves Survival in N2-3-positive Nasopharyngeal Carcinoma Patients

2021 ◽  
Author(s):  
Hao-Yun Tao ◽  
Hui Liu ◽  
Cai-Xian He ◽  
Ran Li ◽  
Kun-Peng Du ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Distant Metastasis ◽  
Concurrent Chemoradiotherapy ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Clinical Value ◽  
Free Survival ◽  
Kaplan Meier

Abstract Objective: This study aimed to explore the clinical value of adjuvant chemotherapy (ACT) in locoregionally advanced nasopharyngeal carcinoma (LANC) following concurrent chemoradiotherapy (CCRT) and induction chemotherapy (ICT).Methods: We included 839 newly diagnosed LANC patients in the study. ICT plus CCRT (ICT+CCRT group) was administered to 443 patients and 396 patients who received ACT after receiving ICT plus CCRT (ICT+CCRT+ACT group). Univariate and multivariate Cox regression analyses were carried out in this study. Furthermore, to balance the study and control groups, propensity score matching (PSM) was applied.Results: 373 pairs of LANC patients were obtained after the PSM analysis. We found that ACT following ICT+CCRT had no significant effect on improving the survival of LANC patients. By further exploring the ICT+CCRT+ACT regimen, we excluded N0-1-positive patients and performed PSM in the ICT+CCRT and ICT+CCRT+ACT groups again. Each group consisted of 237 patients. Kaplan-Meier analysis revealed that there was a difference between the ICT+CCRT and ICT+CCRT+ACT groups in terms of the 5-year overall survival (OS) (78.9% vs. 85.0%, P = 0.034), disease-free survival (DFS) (73.4% vs. 81.7%, P = 0.029), and distant metastasis-free survival (DMFS) (84.9% vs. 76.0%, P = 0.019). In addition, the ICT+CCRT+ACT group had a higher incidence of grade 3-4 acute leukocytopenia/neutropenia.Conclusion: Compared with ICT+CCRT, ACT following ICT plus CCRT can reduce distant metastasis of N2-3-positive LANC and improve the OS and DFS of these patients, thus demonstrating higher clinical feasibility.

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