Cancer Res Treat.  2023 Oct;55(4):1113-1122. 10.4143/crt.2022.1651.

Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy

• Ji P
• Lu Q
• Chen X
• Chen Y
• Peng X
• Chen Z
• Lin C
• Lin S
• Zong J

• KMID: 2547786
• DOI: http://doi.org/10.4143/crt.2022.1651

Abstract

Purpose
This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT).
Materials and Methods
A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test.
Results
There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT.
Conclusion
Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.

Keyword

Nasopharyngeal carcinoma; Epstein-Barr virus DNA; Individualized treatment; Chemoradiotherapy

Figure

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  Fig. 1 Receiver operation characteristic curve analysis for identifying the cutoff value of Epstein-Barr virus DNA. AUC, area under the curve.

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  Fig. 2 Treatment schedule of study patient inclusion. CCRT, concurrent chemoradiotherapy; EBV, Epstein-Barr virus; IMRT, intensity-modulated radiotherapy; NCT, neoadjuvant chemotherapy; NPC, nasopharyngeal carcinoma.

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  Fig. 3 Kaplan-Meier survival curves for high-risk patients after propensity score matching: (A) overall survival, (B) progression-free survival, (C) distant metastasis-free survival, and (D) locoregional relapse-free survival. NCT+CCRT, neoadjuvant chemotherapy combined with concurrent chemoradiotherapy; NCT+IMRT, neoadjuvant chemotherapy combined with concurrent chemoradiotherapy.

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  Fig. 4 Kaplan-Meier survival curves for low-risk patients after propensity score matching: (A) overall survival, (B) progression-free survival, (C) distant metastasis-free survival, and (D) locoregional relapse-free survival. NCT+CCRT, neoadjuvant chemotherapy combined with concurrent chemoradiotherapy; NCT+IMRT, neoadjuvant chemotherapy combined with concurrent chemoradiotherapy.

Reference

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