CC BY-NC-ND 4.0 · South Asian J Cancer 2022; 11(03): 223-228
DOI: 10.1055/s-0042-1742724
Original Article
Head and Neck Cancer

Comparison of Two Standard Treatment Approaches in Locoregionally Advanced Nasopharyngeal Carcinoma

1   Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
,
Fawzi Abu-Hijleh
1   Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
,
Ebrahim Mayta
2   Department of Surgical Oncology, King Hussein Cancer Center, Amman, Jordan
,
Taher Abu-Hejleh
3   Division of Hematology/Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Unites States
,
Wisam Al-Gargaz
2   Department of Surgical Oncology, King Hussein Cancer Center, Amman, Jordan
,
Abdellatif Al Mousa
1   Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
,
Ramiz Abu-Hijlih
1   Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
,
Ali Hosni
4   Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, ON, Canada
› Author Affiliations
Funding None.

Abstract

Zoom Image
Issa Mohamad

Objectives To compare outcomes and toxicity of two standard treatment approaches of advanced nasopharyngeal carcinoma (NPC).

Methods Between 2010 and 2016, patients with NPC, stage II–IVa, treated with induction chemotherapy (IC) (TPF), followed by concurrent chemoradiotherapy (CCRT) (induction group), or CCRT, followed by adjuvant chemotherapy (AC) (PF) (no-induction group), were retrospectively reviewed. CCRT included platinum-based chemotherapy with intensity-modulated radiotherapy. Survival outcomes, the pattern of failures, toxicity, and predictors for survival outcomes were evaluated.

Results A total of 110 patients were included, 65 in the induction group and 45 in the no-induction group. There were no significant differences in the DFS and overall survival (OS) at 3 years between the two groups. On multivariate analysis, performance status (1 vs. 0) predicted worse OS. The 3-year cumulative incidence rates for local, regional, and distant failures were 58.5% (95% confidence interval [CI]: 8.4–89%), 58.00% (95% CI: 8–88.8%), and 63.90% (95% CI: 14.1–90.2%), respectively. IC had more frequent acute grade (G) II anemia (13 vs. 1, p < 0.01), late G II brain toxicity (4 vs. 1, p < 0.01), and late G II dysphagia (32 vs. 11, p = 0.01).

Conclusions Survival outcomes were comparable between the two groups. IC had more frequent acute G II anemia and late G II brain and esophageal toxicities.

Ethics Approval

Institutional IRB approval was obtained to conduct this study




Publication History

Article published online:
27 February 2022

© 2022. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Altun M, Fandi A, Dupuis O, Cvitkovic E, Krajina Z, Eschwege F. Undifferentiated nasopharyngeal cancer (UCNT): current diagnostic and therapeutic aspects. Int J Radiat Oncol Biol Phys 1995; 32 (03) 859-877 DOI: 10.1016/0360-3016(95)00516-2.
  • 2 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 (04) 1310-1317 DOI: 10.1200/JCO.1998.16.4.1310.
  • 3 Forastiere AA, Shank D, Neuberg D, Taylor IV SG, DeConti RC, Adams G. Final report of a phase II evaluation of paclitaxel in patients with advanced squamous cell carcinoma of the head and neck: an Eastern Cooperative Oncology Group trial (PA390). Cancer 1998; 82 (11) 2270-2274
  • 4 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 (07) 536-539 DOI: 10.1093/jnci/dji084.
  • 5 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 (02) 163-171 DOI: 10.1016/S1470-2045(11)70320-5.
  • 6 Sun Y, Li WF, Chen NY. et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol 2016; 17 (11) 1509-1520 DOI: 10.1016/S1470-2045(16)30410-7.
  • 7 Zang J, Xu M, Li C. et al. Gemcitabine and cisplatin versus docetaxel and cisplatin as induction chemotherapy followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma from non-endemic area of China. J Cancer Res Clin Oncol 2020; 146 (09) 2369-2378 DOI: 10.1007/s00432-020-03229-3.
  • 8 Maklad AM, Bayoumi Y, Senosy Hassan MA. et al. Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in Saudi Arabia. OncoTargets Ther 2016; 9: 6561-6567 DOI: 10.2147/OTT.S95457.
  • 9 Mohamad I, Salem A, Abu Hejleh T. et al. Peer-assisted learning: intensity-modulated radiotherapy transition in developing countries. Clin Oncol (R Coll Radiol) 2017; 29 (10) 689-695 DOI: 10.1016/j.clon.2017.06.002.
  • 10 Amin MB, Greene FL, Edge SB. et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017; 67 (02) 93-99 DOI: 10.3322/caac.21388.
  • 11 Kam MK, Teo PM, Chau RM. et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2004; 60 (05) 1440-1450 DOI: 10.1016/j.ijrobp.2004.05.022.
  • 12 Au KH, Ngan RKC, Ng AWY. et al. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: A report of 3328 patients (HKNPCSG 1301 study). Oral Oncol 2018; 77: 16-21 DOI: 10.1016/j.oraloncology.2017.12.004.
  • 13 Chen YP, Tang LL, Yang Q. et al. Induction chemotherapy plus concurrent chemoradiotherapy in endemic nasopharyngeal carcinoma: individual patient data pooled analysis of four randomized trials. Clin Cancer Res 2018; 24 (08) 1824-1833 DOI: 10.1158/1078-0432.CCR-17-2656.
  • 14 Ribassin-Majed L, Marguet S, Lee AWM. et al. What is the best treatment of locally advanced nasopharyngeal carcinoma? An individual patient data network meta-analysis. J Clin Oncol 2017; 35 (05) 498-505 DOI: 10.1200/JCO.2016.67.4119.
  • 15 Wang WY, Twu CW, Chen HH. et al. Long-term survival analysis of nasopharyngeal carcinoma by plasma Epstein-Barr virus DNA levels. Cancer 2013; 119 (05) 963-970 DOI: 10.1002/cncr.27853.