Abstract

BackgroundThe efficiency of concurrent chemotherapy (CC) remains controversial for stage II–IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). Therefore, we aimed to propose a nomogram to identify patients who would benefit from CC.MethodsA total of 434 NPC patients (stage II–IVa) treated with IC followed by IMRT between January 2010 and December 2015 were included. There were 808 dosimetric parameters extracted by the in-house script for each patient. A dosimetric signature was developed with the least absolute shrinkage and selection operator algorithm. A nomogram was built by incorporating clinical factors and dosimetric signature using Cox regression to predict recurrence-free survival (RFS). The C-index was used to evaluate the performance of the nomogram. The patients were stratified into low- and high-risk recurrence according to the optimal cutoff of risk score.ResultsThe nomogram incorporating age, TNM stage, and dosimetric signature yielded a C-index of 0.719 (95% confidence interval, 0.658–0.78). In the low-risk group, CC was associated with a 9.4% increase of 5-year locoregional RFS and an 8.8% increase of 5-year overall survival (OS), whereas it was not significantly associated with an improvement of locoregional RFS (LRFS) and OS in the high-risk group. However, in the high-risk group, patients could benefit from adjuvant chemotherapy (AC) by improving 33.6% of the 5-year LRFS.ConclusionsThe nomogram performed an individualized risk quantification of RFS in patients with stage II–IVa NPC treated with IC followed by IMRT. Patients with low risk could benefit from CC, whereas patients with high risk may require additional AC.

Highlights

  • The cases of newly diagnosed nasopharyngeal carcinoma (NPC) reached about 129,000 in 2018 [1]

  • We aimed at developing a prognostic nomogram based on intensity-modulated radiotherapy (IMRT) dosimetric signature as a risk quantification model and further identifying patient subsets who can benefit from concurrent chemotherapy (CC) in patients with stage II–IVa NPC treated with induction chemotherapy (IC) followed by IMRT

  • Based on dosimetric parameters derived from the IMRT plan in patients with stage II–IVa NPC treated with IC followed by IMRT, we constructed a novel nomogram to quantify the risk of RFS of individuals

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Summary

Introduction

The cases of newly diagnosed nasopharyngeal carcinoma (NPC) reached about 129,000 in 2018 [1]. As for stage II–IVa NPC, concurrent chemotherapy (CC) combined with radiotherapy is used to enhance radiosensitivity and local control. In the two-dimensional (2D) radiotherapy era, concurrent chemoradiotherapy (CCRT) is superior to radiotherapy in patients with stage III–IVa disease for progression-free survival (PFS) and overall survival (OS) [2]. Stage II disease could benefit from CCRT in terms of PFS and OS compared with radiotherapy alone in the 5- and 10-year follow-up [3, 4]. CCRT is widely accepted for treating stage II–IVa NPC [5]. The efficiency of concurrent chemotherapy (CC) remains controversial for stage II–IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). We aimed to propose a nomogram to identify patients who would benefit from CC

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