Combination of pan-immune-inflammation value and frailty index predicts the outcomes of elderly nasopharyngeal carcinoma treated by concurrent chemoradiotherapy.

Nasopharyngeal carcinoma (NPC) is a prevalent form of head and neck cancer, particularly in specific regions with a higher incidence. The optimal treatment strategy for locally advanced NPC (stage III and IVA, LA-NPC) involves various combinations of induction chemotherapy (IC), concurrent chemoradiotherapy (CCRT), and adjuvant chemotherapy (AC), each with distinct advantages. This one institutional study aims to retrospectively analysis the efficacy and clinical outcomes of IC with CCRT (IC+CCRT), CCRT with AC (CCRT+AC), and the comprehensive approach of IC followed by CCRT and subsequently AC (IC+CCRT+AC) in the management of LA-NPC. A total of 352 LA-NPC patients were included: 173 accepted IC+CCRT, 60 received CCRT+AC, and 119 underwent IC+CCRT+AC. The primary endpoints including overall survival (OS) and progression-free survival (PFS), were assessed using the Kaplan-Meier method and log-rank test. The median follow-up was 61.2 months (1-216 months). There was no significant difference in 5-year OS and PFS between IC group and no IC group, extending the observation time to 90 months, the OS and PFS were significantly better in IC group than no IC group (OS: 76% vs. 70%,P<0.05; PFS: 76% vs. 71%, P<0.05). Patients with 1, 2, or 3 cycles of IC had higher 5-year OS and PFS than those with more than 3 cycles (1-4 cycles IC OS: 89% vs. 87% vs. 88% vs. 79%, P<0.05; 1-4 cycles IC PFS: 87% vs. 85% vs. 85% vs. 70%, P<0.05). NP regimen demonstrated higher OS and PFS than TP, PF, and TPF regimens (OS: 95% vs. 82% vs. 85% vs. 71%, P<0.05; PFS: 93% vs. 83% vs. 81% vs. 80%, P<0.05). The 5-year OS and PFS were significantly better in AC group than no AC group (OS: 82% vs. 72%, P<0.05; PFS: 81% vs. 69%, P<0.05). In the AC group, there was no differential effect of chemotherapy cycles and chemotherapy regimens on patients' OS and PFS. In the ThNh group, patients receiving IC+CCRT+AC had higher OS and PFS compared to those receiving IC+CCRT, with no significant difference in the rest (OS: 85% VS 66% P<0.05; PFS: 78% VS 62%, P<0.05). CCRT combined with IC or AC could benefit LA-NPC patients. The IC+CCRT +AC regimen was most beneficial for NPC patients with later T and N stages.

Treatment of Stage IV(A–B) nasopharyngeal carcinoma by induction-concurrent chemoradiotherapy and accelerated fractionation: Impact of chemotherapy schemes

Objective To compare the long-term efficacy between intensity-modulated radiotherapy (IMRT) alone and concurrent chemoradiotherapy (CCRT) in the treatment of stage Ⅱ nasopharyngeal carcinoma (NPC) patients. Methods The clinical data of 123 patients with stage Ⅱ NPC were retrospectively analyzed. Eighty-one patients received IMRT alone, and 42 patients received CCRT.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to compare the survival rates. Results The 5-year overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates in all patients were 96.7%, 94.7%, 93.1%, and 87.8%, respectively. There were no significant differences between the patients receiving IMRT alone and CCRT in 5-year OS (98.7% vs.92.9%, P=0.569), LRFS (94.8% vs. 94.5%, P=0.770), DMFS (94.5% vs. 90.2%, P=0.408), and PFS (90.6% vs. 82.2%, P=0.340). For patients with stage T2N1 NPC, the 5-year OS, LRFS, DMFS, and PFS also showed no significant differences between those receiving IMRT alone and CCRT (P=0.929, 0.967, 0.917, 0.492). The incidence rates of neutropenia, leukopenia, and mucositis were significantly higher in patients receiving CCRT than in those receiving IMRT alone (P=0.000, 0.000, 0.012, 0.010), while the incidence of late toxicities was similar between the two groups of patients (P=0.823, 0.622, 0.113). Conclusions For stage Ⅱ NPC patients treated with IMRT, the addition of concurrent chemotherapy fails to improve the prognosis, and increases the incidence of acute toxicities. Key words: Nasopharygeal neoplasms/chemoradiotherapy; Chemoradiotherapy, concurrent; Radiotherapy, intensity-modulated; Prognosis

The Combination of Frailty and ISS Scores Identifies a Simple Prognostic Index for Overall Survival in Elderly Patients Treated with Novel Agents-Based Induction Therapy

Comparison of Concurrent Cisplatin Chemoradiotherapy Plus Adjuvant Chemotherapy Versus Concurrent Chemoradiotherapy Alone in Locally Advanced Cervical Cancer

Objective: To investigate the clinical value of induction chemotherapy (IC) with docetaxel plus cisplatin (TP) followed by concurrent chemoradiotherapy (CCRT) with TP in locoregionally advanced nasopharyngeal carcinoma (NPC).Methods: A total of 544 patients with locoregionally advanced NPC that was newly diagnosed from January 2009 to December 2015 were included in this study. Among these patients, 251 were treated with TP induction chemotherapy followed by CCRT with cisplatin (DDP) alone (TP + DDP group), 167 were treated with TP followed by CCRT with TP (TP + TP group), and 126 were treated with docetaxel, DDP and fluorouracil (TPF) followed by CCRT with DDP alone (TPF + DDP group). Overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and locoregional relapse-free survival (LRRFS) were analyzed using the Kaplan-Meier method and a Cox proportional hazards model.Results: Survival analysis showed that the 5-year OS, PFS and DMFS rates in the TP + DDP group were significantly lower than those in the TP + TP group after propensity score matching (PSM). Multivariate analysis revealed that CCRT with TP was an independent prognostic factor for OS, PFS and DMFS. During CCRT, the incidence rates of grade 3/4 nausea/vomiting, oral mucositis, leukocytopenia and neutropenia were significantly increased in the TP + TP group compared with the TP + DDP group (all P < 0.05). To further explore the value of TP + TP, we performed PSM again with the TPF + DDP group. After PSM, there were 100 patients in each group. Survival analysis showed no significant differences in the 5-year OS, PFS, DMFS and LRRFS rates between the two groups. During IC and CCRT, the rate of grade 3/4 nausea/vomiting in the TPF + DDP group was higher than that in the TP+TP group (9.0% vs. 2.0%, P = 0.030; 18.0% vs. 8.0%, P = 0.036, respectively). No significant difference in the incidence of grade 3/4 hematologic toxicity was found between the two groups (all P > 0.05).Conclusion: TP + TP can reduce the distant metastasis of locoregionally advanced NPC and improve OS compared with TP + DDP; TP + TP has the same effect as TPF + DDP and is clinically feasible.

Objective: This study aims to compare the treatment outcomes of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in stage II nasopharyngeal carcinoma (NPC) patients.Methods: We retrospectively collected 601 stage II NPC patients treated in two hospitals between June 2003 to June 2016. All patients were divided into the CCRT group (n = 255) and the RT group (n = 346). Overall survival (OS), locoregional failure-free survival (LRFFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. The log-rank test was used to compare the differences between the groups. The Cox-regression hazards model was performed to determine potential prognostic factors.Results: The median follow-up was 99 months. No significant difference was found in locoregional recurrence, distant metastasis, disease progression, and death between the two groups (all p > 0.05). In univariate analysis, the 5-years OS, PFS, LRFFS, and DMFS had no significant differences between the CCRT and RT groups (all p > 0.05). Two-dimensional radiotherapy (2DRT) sub-analysis showed that CCRT remarkably increased DMFS, PFS, and OS rates (all p < 0.05) but not LRFFS (p = 0.258) compared with RT alone. While intensity-modulated radiotherapy (IMRT) sub-analysis showed that the prognosis of the two groups had no significant differences (all p > 0.05). In multivariate analyses, age was significantly and inversely related to OS, PFS, LRFFS, and DMFS. IMRT was an independent favorable factor for improving LRFFS, PFS, and OS. Concurrent chemotherapy was an independent protective factor for DMFS.Conclusion: In the context of 2DRT, it is definite that concurrent chemotherapy provides survival benefits for patients with stage II NPC. While in the IMRT era, the impact of chemotherapy on survival in patients with stage II NPC is weakened. Prospective randomized controlled studies are required to confirm these results.

Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-ⅡA cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy. Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion, depth of stromal invasion or tumor size>4 cm were retrospectively analyzed. The impact of observing (NT), chemotherapy (CT), radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared. The Kaplan-Meier method was used to survival analysis, and log-rank test difference, Cox model was used to prognostic factor analysis. Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0% and 84.8%. Univariate and multivariate analyses demonstrated that TS> 4 cm and therapeutic method were the independent prognostic factors of PFS. The number of risk factors and therapeutic method were the independent prognostic factors of OS. In the whole group, both RT and CCRT could improve the prognosis of patients with no statistical significance (P>0.05). In the subgroup analysis, for patients with a single intermediate risk factor (low risk group), CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692). Compared with NT and CT, RT and CCRT could improve the PFS and OS, whereas no statistical significance was noted between the RT and CCRT (both P>0.05). For those with ≥2 risk factors (high risk group), CCRT could significantly prolong the PFS compared with CT (84.9% vs. 70%; P=0.006), but did not improve the OS (P=0.107). Compared with RT, CCRT could significantly improve the PFS and OS (both P<0.05). Conclusion For patients with only one risk factor, RT can enhance the clinical prognosis. CCRT can improve the clinical prognosis of stage Ⅰ-ⅡA cervical cancer patients with ≥2 risk factors. Key words: Cervical neoplasms/radiotherapy; Cervical neoplasms/chemotherapy; Cervical neoplasms/ concurrent chemoradiotherapy; Prognosis

Background:This study aimed to investigate the efficiency and toxicities of concurrent chemoradiotherapy (CCRT) and induction chemotherapy (IC) followed by radiotherapy (RT) in different risk locoregionally advanced nasopharyngeal carcinoma (NPC).Methods:A total of 1814 eligible patients with stage II–IVB disease treated with CCRT or IC plus RT were included. The overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan–Meier method, and the differences were compared using the log-rank test.Results:Nomograms were developed to predict OS, PFS and DMFS (C-index: 0.71, 0.70 and 0.71, respectively). Patients were then divided into three different risk groups based on the scores calculated by the nomogram for OS. In the low and intermediate-risk group, no significant survival differences were observed between patients treated with IC plus RT alone and CCRT (5-year OS, 97.3% versus 95.6%, p = 0.642 and 87.6% versus 89.7%, p = 0.381, respectively; PFS, 95.9% versus 95.6%, p = 0.325 and 87.6% versus 89.0%, p = 0.160, respectively; DMFS, 97.2% versus 94.8%, p = 0.339 and 87.2% versus 89.3%, p = 0.628, respectively). However, in the high-risk group, IC plus RT displayed an unfavorable 5-year OS (71.0% versus 77.2%, p = 0.022) and PFS (69.4.0% versus 75.4%, p = 0.019) compared with CCRT. A significantly higher incidence of grade 3 and 4 adverse events was documented in patients treated with CCRT than in those treated with IC plus RT in all risk groups (p = 0.040).Conclusion:IC followed by RT represents an alternative treatment strategy to CCRT for patients with low and intermediate-risk NPC, but it is not recommended for patients with high-risk NPC.

A Phase II Prospective Study about the Efficacy and Toxicity of the Locally Advanced Nasopharyngeal Carcinoma Patients Treated with Concurrent Chemoradiotherapy Followed with the Capecitabine Metronomic Chemotherapy

Comparison of Neoadjuvant Chemotherapy Plus Concurrent Chemoradiotherapy vs. Concurrent Chemoradiotherapy Alone in Locally Advanced Cervical Cancer Under 2018FIGO Staging Correction

Simple SummaryInduction chemotherapy (IC) plus concurrent chemoradiotherapy has been recommended as the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). However, concurrent chemotherapy was associated with increased toxicities, poor tolerance, and low completion rates. The aim of this study was to compare the efficacy and toxicity of IC + radiotherapy (RT) and IC + concurrent or adjuvant chemoradiotherapy (IC + CCRT/AC) in patients with negative post-IC EBV DNA. The results showed that IC + RT alone displayed similar efficacy to IC + CCRT/AC. The omission of concurrent or adjuvant chemotherapy did not increase locoregional or distant failure. However, patients treated with IC + RT had fewer acute toxicities than those with IC + CCRT/AC. Our finding provided evidence that the omission of concurrent or adjuvant chemotherapy may be feasible for patients with negative EBV DNA after induction chemotherapy.The purpose of this study was to compare the efficacy and toxicity of induction chemotherapy (IC) plus radiotherapy (RT) and IC plus concurrent or adjuvant chemoradiotherapy (CCRT/AC) in nasopharyngeal carcinoma (NPC) patients with negative Epstein–Barr virus DNA (EBV DNA) after IC. A total of 547 NPC patients with negative plasma EBV DNA post-IC were included. Patients were classified into the IC + RT group and the IC + CCRT/AC group. Locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and progression-free survival (PFS) were estimated and compared using the Kaplan–Meier method. Propensity score matching (PSM) was performed to balance the variables. The median follow-up time was 37 months. The 3-year LRFS, DMFS, OS, and PFS rates for the whole group were 92.2%, 92.4%, 96.4%, and 84.4%, respectively. There was no significant difference in LRFS, DMFS, OS, and PFS between the IC + RT and the IC + CCRT/AC groups, both before PSM (3-year rates of 91.1% vs. 92.6%, p = 0.94; 95.6% vs. 91.5%, p = 0.08; 95.2% vs. 96.8%, p = 0.80; 85.9% vs. 84.0%, p = 0.38) and after PSM (90.7% vs. 92.7%, p = 0.77; 96.8% vs. 93.7%, p = 0.29; 94.5% vs. 93.9%, p = 0.57; 84.7% vs. 85.6%, p = 0.96). Multivariate analysis demonstrated that the treatment schedule was not an independent predictor for survival rates. Patients in the IC + RT group had fewer treatment-related acute toxicities and better tolerance. IC + RT displayed similar survival outcomes as IC + CCRT/AC for NPC patients with negative post-IC EBV DNA.

Objective To evaluate the long-term outcomes of patients with advanced N-stage nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and the effects of IMRT combined with different chemotherapies on the patients' prognosis.Methods A retrospective analysis was performed on the clinical data of 179 patients with advanced N-stage NPC who were admitted to our hospital from January 2001 to January 2008.Of the 179 patients,33 received IMRT alone,and 146 received chemoradiotherapy (CRT).Among the 146 patients,71 received concurrent chemoradiotherapy (CCRT),66 received induction chemotherapy (IC) plus CCRT,and 9 received CCRT plus adjuvant chemotherapy (AC).Results The follow-up rate was 96.5％,and 133 patients were followed up for at least 5 years.The 5-year overall survival rate was 69.0％.The patients receiving IMRT alone and patients receiving CRT had 5-year overall survival rates of 47.7％ and 73.7％ (x2 =13.91,P =0.000),5-year distant metastasisfree survival (DMFS) rates of 49.2％ and 68.3％ (x2 =4.97,P =0.026),relapse-free survival rates of 74.5％ and 92.4％ (x2 =9.87,P =0.002),and progression-free survival rates of 37.5％ and 65.1％ (x2 =11.65,P =0.001).Among the patients receiving CRT,those receiving CCRT,IC plus CCRT,and CCRT plus AC had similar survival rates.IC plus CCRT resulted in a significantly higher DMFS than IMRT alone (x2 =4.65,P =0.031).Conclusions The distant metastasis rate is still high in patients with advanced N-stage NPC after IMRT,for whom IC plus concurrent chemotherapy and IMRT may be a better treatment regimen. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Nasopharyngeal neoplasms/radiochemotherapy; Prognosis

Objective To investigate the correlation of platelets-to-lymphocyte ratio (PLR) with neutrophil-to-lymphocyte ratio (NLR) from pretreatment in the Xinjiang Uygur patients with nasopharyngeal carcinoma. Methods In this retrospective analysis, 96 cases of nasopharyngeal carcinoma patients with pathologically diagnosis were collected. Receiver operating characteristic (ROC) curve analysis suggested that optimum PLR and NLR cut-off point for nasopharyngeal carcinoma. The patients were divided into high-PLR and low-PLR groups, high-NLR and low-NLR groups, respectively. The survival rate was calculated with Kaplan-Meier method. The Log rank statistics was used to test differences between groups. The prognostic factors that may affect patients with nasopharyngeal carcinoma in Uighur population of Xinjiang were analyzed by COX proportional hazards models. Results For high-PLR and low-PLR groups, 5-year overall survival, and progression-free survival were 46.6% and 79.3%, 49.8% and 82.7%, respectively; the difference was statistically significant (all P<0.01). For high-NLR and low-NLR groups, 5-year overall survival rate, and progression-free survival rate were 41.3% and 41.3%, 50.8% and 82.5%, respectively; the difference was statistically significant (all P<0.01). Univariate analysis showed that N stage, clinical stage, NLR, and PLR had significantly impact on overall survival and progression-free survival (all P<0.05); multivariate analysis showed that PLR and clinical stage had statistical significance in Uighur patients with nasopharyngeal carcinoma for progression-free survival and overall survival (all P<0.05). Conclusions PLR may be independent factor that influences the prognosis of patients with nasopharyngeal carcinoma in Uighur population of Xinjiang. Key words: Blood platelets/ME; Lymphocytes/ME; Nasopharyngeal neoplasms/TH; Prognosis

IntroductionThis study investigated the best mode for the application of nimotuzumab (Nimo) in combination with chemoradiotherapy to treat nasopharyngeal carcinoma (NPC).Material and methodsData were prospectively collected from 168 patients with NPC from September 2009 to February 2014. One hundred twelve patients received 2–3 cycles of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), and 56 patients with well-matched propensity scores received IC + CCRT + Nimo. Patients were divided into 3 subgroups according to the application schedule of Nimo: group A, IC + CCRT; group B: IC (combined with Nimo) + CCRT; and group C: IC + CCRT (combined with Nimo). The 5-year overall survival (OS) and progression-free survival (PFS) and adverse events were investigated.ResultsWith a median follow-up of 61.4 months (range: 1.7–96.5 months), the 5-year OS and PFS for group A vs. groups B + C were 74.8 ±4.1% versus 87.0 ±4.6% (p = 0.043) and 72.7 ±4.3% vs. 83.1 ± 5.1% (p = 0.243), respectively. The 5-year OS of group B was significantly improved over that of group A (93.0 ±4.8% vs. 74.8 ±4.1%, p = 0.038); however, there was no benefit to the 5-year PFS (89.3 ±5.9% vs. 72.7 ±4.3%, p = 0.144). The 5-year OS and PFS for group C were 80.4 ±7.9% and 76.4 ±8.5%, respectively, and there was no statistically significant difference from group A (p = 0.257 and p = 0.611, respectively). No significant increase in toxicities was observed with the addition of Nimo.ConclusionsNimo administered with chemoradiotherapy is effective for NPC. Nimo concurrent with IC followed by CCRT could be the optimal mode of sequential treatment.