Establishing workflow for locoregionally advanced nasopharyngeal carcinoma (NPC) patients undergoing induction chemotherapy (IC) prior to radiation therapy (RT)

Abstract

Purpose: Treatment management for locoregionally advanced nasopharyngeal carcinoma (NPC) patients involves concurrent radiation therapy (RT) and chemotherapy. Phase III clinical trial by Sun Yat-sen University Cancer Center, introduced Gemcitabine (Gem) and Cisplatin (Cis) as induction chemotherapy (IC) regime prior to concurrent chemo-radiotherapy (CCRT). This study reported 3-year recurrence-free survival of 85.3% in IC followed by CCRT, which corresponded to 4.3% higher overall survival at 3 years among IC group compared to standard therapy group. In July 2019, IC GemCis followed by CCRT was adopted as standard of care for locoregionally advanced NPC patients in National Cancer Centre Singapore (NCCS), Department of Radiation Oncology (DRO). To enable prompt referral of patients back to DRO for CCRT, new workflow was established.Methods: Since July 2019, >120 NPC patients were included in the pathway of IC and CCRT. Their journey through IC cycles were tracked as part of the newly established workflow and DRO bookings were made between second and third cycles of IC regime. Besides, their original shells were kept to replicate the original position and head tilt of pre- and post- IC.Results: IC NPC patients experienced a prompt referral back to DRO due to precise tracking of patients’ IC journey. The established workflow was found to be robust and beneficial in preventing prolonged delay to facilitate the timely commencement of CCRT. The original shell that helped to replicate the original position allows optimized delineation of gross tumor volume (GTV) post-IC, reduce workload for re-making shell and saves money plus resources.Conclusion: With the success of this robust workflow, valuable database could be obtained to enable future studies. Moving forward, analysis of Epstein-Barr virus (EBV) load, pre- and post-IC GTV, along with evaluation of dosimetric impact on surrounding organs at risk (OARs) will be investigated. Purpose: Treatment management for locoregionally advanced nasopharyngeal carcinoma (NPC) patients involves concurrent radiation therapy (RT) and chemotherapy. Phase III clinical trial by Sun Yat-sen University Cancer Center, introduced Gemcitabine (Gem) and Cisplatin (Cis) as induction chemotherapy (IC) regime prior to concurrent chemo-radiotherapy (CCRT). This study reported 3-year recurrence-free survival of 85.3% in IC followed by CCRT, which corresponded to 4.3% higher overall survival at 3 years among IC group compared to standard therapy group. In July 2019, IC GemCis followed by CCRT was adopted as standard of care for locoregionally advanced NPC patients in National Cancer Centre Singapore (NCCS), Department of Radiation Oncology (DRO). To enable prompt referral of patients back to DRO for CCRT, new workflow was established. Methods: Since July 2019, >120 NPC patients were included in the pathway of IC and CCRT. Their journey through IC cycles were tracked as part of the newly established workflow and DRO bookings were made between second and third cycles of IC regime. Besides, their original shells were kept to replicate the original position and head tilt of pre- and post- IC. Results: IC NPC patients experienced a prompt referral back to DRO due to precise tracking of patients’ IC journey. The established workflow was found to be robust and beneficial in preventing prolonged delay to facilitate the timely commencement of CCRT. The original shell that helped to replicate the original position allows optimized delineation of gross tumor volume (GTV) post-IC, reduce workload for re-making shell and saves money plus resources. Conclusion: With the success of this robust workflow, valuable database could be obtained to enable future studies. Moving forward, analysis of Epstein-Barr virus (EBV) load, pre- and post-IC GTV, along with evaluation of dosimetric impact on surrounding organs at risk (OARs) will be investigated.