Abstract
The prognostic value of plasma Epstein-Barr virus (EBV) DNA remains unknown in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). We retrospectively reviewed medical records of 584 newly diagnosed patients with nonmetastatic and biopsy-proven NPC treated using IMRT. Plasma EBV DNA concentration was measured before therapy (pre-DNA) and within 1 month of completing therapy (post-DNA) using real-time quantitative polymerase chain reaction. Receiver operating characteristic (ROC) curves were generated to identify pre-DNA and post-DNA cut-off values. Prognostic value was assessed using a multivariate Cox proportional hazards model .Three-year disease-free survival (DFS), overall survival (OS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free (DMFS) for pre-DNA >2010 vs.≤2010 were 78.1% vs. 93.6% (P < 0.001), 92.3% vs. 98.9% (P < 0.001), 90.9% vs. 96.6% (P = 0.004) and 85.5% vs. 96.6% (P < 0.001), respectively. Three-year DFS, OS, LRRFS and DMFS for post-DNA >0 vs. = 0 were 49.9% vs. 88.5% (P < 0.001), 72.1% vs. 97.5% (P < 0.001), 86.6% vs. 94.3% (P = 0.019), and 60.5% vs. 93.3% (P < 0.001), respectively. Plasma EBV DNA remains a prognostic factor in IMRT era and should be incorporated into TNM staging to guide individualized treatment strategies in NPC.
Highlights
In recent years, intensity-modulated radiation therapy (IMRT) has gradually replaced 2D-CRT as the primary radiotherapy technique
There is no data on the prognostic value of the pre-treatment EBV DNA concentration and plasma EBV DNA concentration at the first evaluation after radiotherapy in patients with Nasopharyngeal carcinoma (NPC) treated with IMRT
The current study is the first assessment of the prognostic value of pre-treatment EBV DNA (pre-DNA) and post-DNA in a large cohort of patients with non-metastatic NPC treated with IMRT, and demonstrates that both pre-DNA and post-DNA are significant prognostic factors in patients with non-metastatic NPC receiving IMRT
Summary
Intensity-modulated radiation therapy (IMRT) has gradually replaced 2D-CRT as the primary radiotherapy technique. IMRT has an improved tumour target conformity and radiobiological efficacy, which leads to superior disease control and a lower treatment toxicity profile[9]. The relationship between the plasma EBV DNA concentration and the prognosis of patients with NPC treated with IMRT. There is no data on the prognostic value of the pre-treatment EBV DNA (pre-DNA) concentration and plasma EBV DNA concentration at the first evaluation after radiotherapy (within 1 month; post-DNA) in patients with NPC treated with IMRT. On the basis of this premise, we conducted a retrospective study to explore the long-term prognostic impact of pre-DNA and post-DNA on the outcome of patients with NPC undergoing modern radiotherapy treatment
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