Abstract
BackgroundThe impact of cumulative dose of cisplatin on clinical outcomes of nasopharyngeal carcinoma (NPC) patients who received intensity-modulated radiotherapy (IMRT) was evaluated.MethodsThis study included 491 consecutive patients with histologically confirmed NPC who were treated with concurrent chemoradiotherapy with IMRT. The patients were divided into three groups: low- (cumulative dose ≤100 mg/m2), medium- (cumulative dose >100 mg/m2 and ≤200 mg/m2), and high- (cumulative dose >200 mg/m2) dose groups. Subgroups of patients included pre-treatment levels of Epstein–Barr Virus DNA (EBV DNA) <4000 copies/ml and pre-treatment EBV DNA ≥4000 copies/ml. To test for independent significance, the Kaplan–Meier with the log–rank test and the Cox proportional hazards model were used.ResultsThe 5-year overall survival (OS) rates of the low-, medium-, and high-dose groups were 64.1 %, 91.1 %, and 89.4 %, respectively (P = 0.002). Based on multivariate analysis, patients who were in the medium- and high-dose groups had compared with the low-dose group, with an odds ratio of 0.135 (95 % CI 0.045–0.405, P < 0.001) and 0.225 (95 % CI 0.069–0.734, P = 0.013), respectively. For the low-risk patients, the cumulative dose of cisplatin significantly associated with a lower OS (P < 0.001). The medium-dose group had reduced odds of death compared with the low-dose group, with an odds ratio of 0.062 (95 % CI 0.001–0.347, P = 0.002), according to multivariate analysis.ConclusionsThe cumulative dose of cisplatin is associated with OS and distant metastasis-free survival (DMFS) among NPC patients who received IMRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1964-8) contains supplementary material, which is available to authorized users.
Highlights
The impact of cumulative dose of cisplatin on clinical outcomes of nasopharyngeal carcinoma (NPC) patients who received intensity-modulated radiotherapy (IMRT) was evaluated
Patients with a N3 stage and Epstein–Barr virus (EBV) Epstein– Barr virus deoxyribonucleic acid (DNA) ≥4000 copies/ml had an increased odd of death, with odds ratios of 7.404 and 4.953, respectively
This study showed that cumulative cisplatin >200 mg/m2 improved the 5-year PFS rates and significantly improved distant failure-free survival compared with cumulative cisplatin of ≤200 mg/m2 in 214 NPC patients [13]
Summary
The impact of cumulative dose of cisplatin on clinical outcomes of nasopharyngeal carcinoma (NPC) patients who received intensity-modulated radiotherapy (IMRT) was evaluated. The dose intensity of chemotherapy administered during radiotherapy has been shown to have prognostic significance in NPC treatment, but these associations were mostly based on conventional two-dimensional (2D) and three-dimensional conformal techniques [12,13,14]. With the development of radiation techniques, there is little controversy that intensity-modulated radiotherapy (IMRT) is preferred for the treatment of NPC, if resources permit; dosimetric studies have shown that this procedure could improve dose conformity for complex tumour targets and improve the protection of adjacent organs. It is of great importance to identify the optimal cumulative dose of cisplatin for concurrent chemoradiotherapy (CCRT) in patients with NPC who receive IMRT
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