Selection and Validation of Chemotherapy Beneficiaries Among Elderly Nasopharyngeal Carcinoma (NPC) Patients Treated with Intensity-modulated Radiation Therapy (IMRT): a Large Real-world Study

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2022 Aug 8

PMID 35941674

Authors

Yan-Ling Wu

Kai-Bin Yang

Ying Huang

Jing-Rong Shi

Qing-Shui He

Lei Chen

Wen-Fei Li

Xiao-Dan Huang

Li Lin

Yu-Pei Chen

Yan-Ping Mao

Ling-Long Tang

Jun Ma

Affiliations

Soon will be listed here.

Abstract

Purpose: Using real-world evidence, this study aimed to identify elderly nasopharyngeal carcinoma (NPC) patients who would benefit from chemotherapy.

Methods And Materials: 1714 elderly NPC patients between April 2007 and December 2017 were identified. Recursive partitioning analysis (RPA) was used to generate risk-stratified outcomes. Prognostic factors were performed for individual comparisons of different risk groups to assess chemotherapy benefits.

Results: The median follow-up was 59.3 (0.39-170.09) months. Epstein Barr virus (EBV) DNA and T stage were included in the RPA-generated risk stratification, categorizing patients into a good-prognosis group (EBV DNA ≤ 4000 copies/mL & T1-2), and a poor-prognosis group (EBV DNA ≤ 4000 copies/mL & T3-4 and EBV DNA > 4000 copies/mL & any T). Overall survival (OS) was significantly higher in the good-prognosis group compared with the training set (HR = 0.309, 95% CI 0.184-0.517; P < 0.001), and validated in the testing set (HR = 0.276, 95% CI 0.113-0.670; P = 0.002). In the poor-prognosis group, a significantly improved OS for chemoradiotherapy (CRT) compared with RT alone was observed (HR = 0.70, 95% CI 0.55-0.88; P = 0.003). Patients who received induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT) and CCRT had a significantly improved OS compared with RT alone (IC + CCRT vs. RT alone: P = 0.002; CCRT vs. RT alone: P = 0.008) but not in the IC + RT group (P = 0.306). The 5-year OS for CRT versus RT-alone with ACE-27 scores of 0, 1 and 2 were 76.0% versus 70.0% (P = 0.014), 80.5% versus 68.2% (P = 0.150) and 58.5% versus 62.2% (P = 0.490), respectively; for those aged 60-64, 65-70 and ≥ 70 years old they were 80.9% versus 75.9% (P = 0.068), 73.3% versus 63.4% (P = 0.270) and 64.8% versus 67.1% (P = 0.820), respectively.

Conclusions: For elderly NPC patients a simple screening cutoff for chemotherapy beneficiaries might be EBV DNA < 4000 copies/ml & T3-4 and EBV DNA ≥ 4000 copies/ml & any T, but not for those > 70 years old and with an ACE-27 score > 1. IC + CCRT and CCRT were effective forms of chemotherapy.

Citing Articles

Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification.

Li Y, Weng Y, Huang Z, Pan Y, Cai S, Ding Q Radiat Oncol. 2023; 18(1):104.

PMID: 37353800 PMC: 10290415. DOI: 10.1186/s13014-023-02272-x.

The role of Epstein-Barr virus in nasopharyngeal carcinoma.

Su Z, Siak P, Leong C, Cheah S Front Microbiol. 2023; 14:1116143.

PMID: 36846758 PMC: 9947861. DOI: 10.3389/fmicb.2023.1116143.

References

Chua D, Ma J, Sham J, Mai H, Choy D, Hong M . Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials. J Clin Oncol. 2005; 23(6):1118-24. DOI: 10.1200/JCO.2005.12.081. View

Tang L, Chen Q, Fan W, Liu H, Zhang L, Guo L . Prospective study of tailoring whole-body dual-modality [18F]fluorodeoxyglucose positron emission tomography/computed tomography with plasma Epstein-Barr virus DNA for detecting distant metastasis in endemic nasopharyngeal carcinoma at initial.... J Clin Oncol. 2013; 31(23):2861-9. DOI: 10.1200/JCO.2012.46.0816. View

Lv J, Chen Y, Huang X, Zhou G, Chen L, Li W . Hepatitis B virus screening and reactivation and management of patients with nasopharyngeal carcinoma: A large-scale, big-data intelligence platform-based analysis from an endemic area. Cancer. 2017; 123(18):3540-3549. DOI: 10.1002/cncr.30775. View

Miao J, Xiao W, Wang L, Han F, Wu H, Deng X . The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy. J Cancer Res Clin Oncol. 2017; 143(7):1263-1273. DOI: 10.1007/s00432-017-2360-3. View

Lin J, Chen K, Wang W, Jan J, Liang W, Tsai C . Detection of Epstein-Barr virus DNA in the peripheral-blood cells of patients with nasopharyngeal carcinoma: relationship to distant metastasis and survival. J Clin Oncol. 2001; 19(10):2607-15. DOI: 10.1200/JCO.2001.19.10.2607. View

Lee V, Kwong D, Leung T, Choi C, OSullivan B, Lam K . The addition of pretreatment plasma Epstein-Barr virus DNA into the eighth edition of nasopharyngeal cancer TNM stage classification. Int J Cancer. 2018; 144(7):1713-1722. DOI: 10.1002/ijc.31856. View

Kim K, Le Q, Yom S, Ng R, Chan K, Bratman S . Clinical Utility of Epstein-Barr Virus DNA Testing in the Treatment of Nasopharyngeal Carcinoma Patients. Int J Radiat Oncol Biol Phys. 2017; 98(5):996-1001. DOI: 10.1016/j.ijrobp.2017.03.018. View

Liu N, Chen N, Cui R, Li W, Li Y, Wei R . Prognostic value of a microRNA signature in nasopharyngeal carcinoma: a microRNA expression analysis. Lancet Oncol. 2012; 13(6):633-41. DOI: 10.1016/S1470-2045(12)70102-X. View

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

10.

Twu C, Wang W, Liang W, Jan J, Jiang R, Chao J . Comparison of the prognostic impact of serum anti-EBV antibody and plasma EBV DNA assays in nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006; 67(1):130-7. DOI: 10.1016/j.ijrobp.2006.07.012. View

11.

Guo R, Tang L, Mao Y, Du X, Chen L, Zhang Z . Proposed modifications and incorporation of plasma Epstein-Barr virus DNA improve the TNM staging system for Epstein-Barr virus-related nasopharyngeal carcinoma. Cancer. 2018; 125(1):79-89. DOI: 10.1002/cncr.31741. View

12.

Lin S, Pan J, Han L, Zhang X, Liao X, Lu J . Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys. 2009; 75(4):1071-8. DOI: 10.1016/j.ijrobp.2008.12.015. View

13.

VanderWalde N, Meyer A, Deal A, Layton J, Liu H, Carpenter W . Effectiveness of chemoradiation for head and neck cancer in an older patient population. Int J Radiat Oncol Biol Phys. 2014; 89(1):30-7. DOI: 10.1016/j.ijrobp.2014.01.053. View

14.

Lee A, Ng W, Chan L, Hung W, Chan C, Sze H . Evolution of treatment for nasopharyngeal cancer--success and setback in the intensity-modulated radiotherapy era. Radiother Oncol. 2014; 110(3):377-84. DOI: 10.1016/j.radonc.2014.02.003. View

15.

Xu C, Chen Y, Liu X, Li W, Chen L, Mao Y . Establishing and applying nomograms based on the 8th edition of the UICC/AJCC staging system to select patients with nasopharyngeal carcinoma who benefit from induction chemotherapy plus concurrent chemoradiotherapy. Oral Oncol. 2017; 69:99-107. DOI: 10.1016/j.oraloncology.2017.04.015. View

16.

OuYang P, Xiao Y, You K, Zhang L, Lan X, Zhang X . Validation and comparison of the 7th and 8th edition of AJCC staging systems for non-metastatic nasopharyngeal carcinoma, and proposed staging systems from Hong Kong, Guangzhou, and Guangxi. Oral Oncol. 2017; 72:65-72. DOI: 10.1016/j.oraloncology.2017.07.011. View

17.

Yancik R . Cancer burden in the aged: an epidemiologic and demographic overview. Cancer. 1997; 80(7):1273-83. View

18.

Yang X, Wang Y, Liang S, He S, Chen D, Chen H . Comparison of the seventh and eighth editions of the UICC/AJCC staging system for nasopharyngeal carcinoma: analysis of 1317 patients treated with intensity-modulated radiotherapy at two centers. BMC Cancer. 2018; 18(1):606. PMC: 5975550. DOI: 10.1186/s12885-018-4419-1. View

19.

Chen Y, Chan A, Le Q, Blanchard P, Sun Y, Ma J . Nasopharyngeal carcinoma. Lancet. 2019; 394(10192):64-80. DOI: 10.1016/S0140-6736(19)30956-0. View

20.

Bray F, Haugen M, Moger T, Tretli S, Aalen O, Grotmol T . Age-incidence curves of nasopharyngeal carcinoma worldwide: bimodality in low-risk populations and aetiologic implications. Cancer Epidemiol Biomarkers Prev. 2008; 17(9):2356-65. DOI: 10.1158/1055-9965.EPI-08-0461. View