Cancer Research and Treatment

Original Articles

The Effect of Hospital Case Volume on Clinical Outcomes in Patients with Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Analysis (KROG-1106): Boram Ha, Kwan Ho Cho, Sung Ho Moon, Chang-Geol Lee, Ki Chang Keum, Yeon-Sil Kim, Hong-Gyun Wu, Jin Ho Kim, Yong Chan Ahn, Dongryul Oh, Jae Myoung Noh, Jong Hoon Lee, Sung Hwan Kim, Won Taek Kim, Young-Taek Oh, Min Kyu Kang, Jin Hee Kim, Ji-Yoon Kim, Moon-June Cho, Chul Seoung Kay, Jin Hwa Choi; Cancer Res Treat. 2019;51(1):12-23. Published online February 5, 2018; DOI: https://doi.org/10.4143/crt.2017.273

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Purpose
The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC).
Materials and Methods
Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS).
Results
At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170).
Conclusion
A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.

Citations

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Accumulated Dose Deviation of Rotational and Residual Setup Errors on Nasopharyngeal Carcinoma Using MIM Treated by Helical Tomotherapy
Wenyan Yao, Jiang Hu, Peixun Xu, Mengxue He, Yongwen Fang, Mingzhi Liu, Zongtai Li, Huilang He, Hui Liu, Wenzhao Sun, Senkui Xu
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef
Systematic Review and Meta-analysis of the Association Between Radiation Therapy Treatment Volume and Patient Outcomes
Jerry Ye Aung Kyaw, Alice Rendall, Erin F. Gillespie, Tom Roques, Laurence Court, Yolande Lievens, Alison C. Tree, Chris Frampton, Ajay Aggarwal
International Journal of Radiation Oncology*Biology*Physics.2023; 117(5): 1063. CrossRef
The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature
Stephanie Flukes, Rahul K. Sharma, Shivangi Lohia, Marc A. Cohen
Journal of Neurological Surgery Part B: Skull Base.2022; 83(03): 270. CrossRef
A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma
Khodayar Goshtasbi, Brandon M. Lehrich, Jack L. Birkenbeuel, Arash Abiri, Jeremy P. Harris, Edward C. Kuan
Otolaryngology–Head and Neck Surgery.2021; 165(1): 93. CrossRef
Hospital volume and physician volume in association with survival in patients with nasopharyngeal cancer after radiation therapy
Tzu-Yu Lai, Chiu-Mei Yeh, Yu-Wen Hu, Chia-Jen Liu
Radiotherapy and Oncology.2020; 151: 190. CrossRef

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The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis: Jin Ho Song, Hong-Gyun Wu, Bhum Suk Keam, Jeong Hun Hah, Yong Chan Ahn, Dongryul Oh, Jae Myoung Noh, Hyo Jung Park, Chang Geol Lee, Ki Chang Keum, Jihye Cha, Kwan Ho Cho, Sung Ho Moon, Ji-Yoon Kim, Woong-Ki Chung, Young Taek Oh, Won Taek Kim, Moon-June Cho, Chul Seung Kay, Yeon-Sil Kim; Cancer Res Treat. 2016;48(3):917-927. Published online December 28, 2015; DOI: https://doi.org/10.4143/crt.2015.265

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Purpose
We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). Materials and Methods A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed.
Results
After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). Conclusion This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.

Citations

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Age is a significant biomarker for the selection of neoadjuvant chemotherapy plus radiotherapy versus concurrent chemoradiotherapy in patients with advanced nasopharyngeal carcinoma
Yihong Lin, Xiongbin Yu, Linbin Lu, Hong Chen, Junxian Wu, Yaying Chen, Qin Lin, Xuewen Wang, Xi Chen, Xiong Chen
Cancer Biomarkers.2023; 37(1): 1. CrossRef
Effect of Induction Chemotherapy in Nasopharyngeal Carcinoma: An Updated Meta-Analysis
Shan-Shan Yang, Jian-Gui Guo, Jia-Ni Liu, Zhi-Qiao Liu, En-Ni Chen, Chun-Yan Chen, Pu-Yun OuYang, Fei Han, Fang-Yun Xie
Frontiers in Oncology.2021;[Epub] CrossRef
Concurrent chemoradiotherapy with additional chemotherapy for nasopharyngeal carcinoma: A pooled analysis of propensity score‐matching studies
Minmin Li, Bin Zhang, Qiuying Chen, Lu Zhang, Xiaokai Mo, Zhuozhi Chen, Zhe Jin, Luyan Chen, Jingjing You, Shuixing Zhang
Head & Neck.2021; 43(6): 1912. CrossRef
Longitudinal Assessment of Intravoxel Incoherent Motion Diffusion Weighted Imaging in Evaluating the Radio-sensitivity of Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiation Therapy
Youping Xiao, Ying Chen, Yunbin Chen, Zhuangzhen He, Yiqi Yao, Jianji Pan
Cancer Research and Treatment.2019; 51(1): 345. CrossRef
Less is more: role of additional chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal cancer management
Yong Chan Ahn
Radiation Oncology Journal.2019; 37(2): 67. CrossRef
A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma
Pu-Yun OuYang, Xiao-Min Zhang, Xing-Sheng Qiu, Zhi-Qiao Liu, Lixia Lu, Yuan-Hong Gao, Fang-Yun Xie
The Oncologist.2019; 24(4): 505. CrossRef
Induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A systematic review and meta-analysis
Teng Hwee Tan, Yu Yang Soon, Timothy Cheo, Francis Ho, Lea Choung Wong, Jeremy Tey, Ivan W.K. Tham
Radiotherapy and Oncology.2018; 129(1): 10. CrossRef
Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma
Jiraporn Setakornnukul, Kullathorn Thephamongkhol
BMC Cancer.2018;[Epub] CrossRef
TPF induction chemotherapy followed by concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: Long term results of a Tunisian series
N. Toumi, W. Ben Kridis, W. Mnejja, R. Bouzguenda, A. Khanfir, A. Ghorbel, J. Daoud, M. Frikha
Cancer/Radiothérapie.2018; 22(3): 216. CrossRef
Does concurrent chemoradiotherapy preceded by chemotherapy improve survival in locally advanced nasopharyngeal cancer patients? Experience from Ghana
Joel Yarney, Naa A. Aryeetey, Alice Mensah, Emmanuel D. Kitcher, Verna Vanderpuye, Charles Aidoo, Kenneth Baidoo
Cancers of the Head & Neck.2017;[Epub] CrossRef
Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in nasopharyngeal carcinoma patients with cervical nodal necrosis
Mei Lan, Chunyan Chen, Ying Huang, Li Tian, Zhijun Duan, Fei Han, Junfang Liao, Meiling Deng, Terence T. Sio, Anussara Prayongrat, Lie Zheng, Shaoxiong Wu, Taixiang Lu
Scientific Reports.2017;[Epub] CrossRef
A retrospective paired study: efficacy and toxicity of nimotuzumab versus cisplatin concurrent with radiotherapy in nasopharyngeal carcinoma
H. M. Li, P. Li, Y. J. Qian, X. Wu, L. Xie, F. Wang, H. Zhang, L. Liu
BMC Cancer.2016;[Epub] CrossRef

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Analysis of the Prognostic Factors for Distant Metastasis after Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Head and Neck Cancer: Dong Hyun Kim, Won Taek Kim, Joo Hye Lee, Yong Kan Ki, Ji Ho Nam, Byung Joo Lee, Jin Choon Lee, Young Jin Choi, Young Mi Seol, Dong Won Kim; Cancer Res Treat. 2015;47(1):46-54. Published online August 25, 2014; DOI: https://doi.org/10.4143/crt.2013.212

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Purpose
The aim of this study is to identify the prognostic factors of distant metastasis (DM) after induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CRT) for locoregionally advanced head and neck cancer (HNC). Materials and Methods A total of 321 patients with HNC who underwent IC followed by CRT treated between January 2005 and December 2010 were analyzed retrospectively. IC consisted of three courses of docetaxel (70 mg/m2) and cisplatin (75 mg/m2) every three weeks, followed by radiotherapy of 66-70 Gy/2 Gy per fraction/5 fractions per week concurrent with weekly cisplatin (40 mg/m2). Tumor/nodal stage, primary site, tumor differentiation, lower neck node involvement (level IV, VB, and supraclavicular regions), number of concurrent chemotherapy cycles, overall duration of radiotherapy, and response to IC were assessed as potential prognostic factors influencing DM and survival outcome. Results The five-year loco-regional recurrence and DM rates were 23.6% and 18.2%. N stage, overall duration of radiotherapy, lower neck node involvement, and response to IC were significant factors for DM. With a median follow-up period of 52 months (range, 4 to 83 months), the 5-year progression-free, DM-free, and overall survival rates were 41.2%, 50.7%, and 55.1%, respectively. Lower neck node involvement (p=0.008) and poor response to IC (p < 0.001) showed an association with significantly inferior DM-free survival. Conclusion Even with the addition of IC, the DM rate and survival outcome were poor when metastatic lower neck lymph nodes were present or when patients failed to respond after receiving IC.

Citations

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Abhenil Mittal, Atul Sharma
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Journal of Cancer Research and Clinical Oncology.2021; 147(3): 803. CrossRef
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Sajid Durrani, Saleh Al-Dhahari, Haneen Sebeih, Tariq Wani, Khalid Al Qahatani, Humariya Heena
Population Medicine.2020;[Epub] CrossRef
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Simon Keek, Sebastian Sanduleanu, Frederik Wesseling, Reinout de Roest, Michiel van den Brekel, Martijn van der Heijden, Conchita Vens, Calareso Giuseppina, Lisa Licitra, Kathrin Scheckenbach, Marije Vergeer, C. René Leemans, Ruud H Brakenhoff, Irene Naut
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Induction chemotherapy for locally advanced laryngeal and hypopharyngeal cancer: Single institution experience
Or Dagan, Assaf Moore, Yuval Nachalon, Uri Alkan, Ameen Biadsee, Isaac Shochat, Aron Popovtzer
Head & Neck.2020; 42(11): 3118. CrossRef
Meta‐analysis of induction chemotherapy as a selection marker for chemoradiation in the head and neck
Kimberley L. Kiong, Nurun Nisa de Souza, Rehena Sultana, N. Gopalakrishna Iyer
The Laryngoscope.2018; 128(7): 1594. CrossRef
Induction chemotherapy in locally advanced squamous cell carcinoma of the head and neck: role, controversy, and future directions
R.I. Haddad, M. Posner, R. Hitt, E.E.W. Cohen, J. Schulten, J.-L. Lefebvre, J.B. Vermorken
Annals of Oncology.2018; 29(5): 1130. CrossRef
Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma: A Question of Belief
Andy Karabajakian, Max Gau, Thibault Reverdy, Eve-Marie Neidhardt, Jérôme Fayette
Cancers.2018; 11(1): 15. CrossRef
Revisiting Induction Chemotherapy Before Radiotherapy for Head and Neck Cancer, Part I: Carcinoma of Non-Nasopharyngeal Sites
Christopher H Chapman, Upendra Parvathaneni, Sue S Yom
Future Oncology.2017; 13(6): 469. CrossRef
Predictors of Distant Metastasis after Radical Surgery Followed by Postoperative Radiotherapy with or without Chemotherapy for Oropharyngeal Cancer
Mi Joo Chung, Yeon Sil Kim, Ji Yoon Kim, Yun Hee Lee, Ji Hyun Jang, Jin Hyoung Kang, Ie Ryung Yoo, Youn Soo Lee
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J.F. Carrillo, L.C. Carrillo, M.C. Ramirez-Ortega, F.J. Ochoa-Carrillo, L.F. Oñate-Ocaña
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Higher positive lymph node ratio indicates poorer distant metastasis–free survival in adenoid cystic carcinoma patients with nodal involvement
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