Cancer Research and Treatment

Original Articles

Head and Neck cancer

Long-term Survivals, Toxicities and the Role of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiation Therapy: A Retrospective Study with 15-Year Follow-up: Lin Wang, Jingjing Miao, Huageng Huang, Boyu Chen, Xiao Xiao, Manyi Zhu, Yingshan Liang, Weiwei Xiao, Shaomin Huang, Yinglin Peng, Xiaowu Deng, Xing Lv, Weixiong Xia, Yanqun Xiang, Xiang Guo, Fei Han, Chong Zhao; Cancer Res Treat. 2022;54(1):118-129. Published online June 7, 2021; DOI: https://doi.org/10.4143/crt.2021.101

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Purpose
This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients.
Materials and Methods
Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010.
Results
With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group.
Conclusion
Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

Citations

Citations to this article as recorded by

Radiation oncology for the rhinologist
Helena Levyn, Fan Yang, Nancy Y. Lee
Current Opinion in Otolaryngology & Head & Neck Surgery.2024; 32(1): 5. CrossRef
Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey
Victor C. W. Tam, Jerry C. F. Ching, Sindy S. T. Yip, Virginia H. Y. Kwong, Catherine P. L. Chan, Kenneth C. W. Wong, Shara W. Y. Lee
Frontiers in Oncology.2024;[Epub] CrossRef
Multifactorial clinical analysis of factors affecting necrosis of nasal septal mucosal flap after salvage surgery for recurrent nasopharyngeal carcinoma
Qilin Gong, Huaying Li, Hui Liu, Youyuan Shi
Scientific Reports.2024;[Epub] CrossRef
Long noncoding RNA LINC00173 induces radioresistance in nasopharyngeal carcinoma via inhibiting CHK2/P53 pathway
Jingjing Miao, Boyu Chen, Yunyun Xiao, Runda Huang, Xiao Xiao, Shunzhen Lu, Lu Zhang, Xuguang Wang, Ying Ouyang, Xiangfu Chen, Qiuyan Chen, Yanqun Xiang, Xiang Guo, Xiaowu Deng, Lin Wang, Haiqiang Mai, Chong Zhao
Cancer Gene Therapy.2023; 30(9): 1249. CrossRef
Therapeutic hyperthermia regulates complement C3 activation and suppresses tumor development through HSPA5/NFκB/CD55 pathway in nasopharyngeal carcinoma
Chengcong Chen, Anbang Ren, Qi Yi, Jiazuo Cai, Muhammad Khan, Yunen Lin, Zhong Huang, Jie Lin, Jian Zhang, Wei Liu, Anan Xu, Yunhong Tian, YaWei Yuan, Ronghui Zheng
Clinical and Experimental Immunology.2023; 213(2): 221. CrossRef
Immunotherapy for nasopharyngeal carcinoma: Current status and prospects (Review)
Huageng Huang, Yuyi Yao, Xinyi Deng, Zongyao Huang, Yungchang Chen, Zhao Wang, Huangming Hong, He Huang, Tongyu Lin
International Journal of Oncology.2023;[Epub] CrossRef
Quality of life and swallowing outcomes after early proactive swallowing rehabilitation by either transcutaneous neuromuscular electrical stimulation or exercise‐based swallowing training in patients with nasopharyngeal carcinoma after radiotherapy
Peter K. M. Ku, Alexander C. Vlantis, Rita W. M. Wong, Thomas S. C. Hui, Thomas Law, Louisa K. Y. Ng, Eddy W. Y. Wong, W. T. Chang, David R. Johnson, Florence S. T. Mok, K. H. Wong, Victor Abdullah, Andrew van Hasselt, Kathy Y. S. Lee, Michael C. F. Tong
Laryngoscope Investigative Otolaryngology.2023; 8(6): 1532. CrossRef
Prognostic nutritional index and serum lactate dehydrogenase predict the prognosis of nasopharyngeal carcinoma patients who received intensity-modulated radiation therapy
Chunxia Zhang, Zhouwei Zhan, Yunxiang Fang, Yuanyuan Ruan, Mingan Lin, Zhisen Dai, Yanping Zhang, Shanshan Yang, Shuxiang Xiao, Bijuan Chen
Journal of Cancer Research and Clinical Oncology.2023; 149(20): 17795. CrossRef
A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma
Yao-Can Xu, Kai-Hua Chen, Zhong-Guo Liang, Xiao-Dong Zhu
Frontiers in Oncology.2022;[Epub] CrossRef
Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma
Jinping Liu, Zesheng Zeng, Dingting Wang, Gang Qin
Journal of Craniofacial Surgery.2022; 33(8): e834. CrossRef
External Validation of a Nomogram to Predict Survival and Benefit of Concurrent Chemoradiation for Stage II Nasopharyngeal Carcinoma
Pui-Lam Yip, Shing-Fung Lee, Cheuk-Wai Horace Choi, Po-Chung Sunny Chan, Ka-Wai Alice Cheung, Chung-Hang James Chow, Ka-Man Cheung, Wing-Yu Jessica Lai, Ho-Fun Victor Lee, Ka-On Lam, Chi-Leung Chiang, Chun-Yin Edwin Wong, Ming-Chun Darren Poon, Macy Tong,
Cancers.2021; 13(17): 4286. CrossRef

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Combination of Tumor Volume and Epstein-Barr Virus DNA Improved Prognostic Stratification of Stage II Nasopharyngeal Carcinoma in the Intensity Modulated Radiotherapy Era: A Large-Scale Cohort Study: Qiu-Yan Chen, Shao-Yan Guo, Lin-Quan Tang, Tong-Yu Lu, Bo-Lin Chen, Qi-Yu Zhong, Meng-Sha Zou, Qing-Nan Tang, Wen-Hui Chen, Shan-Shan Guo, Li-Ting Liu, Yang Li, Ling Guo, Hao-Yuan Mo, Rui Sun, Dong-Hua Luo, Chong Zhao, Ka-Jia Cao, Chao-Nan Qian, Xiang Guo, Mu-Sheng Zeng, Hai-Qiang Mai; Cancer Res Treat. 2018;50(3):861-871. Published online September 13, 2017; DOI: https://doi.org/10.4143/crt.2017.237

Abstract PDF Supplementary Material PubReader ePub

Purpose
Little is known about combination of the circulating Epstein-Barr viral (EBV) DNA and tumor volume in prognosis of stage II nasopharyngeal carcinoma (NPC) patients in the intensity modulated radiotherapy (IMRT) era. We conducted this cohort study to evaluate the prognostic values of combining these two factors.
Materials and Methods
By Kaplan-Meier, we compare the differences of survival curves between 385 patients with different EBV DNA or tumor volume levels, or with the combination of two biomarkers mentioned above.
Results
Gross tumor volume of cervical lymph nodes (GTVnd, p < 0.001) and total tumor volume (GTVtotal, p < 0.001) were both closely related to pretreatment EBV DNA, while gross tumor volume of nasopharynx (GTVnx, p=0.047) was weakly related to EBV DNA. EBV DNA was significantly correlated with progress-free survival (PFS, p=0.005), locoregional-free survival (LRFS, p=0.039), and distant metastasis-free survival (DMFS, p=0.017), while GTVtotal, regardless of GTVnx and GTVnd, had a significant correlation with PFS and LRFS. The p-values of GTVtotal for PFS and LRFS were 0.008 and 0.001, respectively. According to GTVtotal and pretreatment EBV DNA level, patients were divided into a low-risk group (EBV DNA 0 copy/mL, GTVtotal < 30 cm3; EBV DNA 0 copy/mL, GTVtotal ≥ 30 cm3; or EBV DNA > 0 copy/mL, GTVtotal < 30 cm3) and a high-risk group (EBV DNA > 0 copy/mL, GTVtotal ≥ 30 cm3). When patients in the low-risk group were compared with those in the high-risk group, 3-year PFS (p=0.003), LRFS (p=0.010), and DMFS (p=0.031) rates were statistically significant.
Conclusion
Pretreatment plasma EBV DNA and tumor volume were both closely correlated with prognosis of stage II NPC patients in the IMRT era. Combination of EBV DNA and tumor volume can refine prognosis and indicate for clinical therapy.

Citations

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Pretreatment Serum Amyloid A and C-reactive Protein Comparing with Epstein-Barr Virus DNA as Prognostic Indicators in Patients with Nasopharyngeal Carcinoma: A Prospective Study: Qiu-Yan Chen, Qing-Nan Tang, Lin-Quan Tang, Wen-Hui Chen, Shan-Shan Guo, Li-Ting Liu, Chao-Feng Li, Yang Li, Yu-Jing Liang, Xue-Song Sun, Ling Guo, Hao-Yuan Mo, Rui Sun, Dong-Hua Luo, Yu-Ying Fan, Yan He, Ming-Yuan Chen, Ka-Jia Cao, Chao-Nan Qian, Xiang Guo, Hai-Qiang Mai; Cancer Res Treat. 2018;50(3):701-711. Published online July 14, 2017; DOI: https://doi.org/10.4143/crt.2017.180

Abstract PDF Supplementary Material PubReader ePub

Purpose
The measuring Epstein-Barr virus (EBV) DNA is an important predictor of nasopharyngeal carcinoma (NPC). This study evaluated the predictive value of pretreatment serum amyloid A (SAA) and C-reactive protein (CRP) comparing with EBV DNA in patients with NPC.
Materials and Methods
In an observational study of 419 non-metastatic NPC patients, we prospectively evaluated the prognostic effects of pretreatment SAA, CRP, and EBV DNA on survival. The primary endpoint was progress-free survival (PFS).
Results
The median level of SAA and CRP was 4.28 mg/L and 1.88 mg/L, respectively. For the highSAA group (> 4.28 mg/L) versus the low-SAA (≤ 4.28 mg/L) group and the high-CRP group (> 1.88 mg/L) versus the low-CRP (≤ 1.88 mg/L) group, the 5-year PFS was 64.5% versus 73.1% (p=0.013) and 65.2% versus 73.3% (p=0.064), respectively. EBV DNA detection showed a superior predictive result, the 5-year PFS in the EBV DNA ≥ 1,500 copies/mL group was obviously different than the EBV DNA < 1,500 copies/mL group (62.2% versus 77.8%, p < 0.001). Multifactorial Cox regression analysis confirmed that in the PFS, the independent prognostic factors were including EBV DNA (hazard ratio [HR], 1.788; p=0.009), tumour stage (HR, 1.903; p=0.021), and node stage (HR, 1.498; p=0.049), but the SAA and CRP were not included in the independent prognostic factors.
Conclusion
The results of SAA and CRP had a certain relationship with the prognosis of NPC, and the prognosis of patients with high level of SAA and CRP were poor. However, the predictive ability of SAA and CRP was lower than that of EBV DNA.

Citations

Citations to this article as recorded by

Development and application of a serious adverse events risk model for concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma
Jiahui Li, Qianwen Liu, Huiying Qin
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Selection of induction chemotherapy cycles for stage N3 nasopharyngeal carcinoma based on pre-treatment plasma EBV DNA
Youliang Weng, Sunqin Cai, Chao Li, Yun Xu, Yuhui Pan, Zongwei Huang, Ying Li, Zijie Wu, Yu Chen, Sufang Qiu
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Ying Lu, Zhou Jiang, Huan Lin, Hui Yang, Xishan Chen, Haixin Huang
Future Oncology.2022; 18(22): 2441. CrossRef
Long‐term monitoring of dynamic changes in plasma EBV DNA for improved prognosis prediction of nasopharyngeal carcinoma
Wanxia Li, Jing Chen, Bijun Liang, Zonghua Li, Junzheng Li, Xiaofei Yuan, Shuting Wu, Fangfang Zeng, Xinyu Peng, Yanfei Li, Juan Lu, Feipeng Zhao, Xiong Liu
Cancer Medicine.2021; 10(3): 883. CrossRef
A systematic review and recommendations on the use of plasma EBV DNA for nasopharyngeal carcinoma
Anne W.M. Lee, Victor H.F. Lee, Wai-Tong Ng, Primož Strojan, Nabil F. Saba, Alessandra Rinaldo, Stefan M. Willems, Juan P. Rodrigo, Arlene A. Forastiere, Alfio Ferlito
European Journal of Cancer.2021; 153: 109. CrossRef
Prognostic value of Epstein–Barr virus DNA level for nasopharyngeal carcinoma: a meta-analysis of 8128 cases
Hongling Qu, Yuli Huang, Shufen Zhao, Yuanqing Zhou, Weibiao Lv
European Archives of Oto-Rhino-Laryngology.2020; 277(1): 9. CrossRef
The prognostic value of integration of pretreatment serum amyloid A (SAA)–EBV DNA (S‐D) grade in patients with nasopharyngeal carcinoma
Jianpei Li, Changchun Lai, Songguo Peng, Hao Chen, Lei Zhou, Yufeng Chen, Shulin Chen
Clinical and Translational Medicine.2020;[Epub] CrossRef
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Teng Xu, Li Wang, Shi Wu, Fenfen Zhou, Haihui Huang
Clinical Infectious Diseases.2020; 71(Supplement): S409. CrossRef
The prognostic value of serum amyloid A in solid tumors: a meta-analysis
Hai-yingjie Lin, Guo-qiang Tan, Yan Liu, Shao-qiang Lin
Cancer Cell International.2019;[Epub] CrossRef
Molecular Prognostic Value of Circulating Epstein–Barr Viral DNA in Nasopharyngeal Carcinoma: A Meta-Analysis of 27,235 Cases in the Endemic Area of Southeast Asia
Xulin Xie, Yupei Ren, Kun Wang, Bin Yi
Genetic Testing and Molecular Biomarkers.2019; 23(7): 448. CrossRef
Rapid detection of quantum dot immune chromatography nasopharyngeal carcinoma EBNA1 antibody
Jian He, Jing Xu, Ping Wu, Lingfeng Liao, Huatao Quan, Jing Kang, Yongquan Tian, Yaoyun Tang
Oncology Letters.2018;[Epub] CrossRef

9,195 View
268 Download
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The Prognostic Value of Treatment-Related Lymphopenia in Nasopharyngeal Carcinoma Patients: Li-Ting Liu, Qiu-Yan Chen, Lin-Quan Tang, Shan-Shan Guo, Ling Guo, Hao-Yuan Mo, Ming-Yuan Chen, Chong Zhao, Xiang Guo, Chao-Nan Qian, Mu-Sheng Zeng, Jin-Xin Bei, Jing Tan, Shuai Chen, Ming-Huang Hong, Jian-Yong Shao, Ying Sun, Jun Ma, Hai-Qiang Mai; Cancer Res Treat. 2018;50(1):19-29. Published online April 5, 2017; DOI: https://doi.org/10.4143/crt.2016.595

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study was conducted to evaluate the prognostic value of treatment-related lymphopenia in patients with nasopharyngeal carcinoma (NPC).
Materials and Methods
A total of 413 consecutive stage II-IVb NPC patients treated with concurrent chemoradiotherapy (CCRT) were enrolled. The overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared using the log-rank test.
Results
A minimum (mini)–absolute lymphocyte counts (ALC) of < 390 cells/μL or ALC after 3 months of CCRT (post3m-ALC) < 705 cells/μL was significantly associated with worse outcome than mini-ALC ≥ 390 cells/μL (OS, p=0.002; PFS, p=0.005; DMFS, p=0.004) or post3m-ALC ≥ 705 cells/μL (OS, p < 0.001; PFS, p < 0.001; DMFS, p=0.001). Patients with lymphopenia (mini-ALC < 390 cells/μL and post3m-ALC < 705 cells/μL) had a worse prognosis than those without lymphopenia (mini-ALC ≥ 390 cells/μL and post3m-ALC ≥ 705 cells/μL) (OS, p < 0.001; PFS, p < 0.001; DMFS, p < 0.001). Multivariate analysis revealed that post3m-ALC was an independent prognostic factor for OS (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.12 to 2.78; p=0.015), PFS (HR, 1.86; 95% CI, 1.23 to 2.82; p=0.003), and DMFS (HR, 1.87; 95% CI, 1.13 to 3.08; p=0.014). Multivariate analysis also revealed that patients with lymphopenia had a high risk of death (HR, 3.79; 95% CI, 1.75 to 8.19; p=0.001), disease progression (HR, 2.93; 95% CI, 1.59 to 5.41; p=0.001), and distant metastasis (HR, 3.89; 95% CI, 1.67 to 9.10; p=0.002). Multivariate analysis performed with time dependent Cox regression demonstrated ALC was an independent prognostic factor for OS (HR, 0.995; 95% CI, 0.991 to 0.999; p=0.025) and PFS (HR, 0.993; 95% CI, 0.988 to 0.998; p=0.006).
Conclusion
Treatment-related lymphopenia was a poor prognostic factor in NPC patients.

Citations

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