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Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: A Study Based on EBV DNA.

Abstract

BACKGROUND

The goal of this study was to explore the value of adding neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy (ACT) to concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC) with different risks of treatment failure.

PATIENTS AND METHODS

A total of 2,263 eligible patients with stage III-IVb NPC treated with CCRT ± NACT or ACT were included in this retrospective study. Distant metastasis-free survival (DMFS), overall survival, and progression-free survival were calculated using the Kaplan-Meier method and differences were compared using the log-rank test.

RESULTS

Patients in the low-risk group (stage N0-1 disease and Epstein-Barr virus [EBV] DNA <4,000 copies/mL) who received NACT followed by CCRT achieved significantly better 5-year DMFS than those treated with CCRT alone (96.2% vs 91.3%; P= .008). Multivariate analyses also demonstrated that additional NACT was the only independent prognostic factor for DMFS (hazard ratio, 0.42; 95% CI, 0.22-0.80; P=.009). In both the intermediate-risk group (stage N0-1 disease and EBV DNA ≥4,000 copies/mL and stage N2-3 disease and EBV DNA <4,000 copies/mL) and the high-risk group (stage N2-3 disease and EBV DNA ≥4,000 copies/mL), comparison of NACT or ACT + CCRT versus CCRT alone indicated no significantly better survival for all end points.

CONCLUSIONS

The addition of NACT to CCRT could reduce distant failure in patients with low risk of treatment failure.

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  • Authors+Show Affiliations

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. cGood Clinical Practice Center.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. dDepartment of Molecular Diagnostics, and.

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    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. eDepartment of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

    ,

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. eDepartment of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

    aState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. bDepartment of Nasopharyngeal Carcinoma.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31200353

    Citation

    Liu, Li-Ting, et al. "Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: a Study Based On EBV DNA." Journal of the National Comprehensive Cancer Network : JNCCN, vol. 17, no. 6, 2019, pp. 703-710.
    Liu LT, Chen QY, Tang LQ, et al. Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: A Study Based on EBV DNA. J Natl Compr Canc Netw. 2019;17(6):703-710.
    Liu, L. T., Chen, Q. Y., Tang, L. Q., Guo, S. S., Guo, L., Mo, H. Y., ... Mai, H. Q. (2019). Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: A Study Based on EBV DNA. Journal of the National Comprehensive Cancer Network : JNCCN, 17(6), pp. 703-710. doi:10.6004/jnccn.2018.7270.
    Liu LT, et al. Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: a Study Based On EBV DNA. J Natl Compr Canc Netw. 2019 Jun 1;17(6):703-710. PubMed PMID: 31200353.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: A Study Based on EBV DNA. AU - Liu,Li-Ting, AU - Chen,Qiu-Yan, AU - Tang,Lin-Quan, AU - Guo,Shan-Shan, AU - Guo,Ling, AU - Mo,Hao-Yuan, AU - Li,Yang, AU - Tang,Qing-Nan, AU - Sun,Xue-Song, AU - Liang,Yu-Jing, AU - Zhao,Chong, AU - Guo,Xiang, AU - Qian,Chao-Nan, AU - Zeng,Mu-Sheng, AU - Bei,Jin-Xin, AU - Hong,Ming-Huang, AU - Shao,Jian-Yong, AU - Sun,Ying, AU - Ma,Jun, AU - Mai,Hai-Qiang, PY - 2018/08/26/received PY - 2019/01/07/accepted PY - 2019/6/15/entrez PY - 2019/6/15/pubmed PY - 2019/6/15/medline SP - 703 EP - 710 JF - Journal of the National Comprehensive Cancer Network : JNCCN JO - J Natl Compr Canc Netw VL - 17 IS - 6 N2 - BACKGROUND: The goal of this study was to explore the value of adding neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy (ACT) to concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC) with different risks of treatment failure. PATIENTS AND METHODS: A total of 2,263 eligible patients with stage III-IVb NPC treated with CCRT ± NACT or ACT were included in this retrospective study. Distant metastasis-free survival (DMFS), overall survival, and progression-free survival were calculated using the Kaplan-Meier method and differences were compared using the log-rank test. RESULTS: Patients in the low-risk group (stage N0-1 disease and Epstein-Barr virus [EBV] DNA <4,000 copies/mL) who received NACT followed by CCRT achieved significantly better 5-year DMFS than those treated with CCRT alone (96.2% vs 91.3%; P= .008). Multivariate analyses also demonstrated that additional NACT was the only independent prognostic factor for DMFS (hazard ratio, 0.42; 95% CI, 0.22-0.80; P=.009). In both the intermediate-risk group (stage N0-1 disease and EBV DNA ≥4,000 copies/mL and stage N2-3 disease and EBV DNA <4,000 copies/mL) and the high-risk group (stage N2-3 disease and EBV DNA ≥4,000 copies/mL), comparison of NACT or ACT + CCRT versus CCRT alone indicated no significantly better survival for all end points. CONCLUSIONS: The addition of NACT to CCRT could reduce distant failure in patients with low risk of treatment failure. SN - 1540-1413 UR - https://www.unboundmedicine.com/medline/citation/31200353/Neoadjuvant_or_Adjuvant_Chemotherapy_Plus_Concurrent_CRT_Versus_Concurrent_CRT_Alone_in_the_Treatment_of_Nasopharyngeal_Carcinoma:_A_Study_Based_on_EBV_DNA L2 - https://jnccn.org/doi/10.6004/jnccn.2018.7270 DB - PRIME DP - Unbound Medicine ER -