Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial
TL;DR: NACT improved tumour control compared with CCRT alone in locoregionally advanced NPC, particularly at distant sites, however, there was no early gain in OS.
About: This article is published in European Journal of Cancer.The article was published on 2017-04-01. It has received 201 citations till now. The article focuses on the topics: Chemoradiotherapy & Nasopharyngeal neoplasm.
Citations
More filters
TL;DR: Deep learning PET/CT-based radiomics could serve as a reliable and powerful tool for prognosis prediction and may act as a potential indicator for individual IC in advanced NPC.
Abstract: Purpose: We aimed to evaluate the value of deep learning on positron emission tomography with computed tomography (PET/CT)–based radiomics for individual induction chemotherapy (IC) in advanced nasopharyngeal carcinoma (NPC). Experimental Design: We constructed radiomics signatures and nomogram for predicting disease-free survival (DFS) based on the extracted features from PET and CT images in a training set (n = 470), and then validated it on a test set (n = 237). Harrell9s concordance indices (C-index) and time-independent receiver operating characteristic (ROC) analysis were applied to evaluate the discriminatory ability of radiomics nomogram, and compare radiomics signatures with plasma Epstein–Barr virus (EBV) DNA. Results: A total of 18 features were selected to construct CT-based and PET-based signatures, which were significantly associated with DFS (P Conclusions: Deep learning PET/CT-based radiomics could serve as a reliable and powerful tool for prognosis prediction and may act as a potential indicator for individual IC in advanced NPC.
193 citations
University of Hong Kong1, Pamela Youde Nethersole Eastern Hospital2, Fujian Medical University3, National University of Singapore4, Samsung Medical Center5, St. Vincent's Health System6, Aarhus University Hospital7, Université catholique de Louvain8, Institute of Cancer Research9, Fudan University10, University Medical Center Groningen11, Stanford University12, Memorial Sloan Kettering Cancer Center13, National Yang-Ming University14, Sun Yat-sen University15, University of Florida16, Princess Margaret Cancer Centre17, Acıbadem University18, Peter MacCallum Cancer Centre19, University of Texas MD Anderson Cancer Center20, Institut Gustave Roussy21, University of California, San Francisco22
TL;DR: A set of consensus guidelines has been developed to provide a practical reference for appropriate contouring to ensure optimal target coverage in nasopharyngeal carcinoma, based on optimal geometric expansion and anatomical editing for those structures with substantial risk of microscopic infiltration.
185 citations
TL;DR: Long‐term follow‐up confirmed that TPF IC plus CCRT significantly improved survival in locoregionally advanced NPC with no marked increase in late toxicities and could be an option of treatment for these patients.
Abstract: To report long-term results of a randomized controlled trial that compared cisplatin/fluorouracil/docetaxel (TPF) induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma (NPC). Patients with stage III-IVB (except T3-4 N0) NPC were randomly assigned to receive IC plus CCRT (n = 241) or CCRT alone (n = 239). IC included three cycles of docetaxel (60 mg/m2 d1), cisplatin (60 mg/m2 d1), and fluorouracil (600 mg/m2 /d civ d1-5) every 3 weeks. Patients from both groups received intensity-modulated radiotherapy concurrently with three cycles of 100 mg/m2 cisplatin every 3 weeks. After a median follow-up of 71.5 months, the IC plus CCRT group showed significantly better 5-year failure-free survival (FFS, 77.4% vs. 66.4%, p = 0.019), overall survival (OS, 85.6% vs. 77.7%, p = 0.042), distant failure-free survival (88% vs. 79.8%, p = 0.030), and locoregional failure-free survival (90.7% vs. 83.8%, p = 0.044) compared to the CCRT alone group. Post hoc subgroup analyses revealed that beneficial effects on FFS were primarily observed in patients with N1, stage IVA, pretreatment lactate dehydrogenase ≥170 U/l, or pretreatment plasma Epstein-Barr virus DNA ≥6000 copies/mL. Two nomograms were further developed to predict the potential FFS and OS benefit of TPF IC. The incidence of grade 3 or 4 late toxicities was 8.8% (21/239) in the IC plus CCRT group and 9.2% (22/238) in the CCRT alone group. Long-term follow-up confirmed that TPF IC plus CCRT significantly improved survival in locoregionally advanced NPC with no marked increase in late toxicities and could be an option of treatment for these patients.
143 citations
TL;DR: IC followed by CCRT provides long-term DFS, DMFS and OS benefits compared with C CRT alone in locoregionally advanced NPC and, therefore, can be recommended for these patients.
126 citations
Sun Yat-sen University1, American Society of Clinical Oncology2, National University of Singapore3, Stanford University4, Harvard University5, Princess Margaret Cancer Centre6, Peking Union Medical College7, University of California, San Francisco8, The Chinese University of Hong Kong9, Fudan University10, University of Hong Kong11, Memorial Sloan Kettering Cancer Center12
TL;DR: In this paper, the authors provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with chronic lung cancer using a joint guideline.
Abstract: PURPOSEThe aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with ...
124 citations
References
More filters
TL;DR: A model by which a combined assessment of all existing lesions, characterized by target lesions and nontarget lesions, is used to extrapolate an overall response to treatment is proposed, which is largely validated by the Response Evaluation Criteria in Solid Tumors Group and integrated into the present guidelines.
Abstract: Anticancer cytotoxic agents go through a process by which their antitumor activity-on the basis of the amount of tumor shrinkage they could generate-has been investigated. In the late 1970s, the International Union Against Cancer and the World Health Organization introduced specific criteria for the codification of tumor response evaluation. In 1994, several organizations involved in clinical research combined forces to tackle the review of these criteria on the basis of the experience and knowledge acquired since then. After several years of intensive discussions, a new set of guidelines is ready that will supersede the former criteria. In parallel to this initiative, one of the participating groups developed a model by which response rates could be derived from unidimensional measurement of tumor lesions instead of the usual bidimensional approach. This new concept has been largely validated by the Response Evaluation Criteria in Solid Tumors Group and integrated into the present guidelines. This special article also provides some philosophic background to clarify the various purposes of response evaluation. It proposes a model by which a combined assessment of all existing lesions, characterized by target lesions (to be measured) and nontarget lesions, is used to extrapolate an overall response to treatment. Methods of assessing tumor lesions are better codified, briefly within the guidelines and in more detail in Appendix I. All other aspects of response evaluation have been discussed, reviewed, and amended whenever appropriate.
14,926 citations
TL;DR: The Late Morbidity Scoring Criteria were developed as a joint effort between physicians with renewed interests in fast neutron therapy and Radiation Therapy Oncology Group (RTOG) staff to represent cumulative probabilities of late effects with methods similar to those for estimating local control and survival.
Abstract: The therapeutic use of ionizing radiations is predicated on sparing normal tissue effects while attempting to achieve lethal effects on tumor cells. From quite early in the history of radiation therapy, it was apparent that there were striking differences in effects in the panoply of normal tissues. Although there was early appreciation of some late effects in normal tissues, often not predicted by acute reactions, only in recent years has there been full documentation of the slow and progressive increase in severity of late damage. Pathophysiological mechanisms of acute and late radiation effects are better understood today (2), but interactions of other modalities with radiation therapy require constant monitoring to recognize and mitigate untoward sequelae. The work of Stone (3) is a classic example of unanticipated late effects, which resulted from irradiation with ‘fast neutrons. Acute reactions were moderate and tolerable, but the late sequelae were so marked that there was little interest in pursuing therapy with fast neutrons for nearly three decades. The Late Morbidity Scoring Criteria were developed as a joint effort between physicians with renewed interests in fast neutron therapy and Radiation Therapy Oncology Group (RTOG) staff. In the late 1970s the Neutron/Particle Committee was one of several modality committees of the RTOG. Recognizing the results of Stone, this committee, led by Lawrence Davis worked with RTOG staff to establish criteria and scoring for possible late effects from fast neutron radiation therapy. Investigators from the European Organization for Research and Treatment of Cancer (EORTC), led by William Duncan of the Western General Hospital of Edinburgh, wished to have common toxicity criteria in anticipation of joint studies. RTOG Protocol 7929, an international registry of patients treated with heavy particles, was started in 1980. At the annual meetings of the international participants in particle studies, there were attempts to monitor interobserver variations in scoring effects in normal tissues and to seek consistency in reporting toxicity, but no publications document these efforts. The first prospective trial to use the Late Morbidity Scoring Criteria was RTOG Protocol 8001, a study of fast neutron therapy for malignant tumors arising in salivary glands. Although the RTOG began to use these criteria in reporting toxicity in patients enrolled in all studies from 198 1 (beginning with RTOG Protocol 8 115), the criteria only became a published part of protocols in 1983. At that time, statistical methods began to be used, which presented time-adjusted estimates of late effects, the rationale for which was described by Cox (1). It is now considered standard to represent cumulative probabilities of late effects with methods similar to those for estimating local control and survival. The Acute Radiation Morbidity Scoring Criteria were developed in 1985 as complimentary to the Late Effects Scoring Criteria. The National Cancer Institute promulgated standard toxicity criteria in 1990, but late effects were not considered. An abbreviated version of the RTOG/EORTC toxicity criteria was published by Winchester and Cox in 1992 as part of the Standard for Breast Conservation Treatment. The current RTOG Acute Radiation Morbidity Scoring Criteria are presented in Table 1. The RTOG/EORTC Late Radiation Morbidity Scoring Scheme is detailed in Table 2. In both tables, 0 means an absence of radiation effects and 5 means the effects led to death. The severity
4,111 citations
"Neoadjuvant chemotherapy followed b..." refers methods in this paper
...0) and RT-related toxic effects according to the Late Radiation Morbidity Scoring Criteria of the Radiation TherapyOncologyGroup [23]....
[...]
...We assessed chemotherapy-related toxic effects according to the Common Terminology Criteria for Adverse Events (version 3.0) and RT-related toxic effects according to the Late Radiation Morbidity Scoring Criteria of the Radiation TherapyOncologyGroup [23]....
[...]
TL;DR: It is concluded that chemoradiotherapy is superior to radiotherapy alone for patients with advanced nasopharyngeal cancers with respect to PFS and overall survival.
Abstract: PURPOSEThe Southwest Oncology Group (SWOG) coordinated an Intergroup study with the participation of Radiation Therapy Oncology Group (RTOG), and Eastern Cooperative Oncology Group (ECOG). This randomized phase III trial compared chemoradiotherapy versus radiotherapy alone in patients with nasopharyngeal cancers.MATERIALS AND METHODSRadiotherapy was administered in both arms: 1.8- to 2.0-Gy/d fractions Monday to Friday for 35 to 39 fractions for a total dose of 70 Gy. The investigational arm received chemotherapy with cisplatin 100 mg/m2 on days 1, 22, and 43 during radiotherapy; postradiotherapy, chemotherapy with cisplatin 80 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d on days 1 to 4 was administered every 4 weeks for three courses. Patients were stratified by tumor stage, nodal stage, performance status, and histology.RESULTSOf 193 patients registered, 147 (69 radiotherapy and 78 chemoradiotherapy) were eligible for primary analysis for survival and toxicity. The median progression-free survival (PFS...
2,025 citations
"Neoadjuvant chemotherapy followed b..." refers methods in this paper
...The dose of PF regimen is similar to Al-Sarraf regime (Study 0099), with cisplatin given at a dose of 80 mg/m(2) and fluorouracil of 4 g/m(2) every 3 weeks [5]....
[...]
TL;DR: It is concluded that CCRT is superior to RT alone for patients with advanced NPC in endemic areas.
Abstract: Purpose: Nasopharyngeal carcinoma (NPC) is a radiosensitive and chemosensitive tumor. This randomized phase III trial compared concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in patients with advanced NPC. Patients and Methods: From December 1993 to April 1999, 284 patients with 1992 American Joint Committee on Cancer stage III to IV (M0) NPC were randomly allocated into two arms. Similar dosage and fractionation of RT was administered in both arms. The investigational arm received two cycles of concurrent chemotherapy with cisplatin 20 mg/m2/d plus fluorouracil 400 mg/m2/d by 96-hour continuous infusion during the weeks 1 and 5 of RT. Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Baseline patient characteristics were comparable in both arms. After a median follow-up of 65 months, 26.2% (37 of 141) and 46.2% (66 of 143) of patients developed tumor relapse in the CCRT and RT-alone groups, respectively. The 5-year overall survival r...
675 citations
TL;DR: It is confirmed that chemotherapy improves the distant metastasis control rate in NPC and its applicability to endemic NPC is demonstrated.
Abstract: Purpose The Intergroup 00-99 Trial for nasopharyngeal cancer (NPC) showed a benefit of adding chemotherapy to radiotherapy. However, there were controversies regarding the applicability of the results to patients in endemic regions. This study aims to confirm the findings of the 00-99 Trial and its applicability to patients with endemic NPC. Patients and Methods Between September 1997 and May 2003, 221 patients were randomly assigned to receive radiotherapy (RT) alone (n = 110) or chemoradiotherapy (CRT; n = 111). Patients in both arms received 70 Gy in 7 weeks using standard RT portals and techniques. Patients on CRT received concurrent cisplatin (25 mg/m2 on days 1 to 4) on weeks 1, 4, and 7 of RT and adjuvant cisplatin (20 mg/m2 on days 1 to 4) and fluorouracil (1,000 mg/m2 on days 1 to 4) every 4 weeks (weeks 11, 15, and 19) for three cycles after completion of RT. All patients were analyzed by intent-to-treat analysis. The median follow-up time was 3.2 years. Results Distant metastasis occurred in 38...
571 citations