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Article: Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials

TitleFactors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials
Authors
KeywordsNasopharyngeal carcinoma
Concurrent-adjuvant chemotherapy
Issue Date2011
Citation
European Journal of Cancer, 2011, v. 47, n. 5, p. 656-666 How to Cite?
AbstractBackground: The current standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) was conventional-fractionation radiotherapy plus concurrent-adjuvant chemotherapy as recommended by the Intergroup-0099 Study. This combined analysis of the NPC-9901 and the NPC-9902 Trials aims to provide more comprehensive data to evaluate the efficacy of the Intergroup-0099 regimen and the contributing factors. Methods: Eligible patients with stage III-IVB non-keratinizing NPC were randomly assigned to radiotherapy-alone (RT i group: 218 patients) or chemoradiotherapy (CRTi group: 223 patients) using cisplatin (100 mg/m2) for three cycles in concurrence with radiotherapy, followed by cisplatin (80 mg/m2) plus fluorouracil (1000 mg/m2/day for 4 days) for three cycles. The median follow-up was 6.1 years. Findings: Comparison by intention-to-treat showed that the CRTi group achieved significant improvement in overall failure-free rate (FFR), locoregional-FFR and cancer-specific survival (p ≤ 0.019); but the improvements for distant-FFR and overall survival (OS) were statistically insignificant (p ≥ 0.14). Further exploratory studies based on actual treatment showed that an additional improvement achieved was a significant gain in OS (CRTa versus RTa group: 72% versus 63% at 5-year, p = 0.037). Multivariate analyses showed that the dose of cisplatin during the concurrent phase had significant impact on locoregional-FFR and OS, while that of fluorouracil during the adjuvant phase was significant for distant-FFR. The 5-year locoregional-FFR for patients who received 0-1, 2 and 3 concurrent cycles were 79%, 88% and 88%, respectively; the corresponding distant-FFR by adjuvant cycles were 68%, 78% and 77%, respectively. Interpretation: Our results support the current practice of adding concurrent cisplatin plus adjuvant cisplatin-fluorouracil to radiotherapy for treating patients with locoregionally advanced NPC. The concurrent phase is important for locoregional control and survival, cisplatin 200 mg/m2 in two concurrent cycles might be adequate. Additional chemotherapy using fluorouracil-containing combination contributed to improving distant control. © 2010 Elsevier Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/213945
ISSN
2015 Impact Factor: 6.163
2015 SCImago Journal Rankings: 3.152

 

DC FieldValueLanguage
dc.contributor.authorLee, Anne W M-
dc.contributor.authorTung, Stewart Y.-
dc.contributor.authorNgan, Roger K C-
dc.contributor.authorChappell, Rick-
dc.contributor.authorChua, Daniel T T-
dc.contributor.authorLu, T. X.-
dc.contributor.authorSiu, Lillian-
dc.contributor.authorTan, Terence-
dc.contributor.authorChan, L. K.-
dc.contributor.authorNg, W. T.-
dc.contributor.authorLeung, T. W.-
dc.contributor.authorFu, Y. T.-
dc.contributor.authorAu, Gordon K H-
dc.contributor.authorZhao, C.-
dc.contributor.authorO'Sullivan, Brian-
dc.contributor.authorTan, E. H.-
dc.contributor.authorLau, W. H.-
dc.date.accessioned2015-08-19T13:41:18Z-
dc.date.available2015-08-19T13:41:18Z-
dc.date.issued2011-
dc.identifier.citationEuropean Journal of Cancer, 2011, v. 47, n. 5, p. 656-666-
dc.identifier.issn0959-8049-
dc.identifier.urihttp://hdl.handle.net/10722/213945-
dc.description.abstractBackground: The current standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) was conventional-fractionation radiotherapy plus concurrent-adjuvant chemotherapy as recommended by the Intergroup-0099 Study. This combined analysis of the NPC-9901 and the NPC-9902 Trials aims to provide more comprehensive data to evaluate the efficacy of the Intergroup-0099 regimen and the contributing factors. Methods: Eligible patients with stage III-IVB non-keratinizing NPC were randomly assigned to radiotherapy-alone (RT i group: 218 patients) or chemoradiotherapy (CRTi group: 223 patients) using cisplatin (100 mg/m2) for three cycles in concurrence with radiotherapy, followed by cisplatin (80 mg/m2) plus fluorouracil (1000 mg/m2/day for 4 days) for three cycles. The median follow-up was 6.1 years. Findings: Comparison by intention-to-treat showed that the CRTi group achieved significant improvement in overall failure-free rate (FFR), locoregional-FFR and cancer-specific survival (p ≤ 0.019); but the improvements for distant-FFR and overall survival (OS) were statistically insignificant (p ≥ 0.14). Further exploratory studies based on actual treatment showed that an additional improvement achieved was a significant gain in OS (CRTa versus RTa group: 72% versus 63% at 5-year, p = 0.037). Multivariate analyses showed that the dose of cisplatin during the concurrent phase had significant impact on locoregional-FFR and OS, while that of fluorouracil during the adjuvant phase was significant for distant-FFR. The 5-year locoregional-FFR for patients who received 0-1, 2 and 3 concurrent cycles were 79%, 88% and 88%, respectively; the corresponding distant-FFR by adjuvant cycles were 68%, 78% and 77%, respectively. Interpretation: Our results support the current practice of adding concurrent cisplatin plus adjuvant cisplatin-fluorouracil to radiotherapy for treating patients with locoregionally advanced NPC. The concurrent phase is important for locoregional control and survival, cisplatin 200 mg/m2 in two concurrent cycles might be adequate. Additional chemotherapy using fluorouracil-containing combination contributed to improving distant control. © 2010 Elsevier Ltd. All rights reserved.-
dc.languageeng-
dc.relation.ispartofEuropean Journal of Cancer-
dc.subjectNasopharyngeal carcinoma-
dc.subjectConcurrent-adjuvant chemotherapy-
dc.titleFactors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ejca.2010.10.026-
dc.identifier.pmid21112774-
dc.identifier.scopuseid_2-s2.0-79952103326-
dc.identifier.hkuros266232-
dc.identifier.volume47-
dc.identifier.issue5-
dc.identifier.spage656-
dc.identifier.epage666-

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