Head and Neck Cancer

SS 36 - H&N 4 - Latest Advances in Nasopharyngeal Carcinoma

259 - Chemotherapy May Not be Necessary in Stage II Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiation Therapy

Wednesday, October 24
7:55 AM - 8:05 AM
Location: Room 214 A/B

Chemotherapy May Not be Necessary in Stage II Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiation Therapy
S. Chen1, Y. Meng2, Y. Shen3, X. Ning4, C. Xiong5, Z. Lin6, Q. Zheng7, Z. Zheng3, P. Yin8, H. Huang1, and M. Yao9; 1Department of Medical Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China, 2Department of Oncology, Baise People's Hospital, Baise, Guangxi, China, 3Department of Oncology, The Liuzhou Railway Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China, 4Department of Oncology, The Third Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Liuzhou, Guangxi, China, 5Department of Oncology, The First Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, Guangxi, China, 6Department of Oncology, The Yulin First People's Hospital, Yulin, Guangxi, China, 7Department of Oncology, The Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, Guangxi, China, 8Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China, 9Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH

Purpose/Objective(s): Concurrent chemoradiation (CCRT) with adjuvant chemotherapy (CT) is the standard care for stage II–IV nasopharyngeal carcinoma (NPC) in NCCN guideline. CCRT has been shown to improve outcomes for stage III–IV NPC patients over radiation therapy (RT) alone, but the benefit for stage II NPC patients is controversial,especially in the era of intensity-modulated radiation therapy (IMRT). The study is to evaluate and determine the role of CCRT in stage II NPC underwent IMRT.

Materials/Methods: Patients with stage II NPC (T1N1, T2N0, or T2N1; 7th ed AJCC staging) were recruited from January 2009 to June 2015 at 6 centers in China. They were randomly assigned to CCRT followed by adjuvant CT (CCRT+CT) arm or RT alone arm. All patients were treated with IMRT. The chemotherapy consisted of concurrent cisplatin (80 mg/m2 on day 1, 22, 43) during IMRT and 3 cycles of adjuvant CT with cisplatin 75mg/m2 day 1, 5-FU 750 mg/m2 24h-continuous infusion day 1-5 every 3 weeks. The primary endpoint was overall survival (OS). Secondary endpoints included locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and toxicities. Survivals were calculated with Kaplan-Meier method. The differences between survivals were calculated by Log-rank test. Toxic effects were analyzed using the χ2 test. All statistical tests were two-side.

Results: A total of 168 patients were recruited and 160 were eligible for intent-for-treat analysis. 81 patients were assigned to CCRT+CT arm and 79 in RT alone arm. With a median follow-up of 61.5 months, the 3 -year and 5-year OS of all patients were 93.75% and 90.00%, respectively. The 3-year and 5-year OS of CCRT+CT arm were 93.83%, 91.36%, respectively, and 93.67% and 88.61% in RT arm, respectively. There was no significant difference in OS between two arms(P=0.562). The 3-year and 5-year LRFFS of CCRT+CT arm were 97.53%, 96.26%, respectively, and 94.94% and 93.67% in RT arm, respectively. There was no significant difference in LRFFS between two arms(P =0.690). The 3-year and 5-year DMFS of CCRT+CT arm were 93.82%, 93.82%, respectively, and 96.20% and 93.67% in RT arm, respectively. There was also no significant difference in DMFS between two arms(P =0.967). There were higher local radiation acute and late side effects in the CCRT+CT arm than RT arm although not reached significant. There were significantly higher acute systemic side effects in the CCRT+CT arm, especially the incidence of grade 3-4 hematologic and gastrointestinal reactions (P =0.000). Most of locoregional recurrence (6/8, 75.00%) and distant metastases (6/7, 85.71%) occurred in the T2N1M0 group.

Conclusion: For stage II NPC patients treated with IMRT, CCRT and adjuvant CT did not improve OS, LRFFS and DMFS. But there were more significant toxicities. Chemotherapy may not be necessary in these patients. However, further research with longer follow up is needed especially for those with T2N1 disease.

Author Disclosure: S. Chen: None. C. Xiong: None. Z. Lin: None.

Send Email for Shaojun Chen


Assets

259 - Chemotherapy May Not be Necessary in Stage II Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiation Therapy



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Chemotherapy May Not be Necessary in Stage II Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiation Therapy