A novel scoring model to predict benefit of additional induction chemotherapy to concurrent chemoradiotherapy in stage II–IVa nasopharyngeal carcinoma. (November 2018)

• Record Type: Journal Article
• Authors: Peng, Liang; Chen, Yu-Pei; Xu, Cheng; Tang, Ling-Long; Chen, Lei; Lin, Ai-Hua; Liu, Xu; Sun, Ying; Ma, Jun
• Is Part Of: Oral oncology. Volume 86(2018)
• Page Start: 258
• Page End: 265
• Publication Date: 2018-11
• Subjects: Nasopharyngeal carcinoma -- Induction chemotherapy -- Interaction effect -- Prognostic index -- Benefit prediction model -- Distant metastasis-free survival; aHR adjusted hazard ratio -- AJCC/UICC American Joint Committee on Cancer/International Union against Cancer -- CCI Charlson comorbidity index -- CCRT concurrent chemoradiotherapy -- CI confidence interval -- CTV clinical target volume -- DMFS distant metastasis-free survival -- EBV Epstein–Barr virus -- GTV gross tumour volume -- HR hazard ratio -- IC induction chemotherapy -- ICBS induction chemotherapy benefit score -- IMRT intensity modulated radiotherapy -- LDH lactate dehydrogenase -- MRI magnetic resonance imaging -- NPC nasopharyngeal carcinoma -- OS overall survival -- PET/CT positron emission tomography and computed tomography -- PF cisplatin with 5-fluorouracil -- PI prognostic index -- PTV planning target volume -- RT radiotherapy -- SPECT single photon emission computed tomography -- SYSUCC Sun Yat-Sen University Cancer Centre -- TP cisplatin with docetaxel -- TPF cisplatin plus docetaxel with 5-fluorouracil; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2018.10.007
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: N category, overall stage and EBV DNA determine ICBS and predict IC benefit in NPC. Patients with T4 disease would be more likely to benefit from IC than those with N3 disease. Besides IC, patients with N3 disease need more effective treatments. Most of patients with zero level of EBV DNA should avoid IC. Abstract: Objectives: Induction chemotherapy (IC) is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). We aimed to develop a model to predict benefit from additional IC to concurrent chemoradiotherapy (CCRT). Materials and methods: From an NPC-specific database, 7413 patients with stage II–IVa disease who received CCRT with or without IC were included. Distant metastasis-free survival (DMFS) was the primary outcome and benefit from IC was evaluated by adjusted hazard ratio. Interaction terms between IC and other prognostic factors were identified in multivariate Cox model, and IC benefit score (ICBS) was calculated based on β coefficients from the Cox model. Results: Nodal category, overall stage, and pre-treatment plasma Epstein–Barr virus DNA (log transformed as continuous variable) interacted with IC and determined ICBS. ICBS could discriminate patients who benefited differently from IC in terms of DMFS well, especially for patients with high and low ICBS. As for patients with medium ICBS, predictive performance of ICBS seemed reduced. Conclusions: Based on the ICBS model, we proposed a decision-making process to help in clinical practice. Multi-institutional and prospective studies are warranted to further validate our findings.