Effects of Epstein‐Barr virus viral load and different treatment modality for stage III nasopharyngeal carcinoma. Issue 8 (3rd February 2020)

• Record Type: Journal Article
• Authors: Twu, Chih‐Wen; Wang, Wen‐Yi; Tsou, Hsiao‐Hui; Liu, Yi‐Chun; Jiang, Rong‐San; Liang, Kai‐Li; Lin, Po‐Ju; Lin, Tian‐Yun; Chen, Hsin‐Hong; Lin, Jin‐Ching
• Is Part Of: Head & neck. Volume 42:Issue 8(2020)
• Page Start: 1765
• Page End: 1774
• Publication Date: 2020-02-03
• Subjects: chemoradiotherapy -- Epstein‐Barr virus -- nasopharyngeal carcinoma -- plasma -- stage III; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.26096
• Languages: English
• ISSNs: 1043-3074

Abstract

Abstract: Background: We investigated treatment results, the effects of different treatment modality, and pretreatment Epstein‐Barr virus (EBV) viral load for stage III nasopharyngeal carcinoma (NPC) patients. Methods: The initial definitive treatment for 356 stage III NPC patients consisted of concurrent chemoradiotherapy (CCRT) or induction chemotherapy plus radiotherapy (IndCT‐RT). The pretreatment EBV DNA level separated patients into a high (n = 106) or low (n = 250) viral load (≥ or < 1000 copies/mL) subgroup. Outcome measures include relapse rates and various survivals. Results: The 5‐year rates of overall survival (OS), progression‐free survival (PFS), distant metastasis failure‐free survival (DMFFS), and locoregional failure‐free survival (LRFFS) were 88.6%, 83.0%, 90.5%, and 90.5%, respectively. Patient characteristics and pretreatment viral load between IndCT‐RT and CCRT were no significant differences except for a higher percentage of N2 disease in the IndCT‐RT subgroup. Both treatment modality resulted in similar relapse rates ( P = .56), OS ( P = .20), PFS ( P = .53), DMFFS ( P = .89), and LRFFS ( P = .35). However, patients with a high viral load experienced a higher relapse rate (33.0% vs 12.4%, P < .001) and worse OS (5‐year rate, 79.0% vs 92.8%, P < .001), PFS (73.7% vs 88.4%, P < .001), DMFFS (80.2% vs 95.0%, P < .001), and LRFFS (85.6% vs 92.6%, P = .005) than those with a low viral load. Conclusion: Long‐term treatment results for stage III NPC patients are rather good. IndCT‐RT can achieve the same treatment outcome as CCRT. Risk grouping by pretreatment viral load identified a subgroup (30%) of patients associated with a significantly higher relapse rates and worse survivals. These high‐risk patients need to strengthen treatment intensity in future trials.