Comparison the clinical outcomes with altered versus conventional fractionated radiotherapy plus concurrent chemotherapy for advanced nasopharyngeal carcinoma

Head & Neck ◽  
2018 ◽  
Vol 40 (6) ◽  
pp. 1156-1163 ◽  
Author(s):  
Po-Ju Lin ◽  
Chih-Wen Twu ◽  
Yi-Chun Liu ◽  
Tian-Yun Lin ◽  
Wen-Yi Wang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Clinical Outcomes ◽  
Concurrent Chemotherapy ◽  
Fractionated Radiotherapy

scholarly journals Management of Nasopharyngeal Carcinoma: Is Adjuvant Therapy Needed?

2018 ◽  
Vol 14 (10) ◽  
pp. 594-602 ◽  
Author(s):  
Victor H. Lee ◽  
Ka-On Lam ◽  
Amy T. Chang ◽  
Tai-Chung Lam ◽  
Chi-Leung Chiang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Adjuvant Therapy ◽  
Systemic Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Future Research ◽  
Dramatic Improvement ◽  
Histologic Subtype ◽  
Fractionated Radiotherapy ◽  
Risk Patients

Nasopharyngeal carcinoma of the undifferentiated histologic subtype is endemic and prevalent in southeast Asia. The dramatic improvement of treatment outcomes and overall prognosis during the past few decades has been attributed to advances in disease screening and diagnosis, diagnostic imaging, radiotherapy techniques, use of combination systemic therapy, and dedicated clinical and biomarker surveillance. The current practice of treating patients with advanced locoregional disease using cisplatin concurrent with conventional fractionated radiotherapy, followed by adjuvant cisplatin and fluorouracil, was established in 1998 when the landmark Intergroup-0099 Study demonstrated a survival benefit with the addition of systemic therapy. There is little doubt regarding the need for concurrent chemotherapy, but there has been uncertainty about the magnitude of the benefit attributed to the adjuvant phase. Furthermore, instead of one-size-fits-all recommendations, it will be ideal if we can tailor adjuvant therapy to high-risk patients only to avoid unnecessary toxicities. In addition, recent evidence suggests that induction chemotherapy before concurrent chemoradiation can achieve better outcomes, especially in distant control, even in the modern era of intensity-modulated radiation therapy. This article provides a comprehensive review of key literature on the current management of locoregionally advanced nasopharyngeal carcinoma and highlights future research directions to unravel these controversies.

scholarly journals Low PD-L1 Expression Strongly Correlates with Local Recurrence in Epstein-Barr Virus-Positive Nasopharyngeal Carcinoma after Radiation-Based Therapy

Cancers ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 374 ◽  
Author(s):  
Yu-Jen Liu ◽  
Ngan-Ming Tsang ◽  
Chuen Hsueh ◽  
Chi-Ju Yeh ◽  
Shir-Hwa Ueng ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Nasopharyngeal Carcinoma ◽  
Local Recurrence ◽  
Epstein Barr Virus ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Barr Virus ◽  
Programmed Death ◽  
Favorable Prognostic Factor ◽  
Epstein Barr

The prognostic value of programmed death-ligand 1 (PD-L1) expression in nasopharyngeal carcinoma (NPC) is controversial, with previous studies showing conflicting results. Most NPCs in endemic areas are Epstein-Barr virus (EBV)-positive. Our aim was to evaluate the clinical significance of PD-L1 expression in EBV-positive NPC. We retrospectively analyzed PD-L1 expression on tumor cells (TCs) and immune cells (ICs) by immunohistochemistry in 208 EBV-positive NPC patients who underwent radiotherapy (203 with concurrent chemotherapy). The percentages of TCs and ICs expressing PD-L1 were evaluated respectively. There was a strong correlation between local recurrence and low PD-L1 expression on ICs (p = 0.0012), TCs (p = 0.013) or both (p = 0.000044), whereas all clinical parameters had no influence on local recurrence. Using multivariate analysis, low PD-L1 expression on ICs was an independent adverse prognostic factor (p = 0.0080; HR = 1.88; 95% CI = 1.18–3.00) for disease-free survival. High PD-L1 expression on both ICs and TCs was an independent favorable prognostic factor (p = 0.022; HR = 0.46; 95% CI = 0.24–0.89) for overall survival. We show for the first time that low PD-L1 expression on ICs and TCs strongly correlates with local recurrence in EBV-positive NPC patients after radiation-based therapy. A simple immunohistochemical study for PD-L1 can identify patients prone to local recurrence, and such patients might benefit from more aggressive treatment in future clinical trials.

Patterns of care and clinical outcomes in stage IVA cervical cancer: 14-year experience from a tertiary care centre in South India

2021 ◽  
pp. 1-7
Author(s):  
Neenu Oliver John ◽  
Arvind Sathyamurthy ◽  
Shanthi Prasoona ◽  
Jeba Karunya Ramireddy ◽  
Grace Rebekah ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Outcomes ◽  
South India ◽  
Tertiary Care ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Patterns Of Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gynecology And Obstetrics

Abstract Aim: To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India. Materials and methods: The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis. Results: The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively. Conclusion: The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.

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