Background And Purpose: This study aims to identify the optimal high-risk candidates for clinical trials in locoregionally advanced nasopharyngeal carcinoma (NPC).
Materials And Methods: Non-metastatic NPC patients (n = 9,468) were included. Recursive partitioning analyses (RPA) were performed to generate risk stratification. Receiver operating characteristics curve was used to determine the cut-off value of pre-treatment Epstein-Barr virus (EBV) DNA for progression-free survival (PFS). Individual-level data from two clinical trials were used for validation.
Results: Anatomic stratification based on T and N category (eighth edition TNM, TNM-8) classified the N2-3 or T4 as an anatomic high-risk group with 5-year PFS of 69% (95% confidence interval: 68-71%). Prognostic stratification identified patients with pre-treatment EBV DNA ≥4000 copies/mL as a prognostic high-risk group with 5-year PFS of 69% (67-70%). The c-index was significantly higher for anatomic stratification (0.621, p < 0.001) and prognostic stratification (0.585, p < 0.001) compared with existing TNM-8 stage groups (0.562). The validation cohorts based on clinical trials data showed greater PFS benefit than the results of the original trials [Hazard ratio: NCT01245959, 0.64 vs. 0.67; NCT01872962, 0.42 vs. 0.52]. Moreover, detectable post-treatment EBV DNA indicated a high risk of progression with 5-year PFS of 38.7% and was the most adverse independent factor for all endpoints.
Conclusions: N2-3 or T4 NPC patients were ideal candidates for multicenter clinical trials in locoregionally advanced NPC. Patients with detectable post-treatment EBV DNA are suitable candidates for adjuvant trials.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.radonc.2021.12.029 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Introduction: Locoregional recurrence (LR) is common in locally advanced head and neck cancer (HNSCC), posing challenges for treatment. We analysed outcome parameters and toxicities for patients being treated with radiotherapy (RT) for LR-HNSCC and investigated patient and disease related prognostic factors in this prognostically unfavourable group.
Methods: This analysis includes 101 LR-HNSCC patients treated with RT, radio-chemotherapy (RCT) or radio-immunotherapy (RIT) between 2010 and 2018 at a high-volume tertiary centre.
Constructing individualized follow-up strategies for locally advanced esophageal squamous cell carcinoma patients based on dynamic recurrence risk changes.
Sci Rep
January 2025
Department of Gastrointestinal Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
The aim of this study was to explore the high-risk factors for recurrence in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing definitive chemoradiotherapy or radiotherapy (dCRT or dRT). Conditional survival (CS) was used to evaluate the dynamic survival and recurrence risk of patients after treatment, and individualized monitoring strategies were developed for patients. Logistic regression analysis was performed to determine independent recurrence risk factors.
View Article and Find Full Text PDFAdjuvant Intensity Modulated Radiation Therapy With a Pedicled Flap Reconstruction in Oral Cavity Squamous Cell Carcinomas: Implications on Target Delineation.
Head Neck
December 2024
Department of Head & Neck Surgery, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Objectives: To address controversies regarding target volume delineation for adjuvant intensity-modulated radiation therapy for oral cavity squamous cell carcinoma with pedicled flap reconstruction and elective nodal irradiation (ENI).
Materials And Methods: During target volume delineation, the primary tumor bed was the pre-surgical gross tumor volume with an additional isotropic margin of 5-10 mm. Additionally, the flap and body tissue junction were given a margin of 5-10 mm (if not already given).
the evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies.
View Article and Find Full Text PDFOutcomes of Radical Radiotherapy (RT) or Chemoradiotherapy (CRT) in Surgically Inoperable Advanced Oral Cavity Cancer: A Single Center Experience.
Head Neck
December 2024
Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
Background: Patients with locally advanced, surgically unresectable oral squamous cell cancers (SU-OSCC) are often treated with palliative intent. There is limited information on the outcomes of radical intent treatment with radiotherapy (RT) or chemoradiotherapy (CRT).
Methods: We retrospectively examined patients with Stage III/IV previously untreated SU-OSCC treated definitively from 2011 to 2021 in a single institution with RT or CRT with or without neoadjuvant chemotherapy (NACT).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!