Combining tumor response and personalized risk assessment: Potential for adaptation of concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma in the intensity-modulated radiotherapy era
Combining tumor response and personalized risk assessment: Potential for adaptation of concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma in the intensity-modulated radiotherapy era
复制标题
结合肿瘤反应和个性化风险评估：调强放疗时代同步化疗适应局部晚期鼻咽癌的潜力。
DOI：
10.1016/j.radonc.2020.10.005
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发表时间：
2021-02-01
影响因子：
5.7
通讯作者：
Mao, Yan-Ping
中科院分区：
文献类型：
--
作者：
Luo, Wei-Jie;Zou, Wen-Qing;Mao, Yan-Ping
背景和目的：在调强放疗（IMRT）时代，诱导化疗（IC）后同步放化疗（CCRT）在局部晚期鼻咽癌（LANPC）中的作用尚未确定，同时存在CCRT相关的过度毒性问题。我们的目的是结合联合收割机的肿瘤反应和风险评估，以指导决策同步chemotherapy.材料和方法：从2009年4月至2015年12月，744例LANPC患者接受CCRT/IMRT后IC。采用匹配技术进行治疗效果评价。IC的肿瘤缓解用于患者分层。采用多变量考克斯回归分析建立列线图预测总生存期。肿瘤缓解率为68.3%（完全或部分缓解），其中IC + CCRT的5年无病生存率和OS显著上级IC + IMRT（82.2% vs. 72.5%，P = 0.025; 89.2% vs. 79.9%，P = 0.025）。而不良反应组间差异无统计学意义（均P > 0.05）。对于良好的反应者，建立一个诺模图，整合年龄，吸烟，T分类，N分类，治疗前EB病毒DNA和治疗方式。一致性指数为0.713，校准良好。诺模图确定了三个风险组与不同的OS。高风险患者受益于CCRT后IC关于无病生存，OS和无远处转移生存，而低，中风险患者没有。结论：对于LANPC患者IC反应不利，随后的CCRT似乎不足，渲染强化必要。对于低风险的良好反应者，IC + IMRT代表了合理的去强化方法，尽管需要前瞻性数据的证实。(C)2020 Elsevier B. V.保留所有权利。
Background and purpose: In the intensity-modulated radiotherapy (IMRT) era, the role of concurrent chemoradiotherapy (CCRT) after induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LANPC) is undetermined, while concerns exist about CCRT-associated excessive toxicity. We aimed to combine tumor response and risk assessment to guide decisions about concurrent chemotherapy.Materials and methods: From April 2009 to December 2015, 744 LANPC patients treated with CCRT/IMRT after IC were included. Matching techniques were performed for treatment effect evaluation. Tumor response to IC was used for patient stratification. A nomogram was built based on multivariable Cox regression analysis to predict overall survival (OS).Results: After IC, 508 patients (68.3%) had favorable tumor response (complete or partial response), among whom IC + CCRT achieved significantly superior 5-year disease-free survival and OS than IC + IMRT (82.2% vs. 72.5%, P = 0.025; 89.2% vs. 79.9%, P = 0.025). However, no significant difference was found in patients with unfavorable response (both P > 0.05). For favorable responders, a nomogram was built integrating age, smoking, T category, N category, pretreatment Epstein-Barr virus DNA and treatment modality. The concordance index was 0.713 and calibration was good. The nomogram determined three risk groups with distinct OS. High-risk patients benefited from CCRT after IC regarding disease-free survival, OS and distant metastasis-free survival, whereas low- and intermediate-risk patients did not.Conclusions: For LANPC patients with unfavorable response to IC, subsequent CCRT seems inadequate, rendering intensification necessary. For favorable responders with low risk, IC + IMRT represents a reasonable de-intensification approach, although confirmation by prospective data is needed. (C) 2020 Elsevier B.V. All rights reserved.