Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials
Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials
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DOI：
10.1016/j.ejca.2010.10.026
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发表时间：
2011-03-01
影响因子：
8.4
通讯作者：
Lau, W. H.
中科院分区：
文献类型：
--
作者：
Lee, Anne W. M.;Tung, Stewart Y.;Lau, W. H.
背景资料：目前局部晚期鼻咽癌（NPC）的标准治疗是常规分割放疗加同期辅助化疗，如Intergroup-0099研究所推荐。对NPC-9901和NPC-9902试验的联合分析旨在提供更全面的数据来评估Intergroup-0099方案的疗效及其影响因素。方法：将符合条件的III-IVB期非角化NPC患者随机分配至单纯放疗组（RTi组：218例患者）或放化疗（CRTi组：223例患者）使用顺铂（100 mg/m（2））治疗三个周期，同时进行放疗，然后进行顺铂（80 mg/m（2））加氟尿嘧啶（1000 mg/m（2）/天，持续4天）治疗三个周期。中位随访时间为6.1年。结果：意向治疗比较显示，CRTi组在总体无失败率（FFR）、局部FFR和癌症特异性生存率方面取得了显著改善（p = 0.14）。基于实际治疗的进一步探索性研究表明，获得的额外改善是OS的显著增加（CRTa组与RTa组：5年时分别为72%和63%，p = 0.037）。多变量分析显示，并行期顺铂剂量对局部FFR和OS有显著影响，而辅助期氟尿嘧啶剂量对远端FFR有显著影响。接受0-1、2和3个并行周期的患者的5年局部区域FFR分别为79%、88%和88%;按辅助周期计算的相应距离FFR分别为68%、78%和77%。解释：我们的研究结果支持目前的做法，增加并行顺铂加辅助顺铂-氟尿嘧啶联合放疗治疗局部晚期鼻咽癌的临床研究同步化疗对局部控制和生存率很重要，顺铂200 mg/m2分2个周期同步化疗可能是足够的。使用含氟尿嘧啶的联合化疗有助于改善远程控制。(C)2010爱思唯尔有限公司版权所有。
Background: The current standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) was conventional-fractionation radiotherapy plus concurrent-adjuvant chemotherapy as recommended by the Intergroup-0099 Study. This combined analysis of the NPC-9901 and the NPC-9902 Trials aims to provide more comprehensive data to evaluate the efficacy of the Intergroup-0099 regimen and the contributing factors.Methods: Eligible patients with stage III-IVB non-keratinizing NPC were randomly assigned to radiotherapy-alone (RTi group: 218 patients) or chemoradiotherapy (CRTi group: 223 patients) using cisplatin (100 mg/m(2)) for three cycles in concurrence with radiotherapy, followed by cisplatin (80 mg/m(2)) plus fluorouracil (1000 mg/m(2)/day for 4 days) for three cycles. The median follow-up was 6.1 years.Findings: Comparison by intention-to-treat showed that the CRTi group achieved significant improvement in overall failure-free rate (FFR), locoregional-FFR and cancer-specific survival (p = 0.14). Further exploratory studies based on actual treatment showed that an additional improvement achieved was a significant gain in OS (CRTa versus RTa group: 72% versus 63% at 5-year, p = 0.037). Multivariate analyses showed that the dose of cisplatin during the concurrent phase had significant impact on locoregional-FFR and OS, while that of fluorouracil during the adjuvant phase was significant for distant-FFR. The 5-year locoregional-FFR for patients who received 0-1, 2 and 3 concurrent cycles were 79%, 88% and 88%, respectively; the corresponding distant-FFR by adjuvant cycles were 68%, 78% and 77%, respectively.Interpretation: Our results support the current practice of adding concurrent cisplatin plus adjuvant cisplatin-fluorouracil to radiotherapy for treating patients with locoregionally advanced NPC. The concurrent phase is important for locoregional control and survival, cisplatin 200 mg/m(2) in two concurrent cycles might be adequate. Additional chemotherapy using fluorouracil-containing combination contributed to improving distant control. (C) 2010 Elsevier Ltd. All rights reserved.