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The feasibility of reduced-dose radiotherapy in childhood nasopharyngeal carcinoma with favorable response to neoadjuvant chemotherapy

  • Author Footnotes
    1 The authors contributed equally to this work.
    Ji-Jin Yao
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    VIP Region, Sun Yat-sen University Cancer Center Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, China

    The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China
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  • Author Footnotes
    1 The authors contributed equally to this work.
    Ya-Nan Jin
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China
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  • Author Footnotes
    1 The authors contributed equally to this work.
    Yu-Jing Lin
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province 519001, China
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  • Wang-Jian Zhang
    Affiliations
    Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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  • Tia Marks
    Affiliations
    Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, 12144, USA
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  • Ian Ryan
    Affiliations
    Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, 12144, USA
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  • Hong-Yu Zhang
    Correspondence
    Corresponding authors at: VIP Region, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Affiliations
    The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong 519000, China
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  • Liang-Ping Xia
    Correspondence
    Corresponding authors at: VIP Region, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
    Affiliations
    VIP Region, Sun Yat-sen University Cancer Center Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, China
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  • Author Footnotes
    1 The authors contributed equally to this work.
Published:November 11, 2022DOI:https://doi.org/10.1016/j.radonc.2022.11.003

      Highlights

      • Childhood nasopharyngeal carcinoma cases have high chemoradiothearpy sensitivity and good survival outcomes.
      • The standard high radiation dose (ie. 66-70 Gy) seriously affects the survivors’ quality of life among childhood patients.
      • Identifying a feasible adjustment for radiation dose is of utmost importance in improving the quality of life in children with nasopharyngeal carcinoma.

      Abstract

      Background

      To assess the feasibility of adjusting radiation dose (RD) in childhood NPC with favorable tumor response after neoadjuvant chemotherapy (NAC).

      Patients and methods

      Using an NPC-specific database, children and adolescents (≤18 years) with locoregionally advanced NPC (CA-LANPC) were retrospectively analyzed. Enrolled patients were those who received favorable tumor response after 2-4 cycles of NAC followed by concurrent chemoradiotherapy. Survival outcomes and treatment-related toxicities were compared for the standard RD on primary tumors (PT-RDstandard, 66-72 Gy) and the reduced RD on primary tumors (PT-RDreduced, 60-65.9 Gy).

      Results

      A total of 132 patients were included, and the median follow-up time was 75.2 months (IQR, 53.2-98.7 months) for the entire cohort. The PT-RDreduced group had a significantly decreased incidence of severe mucositis (51.3% vs 32.1%; P=0.034) when compared to the PT-RDstandard group. The total incidence of severe sequela in the PT-RDstandard group were significantly higher than those in the PT-RDreduced group (31.8% vs 13.7%; P=0.029). In the propensity-matched analysis, the PT-RDreduced group resulted in parallel 5-year survival with the PT-RDstandard group from the matched cohort (disease-free survival, 82.7% vs 80.3%, P=0.841; overall survival, 91.7% vs 91.3%, P=0.582; distant metastasis-free survival, 87.5% vs 82.8%, P=0.573; and locoregional relapse-free survival, 95.6% vs 97.3%, P=0.836). In multivariate analysis, the impact of PT-RDreduced on all survival end points remained insignificant.

      Conclusions

      Chemoradiotherapy with RD at levels of 60-65.9 Gy may be a reasonable strategy for CA-LANPC with favorable tumor response after NAC.

      Keywords

      Abbreviations:

      NPC (Nasopharyngeal carcinoma), RT (Radiotherapy), LANPC (locoregionally advanced nasopharyngeal carcinoma), NAC (neoadjuvant chemotherapy), CCRT (concurrent chemoradiotherapy), NCCN (National Comprehensive Cancer Network), CCD (cumulative cisplatin dose), CA-LANPC (children and adolescents with locoregionally advanced nasopharyngeal carcinoma), RD (radiation dose), CR (complete response), PR (partial response), LRFS (locoregional relapse-free survival), DFS (disease-free survival), UICC (Union for International Cancer Control), IMRT (intensity-modulated radiotherapy), MRI (magnetic resonance imaging), PT (primary tumor), LN (lymph nodes), PF (cisplatin plus 5-fluorouracil), TP (docetaxel plus cisplatin), TPF (docetaxel, cisplatin, and 5-fluorouracil), GP (gemcitabine with cisplatin), RTI (radiotherapy interruption), RDstandard (radiation dose of 66-72 Gy), RDreduced (radiation dose of 60-65.9 Gy), EBV (Epstein-Barr virus), CC-CCD (cumulative cisplatin dose during concurrent chemoradiotherapy), NAC-CCD (cumulative cisplatin dose during neoadjuvant chemotherapy), OS (overall survival), DMFS (distant metastasis-free survival), PT-RDstandard (radiation dose of 66-72 Gy to primary tumor), PT-RDreduced (radiation dose of 60-65.9 Gy to primary tumor), LN-RDstandard (radiation dose of 66-72 Gy to lymph nodes), LN-RDreduced (radiation dose of 60-65.9 Gy to lymph nodes)
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