Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
Department of Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Cancer Med. 2022 Feb;11(3):715-727. doi: 10.1002/cam4.4477. Epub 2021 Dec 3.
The optimal cumulative cisplatin dose (CCD) during radiation therapy for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients receiving induction chemotherapy (IC) plus CCRT remains controversial. This study aimed to explore the treatment efficiency of CCD for high-and low-risk patients with LA-NPC.
Data from 472 LA-NPC patients diagnosed from 2014 to 2018 and treated with IC plus CCRT were reviewed. After propensity score matching, the therapeutic effects of a CCD > 200 and CCD ≤ 200 mg/m were evaluated comparatively. Five factors selected by multivariate analysis were incorporated to develop a nomogram. Subgroup analysis was conducted to explore the role of different CCDs in nomogram-defined high- and low-risk groups. Additionally, acute toxicities were evaluated comparatively between the high- and low-CCD groups.
After matching, there was no difference between different CCD groups for all patients in terms of 3-year overall survival (OS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRRFS), or progression-free survival (PFS). A nomogram was built by integrating pretreatment EBV DNA, clinical stage, and post-IC EBV DNA, post-IC primary gross tumor and lymph node volumes obtained a C-index of 0.674. The high-risk group determined by the nomogram had poorer 3-year PFS, OS, DMFS, and LRRFS than the low-risk group. A total of CCD > 200 mg/m increased the survival rates of 3-year PFS and DMFS (PFS: 72.5% vs. 54.4%, p = 0.012; DMFS: 81.9% vs. 61.5%, p = 0.014) in the high-risk group but not in the low-risk group. Moreover, the high CCD increased treatment-related acute toxicities.
A high CCD was associated with better 3-year PFS and DMFS rates than a low dose for high-risk patients but could not produce a survival benefit for low-risk patients.
接受诱导化疗（IC）加同期放化疗（CCRT）的局部晚期鼻咽癌（LA-NPC）患者，其放射治疗过程中最佳累积顺铂剂量（CCD）仍存在争议。本研究旨在探讨 CCD 对 LA-NPC 高危和低危患者的治疗效果。
回顾性分析 2014 年至 2018 年间诊断为 LA-NPC 并接受 IC 加 CCRT 治疗的 472 例患者的数据。经倾向性评分匹配后，比较 CCD＞200mg/m 和 CCD≤200mg/m 的治疗效果。采用多因素分析选择的 5 个因素构建列线图。进行亚组分析以探讨不同 CCD 在列线图定义的高危和低危组中的作用。此外，还比较了高低 CCD 组之间的急性毒性。
匹配后，对于所有患者，不同 CCD 组之间的 3 年总生存率（OS）、无远处转移生存率（DMFS）、无局部区域复发生存率（LRRFS）和无进展生存率（PFS）均无差异。通过整合治疗前 EBV DNA、临床分期、IC 后 EBV DNA、IC 后原发肿瘤和淋巴结体积，构建了一个 C 指数为 0.674 的列线图。该列线图确定的高危组的 3 年 PFS、OS、DMFS 和 LRRFS 均低于低危组。对于高危组，总 CCD＞200mg/m 可提高 3 年 PFS 和 DMFS 生存率（PFS：72.5% vs. 54.4%，p=0.012；DMFS：81.9% vs. 61.5%，p=0.014），但在低危组中无此作用。此外，高 CCD 增加了与治疗相关的急性毒性。
对于高危患者，高 CCD 与 3 年 PFS 和 DMFS 率的提高相关，但对于低危患者，不能产生生存获益。
