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  • [J Clin Oncol.] Prognostic Model for Stratification of Radioresistant Nasopharynx Carcinoma to Curative Salvage Radiotherapy.

    National Cancer Centre Singapore / Melvin L.K. Chua*, MBBS, FRCR

  • 출처
    J Clin Oncol.
  • 등재일
    2018 Mar 20
  • 저널이슈번호
    36(9):891-899.
  • 내용

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    Abstract

    Purpose

    To investigate for a prognostic index (PI) to personalize recommendations for salvage intensity-modulated radiotherapy (IMRT) in patients with locally recurrent nasopharyngeal carcinoma (lrNPC).

    Methods

    Patients with lrNPC from two academic institutions (Sun Yat-Sen University Cancer Center [SYSUCC-A; n = 251 (training cohort)] and National Cancer Centre Singapore [NCCS; n = 114] and SYSUCC-B [n = 193 (validation cohorts)]) underwent salvage treatment with IMRT from 2001 to 2015. Primary and secondary clinical end points were overall survival (OS) and grade 5 toxicity-free rate (G5-TFR), respectively. Covariate inclusion to the PIs was qualified by a multivariable two-sided P < .05. Discrimination and calibration of the PIs were assessed.

    Results

    The primary PI comprised covariates that were adversely associated with OS in the training cohort (gross tumor volumerecurrence hazard ratio [HR], 1.01/mL increase [ P < .001], agerecurrence HR, 1.02/year increase [ P = .008]; repeat IMRT equivalent dose in 2-Gy fractions [EQD2] ≥ 68 Gy HR, 1.42 [ P = .03]; prior radiotherapy-induced grade ≥ 3 toxicities HR, 1.90 [ P = .001]; recurrent tumor [rT]-category 3 to 4 HR, 1.96 [ P = .005]), in ascending order of weight. Discrimination of the PI for OS was comparable between training and both validation cohorts (Harrell's C = 0.71 [SYSUCC-A], 0.72 [NCCS], and 0.69 [SYSUCC-B]); discretization by using a fixed PI score cutoff of 252 determined from the training data set yielded low- and high-risk subgroups with disparate OS in the validation cohorts (NCCS HR, 3.09 [95% CI, 1.95 to 4.89]; SYSUCC-B HR, 3.80 [95% CI, 2.55 to 5.66]). Our five-factor PI predicted OS and G5-TFR (predicted v observed 36-month OS and G5-TFR, 22% v 15% and 38% v 44% for high-risk NCCS and 26% v 31% and 45% v 46% for high-risk SYSUCC-B).

    Conclusion

    We present a validated PI for robust clinical stratification of radioresistant NPC. Low-risk patients represent ideal candidates for curative repeat IMRT, whereas novel clinical trials are needed in the unfavorable high-risk subgroup.

     

     

    Author information

    Li YQ1, Tian YM1, Tan SH1, Liu MZ1, Kusumawidjaja G1, Ong EHW1, Zhao C1, Tan TWK1, Fong KW1, Sommat K1, Soong YL1, Wee JTS1, Han F1, Chua MLK1.

    1 You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine, Guangzhou; Sun Yat Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong, People's Republic of China.

  • 편집위원

    re-RT가 치료 선택지로 흔히 고려되는 국소재발성 비인두암에서 clinical trial의 대상을 선별하는 방법론이 흥미로움

    2018-04-17 10:50:01

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