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  • Can Epstein–Barr virus‐deox...
    Zhang, Qun; Peng, Zhen‐Wei; Gu, Zhuo‐Sheng; Wang, Yan; He, Fang; Zhao, Wen‐Bin; Luo, Wei; Mei, Yong‐Yu

    Cancer medicine, January 2023, Letnik: 12, Številka: 1
    Journal Article

    Background Induction chemotherapy (IC) comprising docetaxel, cisplatin, and fluorouracil (TPF), combined with concurrent chemoradiotherapy (CCRT) effectively improves the survival rate of locally advanced nasopharyngeal carcinoma (LA‐NPC). Selecting patients whose risk of tumor recurrence and metastasis is high and the appropriate chemotherapy intensity is a concern. We combined tumor‐node‐metastasis staging with the load of Epstein–Barr virus (EBV) after IC to select the individualized chemotherapy strength. Methods The clinical data and prognostic factors of patients with stage III–IV LA‐NPC treated with TPF IC combined with CCRT were analyzed retrospectively. The conventional treatment group received the standard three cycles TPF IC combined with CCRT. For the new treatment group, the cycles of IC were determined according to whether the EBV‐DNA disappeared completely after a certain course of IC, if so, subsequent IC was stopped and the chemoradiotherapy stage was entered. Propensity score matching (PSM) was performed at a ratio of 1:1 to balance baseline characteristics. Survival outcomes and adverse events between the conventional treatment group and the new method treatment group were compared. Results The study included 256 patients, among whom 192 were matched successfully into 96 pairs. The patients were followed up for a median of 51 months. The proportions of patients receiving three, two, and one cycle of IC after PSM in the routine and new treatment cohorts were 93.8%, 3.1%, 3.1% versus 21.9%, 49.0%, 24.0%, respectively. However, their 3‐year distant metastasis‐free survival, local recurrence‐free survival, progression‐free survival, and overall survival did not differ significantly. The incidence of grade 3–4 neutropenia toxicity in CCRT decreased significantly in patients receiving the new treatment method compared with that in the conventional treatment group (p = 0.026). Conclusion Combining TNM stage and EBV‐DNA load after IC to determine the courses of IC in patients with LA‐NPC did not alter the curative effect but decreased toxicity. The cycles of induction chemotherapy IC were determined according to whether the EBV‐DNA disappeared completely after a certain course of IC. In the new method group, the cycles of induction chemotherapy were reduced by 28%, and the serious neutropenia toxicity was decreased by 10% during concurrent chemoradiotherapy, comparted with the routine strategy. However, their 3‐year distant metastasis free survival, local recurrence free survival, progression free survival, and overall survival did not differ significantly.