Induction chemotherapy followed by concurrent chemoradiotherapy is a standard in the treatment of advanced, nonmetastatic nasopharyngeal carcinoma. This approach significantly improve survival, and ...it is accepted as a standard of care for stage III-IVA disease. However, this strategy is associated with considerable acute toxicity and a risk of short-term mortality.
The aims of this study were to determine the rate and to characterize the causes of early death, in order to define the subset of patient with higher risk of early mortality.
We conducted a single-center retrospective study including patients, diagnosed with locally advanced non-metastatic undifferentiated carcinoma of the nasopharynx treated with induction chemotherapy followed by concurrent chemoradiotherapy, in the National Institute of Oncology in Morocco, from 1 January 2018 until 31 December 2021.
Early death was defined as any death during the course of therapy or within 6 months following the end of chemoradiotherapy.
Clinicopathological characteristics was collected, and their prognostic value affecting early mortality was tested using univariate and multivariate Cox proportional hazards models.
A total of 263 patients were included (median age 55, range 21-77 years, 61.5% male). Disease were predominately stage III (68.2 %) and 31.8% were stage IVA in the AJCC 8th edition.
Induction chemotherapy consisted of 3 cycles of cisplatin-based chemotherapy followed by concurrent chemoradiotherapy (Volumetric-modulated arc therapy plus platinum weekly chemotherapy).
22 patients (8.4%) did not complete all three cycles of induction chemotherapy, and only 195 of 263 patients (74.1%) received concurrent chemoradiotherapy with the full planned course of chemotherapy.
Early death occurred in 18 patients (6.8%), of these 15 (83.3%) patients died of a treatment-related cause. The incidence of acute adverse events of grade ≥ 3 was 78.5%.
Age, low performance status, and low body mass index before treatment were significantly correlated with the occurrence of early death in multivariate analysis.
At a median follow-up of 41.5 months, the 2-year relapse-free survival and overall survival rates were 76.1% and 82% respectively.
Almost 7% of patient with advanced, nonmetastatic nasopharyngeal carcinoma will die within the 6 months following the end of treatment.
Identification of patients who are at risk may help in minimizing the risk of early death, by optimizing performance and nutritional status before therapy, along with the proposition of a less aggressive treatment strategy in older patients.
Nasopharyngeal carcinoma (NPC) is one of the most frequent cancers in Morocco, with 5-7 cases per 100,000 persons annually.
The most common histological type is undifferentiated carcinoma of ...nasopharyngeal type (UCNT), while squamous cell carcinoma represents only 5 to 10% of cases.
The aim of this study is to characterize the epidemiological, clinical, and evolutionary features of nasopharyngeal squamous cell carcinoma.
Data were collected from the records of 61 patients with non metastatic nasopharyngeal cancers treated in the Radiotherapy department at the National Oncology Institute in Rabat, Morocco, between January 1st, 2019, and December 31, 2019.
Among the 61 cases of nasopharyngeal carcinoma, only 7 were squamous cell carcinomas. The majority of patients were male (70%), with an average age of 49 years (range 18-61), and 70% were chronic smokers.
Stage at diagnosis was III and II According to the TNM classification (UICC 8th edition 2017), in 58% and 42% of cases respectively.
Neoadjuvant chemotherapy was indicated in 85% of cases, followed by curative concurrent chemoradiotherapy, using the VMAT (Volumetric Modulated Arc Therapy) technique, delivering 70 Gy in 33 fractions, along with cisplatin-based chemotherapy (40mg/m2/week) with an average of 5 cycles.
At 4-year follow-up, local relapses were observed in 2 patients (28% of cases), while metastatic relapses in the lungs and bones were observed in 3 patients (42% of cases), and a complete response was observed in 2 patients (28%).
Our study shows that squamous cell carcinoma of the nasopharynx remains a relatively rare histological form of nasopharyngeal cancers, strongly associated with chronic smoking, and exhibits an unfavorable outcome compared to UCNT.
nasopharyngeal cancer often involves heavy treatment based on radio-chemotherapy which can affect the body image of patients, however,this parameter is often neglected by health professionals and its ...impact can be devastating.
Evaluate body image in patients with cavum cancers at different times during treatment.
This is a descriptive cohort study assessing body image that included 30 patients treated between January and March 2022. For cavum cancer. The Body Image Scale (BIS) was used for this assessment.
A high score reflected an alteration in body image. The average age was 45 years (20-65 years) with a sex ratio of 2.5. The majority of patients were married, of urban origin (17 patients; 56%) and of primary education level (15 patients; 50%). The tumor stage (III) was the most represented (24 patients; 80%); the questionnaire was carried out during treatment for 20 patients (66%) Before treatment for 5 patients (16%) and in the first 6 months of follow-up for 5 patients (16%); 2 patients had a recurrence of the disease (6%).
Patients presented functional symptoms related to cancer or treatments in 90% (27 patients). The most common symptoms were: dysphagia (15 patients), xerostomia (8 patients), hair loss and dysgeusia (6 patients) and fatigue, pain and burning sensations in 5 patients.
These symptoms bothered the patients in 90% of cases (27 patients) and had caused a negative psychological impact in 66% of cases (20patients); 8 patients (26%) expressed an avoidance of the mirror, felt less attractive and believed they were victims of mutilating treatment.
10 patients (33%) expressed social avoidance and discomfort with themselves and 7 patients expressed a lack of self-confidence (23%) and discomfort with their partner (20%). 13 patients felt depressed (43%), however 17 patients felt optimistic (56%) and no patients expressed suicidal thoughts. All patients claimed to have a containing family and 13 patients (43%) complained of a negative impact on the profession. 14 patients used camouflage objects (46%), the most frequent of which: a scarf in 8 patients and a cap or hat in 6 patients, the average BSI score was 17 (10-37).
Screening for altered body image in patients with cavum cancer seems to be essential by all health professionals, which helps improve the quality of life of patients.
Nasopharyngeal cancer is common in Morocco. It is a clinicobiological and histological entity that differs from other head and neck cancers, notably in its geographical distribution and evolutionary ...profile.
The aim of our work was to evaluate the impact of treatment tolerance and toxicity in nasopharyngeal cancer in elderly (age at diagnosis ≥ 60 years).
This was a retrospective study of patients with nasopharyngeal cancer treated by VMAT technique in the radiotherapy department at the Institute of Oncology RABAT between January 2018 and December 2021.
Patients received radiotherapy with or without concomitant systemic therapy.
We identified 257 patients: 21% elderly and 79% young, with no differences in AJCC stage 8th edition, Tumors were classified as T1 in 11 %, T2 in 33%, T3 in 24 %, and T4 in 32 %.
Median age in elderly group was 66 years, Sex repartition: 79% men and 21% women. Comorbidities were observed in 14% cases.
The predominant histological type was undifferentiated nasopharyngeal carcinoma (UCNT) in 87% of cases.
Median total duration was 45 days, with 3% patient who did not complete the prescribed RT course with no differences across age groups.
31% patient received radiotherapy alone and 69% received concomitant radio-chemotherapy to a total dose of 69.96 Gy, combined with weekly Cisplatin at a dose of 40 mg/m2/week.
Patients underwent weekly clinical and tomographic monitoring. The dominant side effect was radiomucositis: 55% G1, 20% G2, 22% of patients presented G3, and 3% were hospitalized for G4.
In terms of evolution, locoregional control was found in 75% of patients treated, with 11% of recurrence and 4% metastatic progression. 6% of patients died of their cancer and 4% were lost to follow-up.
Nasopharyngeal Cancer presents a particular evolutionary profile, which partly explains the therapeutic failures despite high radiosensitivity. For the age group studied, this evolutionary profile is compounded by a high delay in consultation and a terrain already weakened by age.
Nasopharyngeal carcinoma (NPC) is one of the most important cancers in Morocco, with 5-7 cases/100,000 persons a year. Its etiology is not well known, but cigarette smoking has been implicated in ...some epidemiologic studies.
This is a retrospective epidemiological study of the NPC in the North-West of Morocco, to evaluates the impact of the consumption of tobacco on the risk of development of NPC.
In this retrospective study, we identified 194 patients with nasopharyngeal cancers, treated in the Radiotherapy department at the National Oncology Institute in Rabat between January 1st, 2019 and December 31, 2021 by curative concurrent chemo-radiotherapy.
We compared the number of patients using cigarettes with the number of non-smokers patients.
The study show that this cancer was predominant in men, particularly in the population between 40-and 59-years-old.
The percentage of patients who smoked was 33% (63 patients) compared with 67% of non-smokers patients (131 patients).
Based on the information provided earlier, we can conclude that our findings indicate there is no association between long-term cigarette smoking and the risk of developing Nasopharyngeal carcinoma.
The local control rate of nasopharyngeal carcinomas has increasingly increased since the routine use of intensity-modulated conformal radiotherapy. The treatment of local recurrences is essentially ...based on reirradiation; but it is limited by the doses previously received by the organs at risk in series. Evaluate the Efficacy and Toxicity of Reirradiation of Local Relapses of Nasopharyngeal Carcinoma
This is a retrospective study, including 12 patients re-irradiated at the National Institute of Oncology in Rabat for a local or locoregional relapse between 2015 and 2020.
Among 600 irradiated patients, 12 patients had a local or locoregional recurrence for which they received intensity-modulated reirradiation. The average age of patients at the time of initial diagnosis was 40.8 years (range 22 to 52 years). The tumor was initially classified according to the AJCC 2017 classification stage II, stage III and stage IV in 2 cases (16%), 4 cases (34%) and 6 cases (50%) respectively. Initial treatment was based on neoadjuvant chemotherapy followed by concomitant chemoradiotherapy in 9 patients (75%) and concomitant chemoradiotherapy alone in 3 patients (30%). Initial irradiation was using a conventional three-dimensional technique having delivered a total dose of 70 Gy at a rate of 2 Gy per session. All patients were in complete remission. The average time to local relapse was 7 years (range: 3 years – 10 years). The diagnosis was confirmed by a pathological study in all patients. Recurrence was classified stage II, stage III and stage IV respectively in 3 cases (25%), 5 cases (41%) and 4 cases (33%). Therapeutically, 5 patients (50%) received neoadjuvant chemotherapy followed by concomitant chemoradiotherapy; 6 patients (90%) received radiochemotherapy concomitant therapy alone and one patient received exclusive radiotherapy. The reirradiation was with intensity modulation by Arc Therapy, having delivered a total dose of 60 Gy in all patients at a rate of 2Gy per fraction. After a mean follow-up of 19 months (range: 10 months – 34 months), seven patients were in complete remission; two died of the disease after an average follow-up of 10 months and three patients were lost to follow-up. The late toxicity of reirradiation was an increase in hearing toxicity (grade 3 becoming grade 4) in 4 patients, trismus in two patients and cervical fibrosis in two patients.
Reirradiation is the only salvage treatment for recurrences of nasopharyngeal carcinomas, precisely conformal radiotherapy with intensity modulation which makes it possible to deliver sufficient doses to the tumor volume while sparing the organs at risk already irradiated; however, given the associated toxicity, patients must be rigorously selected.
Nasopharyngeal cancer presents clinical, therap,eutic and progressive particularities; it is a chemo- and radiosensitive disease, its management is complex due to the lack of specific trials for ...children. Primary aim was evaluating the role of radiotherapy in the management of nasopharyngeal cancer in children. And describing the epidemiological, clinical assecondary aims.
A retrospective analysis of patients aged under 15 years, and treated for nasopharyngeal cancer between January 2017 and december 2020 in the radiotherapy department of the National Institute of Oncology in Morocco; data were collected from medical records.
Twenty patients were collected, the median age was 13 years, the tumors were classified as stage III in 9 cases (45%) and stage IVA in 11 cases (55%). One patient (5%) was metastatic at the time of diagnosis, 13 patients (65%) received induction chemotherapy with TPF (docetaxel, cisplatin, 5FU), 2 (10%) with ECF (epirubicin, cisplatin,5FU). After a median follow-up of 24 months, 4 patients (20%) presented with a metastatic relapse, and one patient (5%) presented with local regional or distant. Overall survival at 2 years was is 90%. In subgroup analysis, a number of courses greater than 4 or greater than 5 and a cumulative dose of cisplatin greater than 380 mg/m2 were associated with better OS. No grade 3-4 late toxicity was observed; the most common late toxicity was grade 1-2 xerostomia in 9 patients (45%), grade 1 skin fibrosis in 15% of patients.
Childhood nasopharyngeal cancers treated with induction chemotherapy followed by concomitant radiotherapy and chemotherapy have a better prognosis than that of older patients, however metastatic relapses remain frequent and determine the prognosis. The number of chemotherapy courses as well as the cumulative dose of cisplatin seem to largely influence the therapeutic results.
Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy (NAC-CCRT) is an alternative strategy for decreasing tumor size and controlling micrometastases before main treatment. The aim of ...this study was to investigate
This retrospective study included consecutive histologically confirmed Locally Advanced Nasopharyngeal cancer patient treated with NAC-CCRT at the Institute of Oncology RABAT Hospital during the January 2018 to December 2021.
CCRT protocols consisted of 3-week cycles of cisplatin 100 mg/m2 with concurrent radiotherapy. NAC consisted of 3-week cycles of cisplatin on day 1 and, 5 fluorouracil on days 1–4, or Doxorubicine on day 1 for a maximum three cycles.
Of the 257 patients that received treatment during the study period,
86% patient received NAC-CCRT, and 14 % patient received CCRT (p < 0.001).
Median follow-up was 36 months. Significantly more patients with advanced clinical stage (stage IVA-IVB).
Toxicities were reported at 42% of the patients, with a higher incidence of neutropenia, anemia, nausea and vomiting, renal toxicity and radiomucositis Grade 3 and 4.
At a Median follow-up of 48 months, locoregional control was found in 75% of patients treated, with 11 % of recurrence and 4% metastatic progression. 6% of patients died of their cancer and 4% were lost to follow-up
In patients that received neo adjuvant chemotherapy, locoregional relapse should be of concern. High-risk distant metastasis patients (N3 stage) that could achieve survival advantage from NAC-CCRT is an interesting and important topic for further study.
Concurrent chemo-radiotherapy (CCR) is currently the gold standard treatment for nasopharyngeal carcinoma (NPC). The objective of this retrospective study is to analyze the variations in weight ...observed in patients with nasopharyngeal cancers under concurrent chemo-radiotherapy, in order to optimize dietary care.
240 patients with nasopharyngeal cancers, treated in the Radiotherapy department at the National Oncology Institute in Rabat between January 1st, 2018 and December 30, 2021 by curative concurrent chemo-radiotherapy, using the VMAT (Volumetric Modulated Arc Therapy) technique delivering 70 Gy in 33 fractions, with chemotherapy based on cisplatin (40mg / m2 / week) with an average of 5 cures.
Variations in weight were collected at the beginning, the mid, and the end of treatment.
From the beginning to the end of treatment, it can be seen that 85% of patients lost weight (median = 6,05 kg 1,5kg- 13,6kg), according to a separate distribution: 33% had lost more than 8 kg, 56% had lost between 3 and 8 kg, and only 11% had lost less than 3 kg.
Weight loss from mid to end of treatment (median = 3, 55 kg 1 kg–8,1 kg) was greater than that from baseline to mid-treatment (median = 2,5 kg 0,5 kg–5,5kg) (P = 0.016).
For the rest of patients (15%) : 7% had kept a stable weight, and 8% gained an average of 2 to 6 kg.
Three-quarters of patients receiving concurrent chemo-radiotherapy lost weight during treatment, despite weekly adverse reaction monitoring.
Early nutrition intervention with dietary advice associated with oral nutritional supplementation is necessary in order to favorably influence the outcome of patients by limiting weight loss.
Treatment of nasopharyngeal cancer is based on radiotherapy associated to chemotherapy.
The standard for patients with locoregionally advanced carcinoma is induction chemotherapy associated to ...concurrent chemoradiotherapy.
The aim of our study is to determine the recurrence free survival and overall survival.
Our study focused on non metastatic patients with locoregionally advanced nasopharyngeal carcinoma: T3-T4 with positive nodes.
Treated by induction chemotherapy and concurrent chemoradiotherapy between 2018 and 2021.
For the induction chemotherapy, patients received cisplatin associated to gemcitabine for three cycles.
In concurrent chemoradiotherapy, total dose was 69,96-70 Gray in 33-35 fractions 5 days a week using Volumetric Modulated Arc Therapy (VMAT) plus cisplatin weekly at a dose of 40 mg per square meter of body surface.
Treatment, side effects, loco-regional and distant control and overall survival were collected.
A total of 153 patients were included in the study, patients with metastatic disease were excluded.
We had 61,4% of men vs 38,6% of women with a median age of 49 years old.
13,7% of patients had arterial hypertension or diabetes.
A total of 83,1% of the patients received three cycles of induction chemotherapy.
81,6% received the full dose of radiotherapy, the others interrupted the treatment for side effects.
52,3% of the patients received seven cycles of concurrent chemotherapy.
Side effects were reported in 41,8% of the patients with a higher incidence of neutropenia, anemia, nausea-vomiting, renal toxicity and mucositis.
Grade 3 or 4 toxic side effects were reported in 19,6% of the patients.
At a median follow-up of 44 months, the 2-year recurrence-free survival was 73,2%.
Overall survival at 2 years was 89.4%.
The results of our study are similar to literature's results; the induction chemotherapy followed by concurrent chemoradiotherapy in the locoregionally advanced nasopharyngeal carcinoma promotes distant control and increases overall survival.
Sides effects are unavoidable so they must be recognized and treated early to avoid grade 3 and 4.
