PURPOSE: The treatment of childhood nasopharyngeal carcinoma has been adapted from adult regimens; pediatric-specific studies are limited. The ARAR0331 study sought to evaluate the impact of induction chemotherapy (IC) and concurrent chemoradiotherapy (CCR). PATIENTS AND METHODS: Patients with American Joint Committee on Cancer stages IIb to IV were scheduled to receive three cycles of IC with cisplatin and fluorouracil, followed by CCR with three cycles of cisplatin. Patients with complete or partial response to IC received 61.2 Gy to the nasopharynx and neck, and patients with stable disease received 71.2 Gy. RESULTS:Between February 2006 and January 2012, 111 patients (75 male) were enrolled. Median age was 15 years, and 46.8% of the patients were African American. After a feasibility analysis, the study was amended to reduce cisplatin to two cycles during CCR. The 5-year event-free survival (EFS) and overall survival estimates were 84.3% and 89.2%, respectively. The 5-year EFS for stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two CCR cycles of cisplatin had improved 5-year postinduction EFS (90.7% v 81.2%, P = .14). CONCLUSION: Patients in ARAR0331 were characterized by advanced disease and by a high proportion of black children and adolescents. Treatment with IC and CRT resulted in excellent outcomes. A radiation dose reduction is possible for patients responding to IC. Although the outcomes are comparable, we observed a trend toward decreased EFS for patients assigned to receive fewer doses of cisplatin during CCR.
RCT Entities:
PURPOSE: The treatment of childhood nasopharyngeal carcinoma has been adapted from adult regimens; pediatric-specific studies are limited. The ARAR0331 study sought to evaluate the impact of induction chemotherapy (IC) and concurrent chemoradiotherapy (CCR). PATIENTS AND METHODS: Patients with American Joint Committee on Cancer stages IIb to IV were scheduled to receive three cycles of IC with cisplatin and fluorouracil, followed by CCR with three cycles of cisplatin. Patients with complete or partial response to IC received 61.2 Gy to the nasopharynx and neck, and patients with stable disease received 71.2 Gy. RESULTS: Between February 2006 and January 2012, 111 patients (75 male) were enrolled. Median age was 15 years, and 46.8% of the patients were African American. After a feasibility analysis, the study was amended to reduce cisplatin to two cycles during CCR. The 5-year event-free survival (EFS) and overall survival estimates were 84.3% and 89.2%, respectively. The 5-year EFS for stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two CCR cycles of cisplatin had improved 5-year postinduction EFS (90.7% v 81.2%, P = .14). CONCLUSION:Patients in ARAR0331 were characterized by advanced disease and by a high proportion of black children and adolescents. Treatment with IC and CRT resulted in excellent outcomes. A radiation dose reduction is possible for patients responding to IC. Although the outcomes are comparable, we observed a trend toward decreased EFS for patients assigned to receive fewer doses of cisplatin during CCR.
Authors: Lachlan J McDowell; Kathy Rock; Wei Xu; Biu Chan; John Waldron; Lin Lu; Shereen Ezzat; David Pothier; Lori J Bernstein; Nathaniel So; Shao Hui Huang; Meredith Giuliani; Andrew Hope; Brian O'Sullivan; Scott V Bratman; John Cho; John Kim; Raymond Jang; Andrew Bayley; Jolie Ringash Journal: Int J Radiat Oncol Biol Phys Date: 2018-06-04 Impact factor: 7.038
Authors: Michela Casanova; Gianni Bisogno; Lorenza Gandola; Giovanni Cecchetto; Andrea Di Cataldo; Eleonora Basso; Paolo Indolfi; Paolo D'Angelo; Francesca Favini; Paola Collini; Paolo Potepan; Andrea Ferrari Journal: Cancer Date: 2011-09-14 Impact factor: 6.860
Authors: Chrystal U Louis; Karin Straathof; Catherine M Bollard; Sravya Ennamuri; Claudia Gerken; Teresita T Lopez; M Helen Huls; Andrea Sheehan; Meng-Fen Wu; Hao Liu; Adrian Gee; Malcolm K Brenner; Cliona M Rooney; Helen E Heslop; Stephen Gottschalk Journal: J Immunother Date: 2010 Nov-Dec Impact factor: 4.456
Authors: Martina Buehrlen; Christian Michel Zwaan; Bernd Granzen; Lisa Lassay; Peter Deutz; Peter Vorwerk; Gundula Staatz; Günther Gademann; Hans Christiansen; Foppe Oldenburger; Miriam Tamm; Rolf Mertens Journal: Cancer Date: 2012-02-22 Impact factor: 6.860
Authors: Brigette B Y Ma; Wan-Teck Lim; Boon-Cher Goh; Edwin P Hui; Kwok-Wai Lo; Adam Pettinger; Nathan R Foster; Jonathan W Riess; Mark Agulnik; Alex Y C Chang; Akhil Chopra; Julie A Kish; Christine H Chung; Douglas R Adkins; Kevin J Cullen; Barbara J Gitlitz; Dean W Lim; Ka-Fai To; K C Allen Chan; Y M Dennis Lo; Ann D King; Charles Erlichman; Jun Yin; Brian A Costello; Anthony T C Chan Journal: J Clin Oncol Date: 2018-03-27 Impact factor: 50.717
Authors: Tristan Römer; Sabrina Franzen; Hanna Kravets; Ahmed Farrag; Anna Makowska; Hans Christiansen; Michael J Eble; Beate Timmermann; Gundula Staatz; Felix M Mottaghy; Martina Bührlen; Ulrich Hagenah; Alexander Puzik; Pablo Hernáiz Driever; Jeanette Greiner; Norbert Jorch; Stephan Tippelt; Dominik T Schneider; Gabriele Kropshofer; Tobias R Overbeck; Holger Christiansen; Triantafyllia Brozou; Gabriele Escherich; Martina Becker; Waltraud Friesenbichler; Tobias Feuchtinger; Wolfram Puppe; Nicole Heussen; Ralf D Hilgers; Udo Kontny Journal: Cancers (Basel) Date: 2022-02-28 Impact factor: 6.639