Paolo Bossi1, Annalisa Trama2, Alice Bernasconi3, Salvatore Grisanti4, Issa Mohamad5, Isabel L Galiana6, Enis Ozyar7, Pierfrancesco Franco8, Stefania Vecchio9, Pierluigi Bonomo10, Beatriz C Cirauqui11, Mustafa El-Sherify12, Stefano Ursino13, Athanassios Argiris14, Jonathan Pan15, Claus Wittekindt16, Elisa D'Angelo17, Loredana Costa18, Michela Buglione19, Jennifer Johnson20, Mario Airoldi21, Ricard Mesia22, Carlo Resteghini23, Lisa Licitra24, Ester Orlandi25. 1. Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy; Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy. Electronic address: paolo.bossi@unibs.it. 2. Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy. Electronic address: annalisa.trama@istitutotumori.mi.it. 3. Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy. Electronic address: alice.bernasconi@istitutotumori.mi.it. 4. Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy. Electronic address: grisanti.salvatore@gmail.com. 5. Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan. Electronic address: imohamad@khcc.jo. 6. Radiation Oncology Department, Hospital Duran IReynals, Institut Català D'Oncologia-L'Hospitalet, Radiobiology and Cancer Group, IDIBELL, Barcelona, Spain. Electronic address: ilinaresgaliana@iconcologia.net. 7. Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey. Electronic address: enis.ozyar@acibadem.com. 8. Department of Translational Medicine (DIMET), University of Eastern Piedmont and AOU 'Maggiore Della Carita', Novara, Italy. Electronic address: pierfrancesco.franco@unito.it. 9. Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy. Electronic address: stefania.vecchio@hsanmartino.it. 10. Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: bonomopierlu@gmail.com. 11. Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain. Electronic address: bcirauqui@iconcologia.net. 12. Radiation Oncology Department, Kuwait Cancer Control Centre, Kuwait. Electronic address: mustafashawki@yahoo.com. 13. Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Electronic address: stefanoursino9@gmail.com. 14. Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: athanassios.argiris@gmail.com. 15. Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: jonathan.pan@jefferson.edu. 16. Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Justus-Liebig University Giessen, Giessen, Germany. Electronic address: Claus.Wittekindt@hno.med.uni-giessen.de. 17. Radiation Oncology Unit, University Hospital of Modena, Italy. Electronic address: dangelo.elisa@policlinico.mo.it. 18. Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy. Electronic address: lcosta77@libero.it. 19. Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy. Electronic address: michela.buglione@unibs.it. 20. Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: Jennifer.M.Johnson@jefferson.edu. 21. Medical Oncology, Città Della Salute e Della Scienza, Torino, Italy. Electronic address: airoldim@yahoo.com. 22. Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain. Electronic address: rmesia@iconcologia.net. 23. Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy. Electronic address: carlo.resteghini@istitutotumori.mi.it. 24. Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: lisa.licitra@istitutotumori.mi.it. 25. Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. Electronic address: Ester.orlandi@cnao.it.
Abstract
AIM: Recommendations for managing patients with nasopharyngeal carcinoma (NPC) in non-endemic areas are largely derived from studies conducted in endemic areas. We analysed the impact of treatment approaches on survival in non-endemic areas. METHODS: In an international, multicentre, retrospective study, we analyse consecutive patients with NPC diagnosed between 2004 and 2017 in 36 hospitals from 11 countries. Treatment was categorised as non-intensive (NIT), including radiotherapy alone or concomitant chemoradiotherapy (cCRT), and intensive (IT) including cCRT preceded by and/or followed by chemotherapy (CT). The impact of IT on overall survival (OS) and disease-free survival (DFS) was adjusted for all the available potential confounders. RESULTS: Overall, 1021 and 1113 patients were eligible for overall survival (OS) and disease-free survival (DFS) analyses, respectively; 501 and 554 with Epstein Barr-encoded RNA (EBER) status available. In the whole group, 5-year OS was 84% and DFS 65%. The use of NIT was associated with a risk of death or recurrence 1.37 times higher than patients receiving IT. Patients submitted to NIT and induction CT + concurrent concomitant chemo and three-dimensional Conformal Radiation Therapy (3DCRT) had a risk of death or recurrence 1.5 and 1.7 times higher than patients treated with induction CT + cCRT with intensity-modulated radiotherapy (IMRT), respectively. The IT had no impact on OS in neither patients with EBER+ nor in patients with EBER-; IT showed better DFS in EBER+ but not in patients with EBER-. CONCLUSIONS: In low-incidence areas, patients with NPC treated with induction CT followed by concurrent IMRT cCRT achieved the highest DFS rate. The benefit of IT on DFS was restricted to patients with EBER+, suggesting that additional therapy offers no advantages in EBER- cases.
AIM: Recommendations for managing patients with nasopharyngeal carcinoma (NPC) in non-endemic areas are largely derived from studies conducted in endemic areas. We analysed the impact of treatment approaches on survival in non-endemic areas. METHODS: In an international, multicentre, retrospective study, we analyse consecutive patients with NPC diagnosed between 2004 and 2017 in 36 hospitals from 11 countries. Treatment was categorised as non-intensive (NIT), including radiotherapy alone or concomitant chemoradiotherapy (cCRT), and intensive (IT) including cCRT preceded by and/or followed by chemotherapy (CT). The impact of IT on overall survival (OS) and disease-free survival (DFS) was adjusted for all the available potential confounders. RESULTS: Overall, 1021 and 1113 patients were eligible for overall survival (OS) and disease-free survival (DFS) analyses, respectively; 501 and 554 with Epstein Barr-encoded RNA (EBER) status available. In the whole group, 5-year OS was 84% and DFS 65%. The use of NIT was associated with a risk of death or recurrence 1.37 times higher than patients receiving IT. Patients submitted to NIT and induction CT + concurrent concomitant chemo and three-dimensional Conformal Radiation Therapy (3DCRT) had a risk of death or recurrence 1.5 and 1.7 times higher than patients treated with induction CT + cCRT with intensity-modulated radiotherapy (IMRT), respectively. The IT had no impact on OS in neither patients with EBER+ nor in patients with EBER-; IT showed better DFS in EBER+ but not in patients with EBER-. CONCLUSIONS: In low-incidence areas, patients with NPC treated with induction CT followed by concurrent IMRT cCRT achieved the highest DFS rate. The benefit of IT on DFS was restricted to patients with EBER+, suggesting that additional therapy offers no advantages in EBER- cases.