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- Title
Determining the suitability of definitive radiation therapy in patients with metastatic nasopharyngeal carcinoma based on PET/CT: a large cohort study.
- Authors
Yang, Zhen-Chong; Hu, Ying-Ying; Liu, Li-Ting; Guo, Shan-Shan; Du, Chao-Chao; Liang, Yu-Jing; Chen, Qiu-Yan; Mai, Hai-Qiang
- Abstract
Objectives: To determine patients with de novo metastatic nasopharyngeal carcinoma (mNPC) who would benefit from receiving definitive radiation therapy (DRT) along with their pre-existing palliative chemotherapy (PCT) by evaluating their post-PCT Deauville scores and EBV DNA. Methods: A total of 570 mNPC patients, treated with PCT or PCT+DRT, were studied. EBV DNA levels, along with post-PCT Deauville scores, were used to stratify risk based on the recursive partitioning analysis (RPA). Results: Significant differences were observed in the survival rates of patients with Deauville scores of 1–3 and 4–5 (2-year progression-free survival (PFS): 23.4% versus 8.5%, p < 0.001; 2-year overall survival (OS): 56.8% versus 18.8%, p < 0.001). RPA yielded three distinct groups in the increasing order of risk (Deauville scores of all RPA I-II were within the range of 1–3): (1) RPA I: EBV DNA levels at a pretreatment concentration ≤ 4000 copies/mL and undetectable post-PCT; (2) RPA II: EBV DNA levels either at a pretreatment concentration > 4000 copies/mL or at a pretreatment concentration ≤ 4000 copies/mL and detectable post-PCT; (3) RPA III: Deauville scores 4–5. While patients in RPA I and RPA II had significantly PFS rates when treated with PCT+DRT than when treated with PCT alone (RPA I: 72.7% versus 13.4%, RPA II: 37.8% versus 6.3%), those in RPA III did not experience such PFS benefits (6.5% versus 9.7%). Conclusion: PCT+DRT might improve the survival rates in mNPC patients in the low- and mid-risk strata but not those of patients in the high-risk strata. Key Points: We use the Deauville scores and the concentrations of the Epstein-Barr virus (EBV) DNA to determine those patients with de novo metastatic NPC who would benefit from radiation therapy.
- Subjects
NASOPHARYNX cancer; RADIOTHERAPY; PROGRESSION-free survival; EPSTEIN-Barr virus; THERAPEUTICS
- Publication
European Radiology, 2022, Vol 32, Issue 11, p7722
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-022-08814-3