China News Service, Guangzhou, August 24th (Cai Minjie Wen Chaoyang Chen Jun) Sun Yat-sen University Cancer Center announced on the 24th that the Chinese medical expert team for the first time innovated the "attenuated" treatment strategy for low-risk nasopharyngeal cancer patients and improved the nasopharyngeal quality of life of cancer patients.
The above research was led by the team of Executive Deputy Director Ma Jun and Deputy Director Sun Ying of Sun Yat-sen University Cancer Center, in conjunction with Foshan First People's Hospital, Wuzhou Red Cross Hospital, Fifth Affiliated Hospital of Sun Yat-sen University, and Tongji Medical College of Huazhong University of Science and Technology. A total of 5 units in Union Medical College jointly completed a prospective phase III clinical study of radiotherapy alone versus concurrent radiochemotherapy in patients with low-risk nasopharyngeal carcinoma.
The study was selected for the oral report of the 2022 American Society of Clinical Oncology Annual Meeting, and was published online in the top international medical journal "Journal of the American Medical Association" on August 23, local time in the United States.
The incidence of nasopharyngeal cancer is high in China, accounting for 47% of the new cases of nasopharyngeal cancer in the world, especially in Guangdong, Guangxi, Fujian and other regions.
According to the recommendations of NCCN (National Comprehensive Cancer Network) guidelines, early (stage I) patients are mainly treated with radiotherapy alone, and intermediate and advanced (II-IV) patients are based on concurrent chemoradiotherapy, with or without induction/adjuvant chemotherapy, however, The evidence for the recommendation of concurrent chemoradiotherapy for intermediate-stage (stage II) patients mainly comes from the phase III clinical trial data in the two-dimensional conventional radiotherapy period.
Since intensity-modulated radiation therapy can provide better tumor target conformity, higher target dose coverage and better normal tissue protection, and improve the efficacy of nasopharyngeal cancer, in recent years, intensity-modulated radiation therapy has replaced two conventional radiotherapy.
In the mode of intensity-modulated radiation therapy, the tumor-free survival, overall survival, distant metastasis-free survival and recurrence-free survival of patients with stage II nasopharyngeal carcinoma can reach more than 90%. Benefit space will be significantly reduced.
At the same time, concurrent platinum-based chemotherapy significantly increases the patient's treatment toxicity, risk of treatment-related death, and treatment costs.
Therefore, under the intensity-modulated treatment mode, whether patients with low-risk nasopharyngeal carcinoma still need concurrent cisplatin chemotherapy is an important scientific issue to be solved urgently.
To this end, the team led by Ma Jun and Sun Ying conducted this large-scale prospective, multicenter, randomized controlled, non-inferior phase 3 clinical trial of radiotherapy alone versus concurrent radiotherapy and chemotherapy in patients with low-risk nasopharyngeal carcinoma.
A total of 341 patients with "low risk" nasopharyngeal carcinoma were enrolled in this trial, and they were randomly assigned to radiotherapy alone group (172 cases) and concurrent chemoradiotherapy group (169 cases) according to 1:1.
The results of the study showed that in patients with low-risk nasopharyngeal carcinoma, the survival outcomes of the radiotherapy alone group and the concurrent chemoradiotherapy group were similar in the two groups.
Among them, the 3-year tumor-free survival of the radiotherapy group (90.5%) was similar to that of the concurrent chemoradiotherapy group (91.9%).
Likewise, 3-year overall survival, recurrence-free survival, and distant metastasis-free survival were similar between the two groups.
In terms of toxicity and quality of life, the incidence of severe grade 3 to 4 toxicity in the radiotherapy group (17%) was significantly lower than that in the concurrent chemoradiotherapy group (46%), including leukopenia, neutropenia, nausea, Vomiting, decreased appetite, weight loss, mucositis.
In addition, the quality of life of the patients in the radiotherapy group was significantly better than that in the concurrent radiotherapy and chemotherapy group.
This study is the first to innovate the "attenuated" treatment strategy for patients with low-risk nasopharyngeal carcinoma, which can significantly reduce the toxic and side effects of severe gastrointestinal reactions, bone marrow suppression, severe mucosal reactions, and weight loss during the treatment without reducing the therapeutic effect of the patients. , At the same time ototoxicity, hypothyroidism and other late toxicity is also reduced.
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