The Role of Post-Neoadjuvant Chemotherapy Tumor Volume for Prognostication and Treatment Guidance in Loco-Regionally Advanced Nasopharyngeal Carcinoma

Fo-Ping Chen; Dan-Wan Wen; Feng Li; Li Lin; Jia Kou; Wei-Hong Zheng; Li Li; Guan-Qun Zhou; Ying Sun

doi:10.3390/cancers11111632

The Role of Post-Neoadjuvant Chemotherapy Tumor Volume for Prognostication and Treatment Guidance in Loco-Regionally Advanced Nasopharyngeal Carcinoma

Cancers (Basel). 2019 Oct 24;11(11):1632. doi: 10.3390/cancers11111632.

Authors

Fo-Ping Chen^{1

2}, Dan-Wan Wen^{3

4}, Feng Li^{5

6}, Li Lin^{7

8}, Jia Kou^{9

10}, Wei-Hong Zheng^{11

12}, Li Li¹³, Guan-Qun Zhou^{14

15}, Ying Sun^{16

17}

Affiliations

¹ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. chenfp@sysucc.org.cn.
² Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. chenfp@sysucc.org.cn.
³ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. 1040356227@qq.com.
⁴ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. 1040356227@qq.com.
⁵ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. lifeng1@sysucc.org.cn.
⁶ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. lifeng1@sysucc.org.cn.
⁷ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. linli@sysucc.org.cn.
⁸ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. linli@sysucc.org.cn.
⁹ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. koujia@sysucc.org.cn.
¹⁰ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. koujia@sysucc.org.cn.
¹¹ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. zhengwh@sysucc.org.cn.
¹² Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. zhengwh@sysucc.org.cn.
¹³ Department of imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. lil@sysucc.org.cn.
¹⁴ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. zhougq@sysucc.org.cn.
¹⁵ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. zhougq@sysucc.org.cn.
¹⁶ Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangdong 510060, China. sunying@sysucc.org.cn.
¹⁷ Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Eastern Road, Guangdong 510060, China. sunying@sysucc.org.cn.

Abstract

The value of post-neoadjuvant chemotherapy (NACT) tumor volume for prognostication in loco-regionally advanced nasopharyngeal carcinoma (LA-NPC) is unascertained. Here, we recruited 4109 histologically proven LA-NPC (stage III-IVA) that were treated with radical chemo-intensive-modulated radiotherapy (IMRT). Post-NACT gross primary tumor (GTVp) and lymph node (GTVnd) volumes of each patient were calculated from planning computed tomography (CT). We observed similar linear association between GTVp/GTVnd and overall survival (OS); thresholds of 52 cm³ for GTVp and 12 cm³ for GTVnd were consistent for risk discretization for OS, disease-free survival (DFS), distant metastasis-free survival (DMFS), and local relapse-free survival (LRFS). Recursive partitioning analysis (RPA) modelling incorporating T-/N-categories and GTVp/GTVnd yielded four T-N-volume (TNV) risk groupings with disparate OS (p < 0.001). TNV risk stratification outperformed GTVp/GTVnd and eighth edition TNM for predicting OS (AUC 0.643 vs. 0.541-0.591; p < 0.001), DFS (0.629 vs. 0.545-0.580; p < 0.001), and DMFS (0.652 vs. 0.522-0.621; p < 0.001). NACT + concurrent chemoradiotherapy (CCRT) over NACT + IMRT was not superior for low- and low-intermediate-risk groupings (p > 0.05 for both), but superior for intermediate- and high-risk groupings in terms of OS (HR 0.68 (95% CI 0.47-0.99) for intermediate risk, 0.73 (0.55-0.97) for high risk; both p < 0.05). Overall, GTVp/GTVnd represent effective indicators for prognostication and decision-making in LA-NPC after NACT.

Keywords: concurrent chemotherapy; intensity-modulated radiation therapy; nasopharyngeal carcinoma; neoadjuvant chemotherapy; treatment outcome; tumor volume.