Optimizing the cumulative cisplatin dose during radiotherapy in nasopharyngeal carcinoma: Dose-effect analysis for a large cohort

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Liang Peng, Cheng Xu, Yu-Pei Chen, Rui Guo, Yan-Ping Mao, Ying Sun, Jun Ma, Ling-Long Tang

Abstract

Objectives

Definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The cumulative cisplatin dose (CCD) during radiotherapy is an important prognostic factor; however, the optimal CCD is undetermined.

Materials and methods

In this retrospective analysis, patients with locoregionally advanced NPC treated with single-agent cisplatin-based CCRT or RT alone from 2009 through 2015 were identified. CCD was entered into a multivariate Cox regression model as a continuous variable using natural cubic splines to allow for a nonlinear relationship between CCD and outcomes. The primary endpoint was overall survival, and the secondary endpoints were locoregional relapse‐free survival and distant metastasis‐free survival.

Results

A total of 2 924 patients were included in our study, with a median CCD of 160 mg/m² (range, 0–300 mg/m²). As the CCD increased, the risk of death remained steady until 180 mg/m², then decreased sharply until 250 mg/m², and then increased until 300 mg/m². The optimal CCD of 230–270 mg/m² was associated with the lowest risk of death and disease relapse. However, the CCD had less prognostic value for disease control, especially for distant control among high-risk patients (N2–3 or T4).

Conclusions

A CCD dose of 230–270 mg/m² (240 mg/m² is recommended) is optimal for patients with locoregionally advanced NPC, especially for those at low risk (T1–3 and N0–1). For high-risk patients (N2–3 or T4), additional chemotherapy should be administered before or after CCRT.

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