Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand
Abstract Background Chemoradiotherapy (CRT) with high cumulative doses (CDs) of cisplatin has been considered the standard of care for non-metastatic nasopharyngeal carcinoma (NPC). However, given most patients’ inability to tolerate high CDs due to cisplatin-related toxicities, the optimal CD of ci...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-020-07024-8 |
| _version_ | 1811333698644082688 |
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| author | Nuttapong Ngamphaiboon Arunee Dechaphunkul Jiraporn Setakornnukul Tanadech Dechaphunkul Rungarun Jiratrachu Bhoom Suktitipat Chuleeporn Jiarpinitnun Poompis Pattaranutaporn Pongwut Danchaivijitr |
| author_facet | Nuttapong Ngamphaiboon Arunee Dechaphunkul Jiraporn Setakornnukul Tanadech Dechaphunkul Rungarun Jiratrachu Bhoom Suktitipat Chuleeporn Jiarpinitnun Poompis Pattaranutaporn Pongwut Danchaivijitr |
| author_sort | Nuttapong Ngamphaiboon |
| collection | DOAJ |
| description | Abstract Background Chemoradiotherapy (CRT) with high cumulative doses (CDs) of cisplatin has been considered the standard of care for non-metastatic nasopharyngeal carcinoma (NPC). However, given most patients’ inability to tolerate high CDs due to cisplatin-related toxicities, the optimal CD of cisplatin during CRT remains undetermined. Methods Patients with non-metastatic NPC who received CRT with cisplatin between 2007 and 2017 were identified through the Thai head and neck cancer multicenter database and then categorized according to cisplatin CD (mg/m2) received. All complications and cisplatin-related toxicities during CRT were recorded. Results We identified 779 non-metastatic NPC patients receiving low (≤150; n = 97), intermediate (151–250; n = 411), and high (> 250; n = 271) CDs of cisplatin. Low CD patients had significantly lower mean actual radiation dose (p < 0.001) and more radiotherapy delay (p = 0.010), while intermediate CD patients had the least hospitalization (p < 0.001). Overall, 39.3% of the patients experienced cisplatin-related toxicity, which was associated with poor overall survival (OS) (p = 0.001). Acute kidney injury was observed in 7% in all patients, which was highest among low CD patients (15.5%; p = 0.002). Intermediate CD patients had significantly longer median OS than the low and high groups (64 vs. 49.8 vs. 53.2, respectively; p = 0.015). Univariate, but not multivariate, analysis showed that CD of cisplatin was significantly associated with OS. Conclusion CD of cisplatin during CRT was not an independent prognostic factor for OS. An intermediate CD induced minimal toxicity without compromising survival and should be considered the optimal CD. Nonetheless, a randomized phase 3 study evaluating the optimal CD of cisplatin is warranted. |
| first_indexed | 2024-04-13T16:56:48Z |
| format | Article |
| id | doaj.art-579256eb56944e2c969acb113232ee16 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-13T16:56:48Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-579256eb56944e2c969acb113232ee162022-12-22T02:38:47ZengBMCBMC Cancer1471-24072020-06-0120111010.1186/s12885-020-07024-8Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in ThailandNuttapong Ngamphaiboon0Arunee Dechaphunkul1Jiraporn Setakornnukul2Tanadech Dechaphunkul3Rungarun Jiratrachu4Bhoom Suktitipat5Chuleeporn Jiarpinitnun6Poompis Pattaranutaporn7Pongwut Danchaivijitr8Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityDivision of Medical Oncology, Department of Medicine, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla UniversityDivision of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDepartment of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla UniversityDivision of Radiation Oncology, Department of Radiology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla UniversityDepartment of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDivision of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityDivision of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityDivision of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background Chemoradiotherapy (CRT) with high cumulative doses (CDs) of cisplatin has been considered the standard of care for non-metastatic nasopharyngeal carcinoma (NPC). However, given most patients’ inability to tolerate high CDs due to cisplatin-related toxicities, the optimal CD of cisplatin during CRT remains undetermined. Methods Patients with non-metastatic NPC who received CRT with cisplatin between 2007 and 2017 were identified through the Thai head and neck cancer multicenter database and then categorized according to cisplatin CD (mg/m2) received. All complications and cisplatin-related toxicities during CRT were recorded. Results We identified 779 non-metastatic NPC patients receiving low (≤150; n = 97), intermediate (151–250; n = 411), and high (> 250; n = 271) CDs of cisplatin. Low CD patients had significantly lower mean actual radiation dose (p < 0.001) and more radiotherapy delay (p = 0.010), while intermediate CD patients had the least hospitalization (p < 0.001). Overall, 39.3% of the patients experienced cisplatin-related toxicity, which was associated with poor overall survival (OS) (p = 0.001). Acute kidney injury was observed in 7% in all patients, which was highest among low CD patients (15.5%; p = 0.002). Intermediate CD patients had significantly longer median OS than the low and high groups (64 vs. 49.8 vs. 53.2, respectively; p = 0.015). Univariate, but not multivariate, analysis showed that CD of cisplatin was significantly associated with OS. Conclusion CD of cisplatin during CRT was not an independent prognostic factor for OS. An intermediate CD induced minimal toxicity without compromising survival and should be considered the optimal CD. Nonetheless, a randomized phase 3 study evaluating the optimal CD of cisplatin is warranted.http://link.springer.com/article/10.1186/s12885-020-07024-8Nasopharyngeal carcinomaCisplatinChemoradiotherapyCumulative doseNephrotoxicity |
| spellingShingle | Nuttapong Ngamphaiboon Arunee Dechaphunkul Jiraporn Setakornnukul Tanadech Dechaphunkul Rungarun Jiratrachu Bhoom Suktitipat Chuleeporn Jiarpinitnun Poompis Pattaranutaporn Pongwut Danchaivijitr Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand BMC Cancer Nasopharyngeal carcinoma Cisplatin Chemoradiotherapy Cumulative dose Nephrotoxicity |
| title | Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand |
| title_full | Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand |
| title_fullStr | Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand |
| title_full_unstemmed | Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand |
| title_short | Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: a multicenter analysis in Thailand |
| title_sort | optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non metastatic nasopharyngeal carcinoma a multicenter analysis in thailand |
| topic | Nasopharyngeal carcinoma Cisplatin Chemoradiotherapy Cumulative dose Nephrotoxicity |
| url | http://link.springer.com/article/10.1186/s12885-020-07024-8 |
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