Yan-Ming Jiang

Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: meta-analysis of 1,096 patients from 11 randomized controlled trials.

PURPOSE To evaluate the efficacy and toxicity of induction chemotherapy followed by concurrent chemoradiotherapy (the treatment group) versus concurrent chemoradiotherapy with or without adjuvant chemotherapy (the control group) for locoregionally advanced nasopharyngeal carcinoma. METHODS The search strategy included Pubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, Chinese Biomedical Database and Wanfang Database. We also searched reference lists of articles and the volumes of abstracts of scientific meetings. All randomized controlled trials were included for a meta-analysis performed with RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence. RESULTS Eleven studies were included. Risk ratios of 0.99 (95%CI 0.72-1.36), 0.37 (95%CI 0.20-0.69), 1.08 (95%CI 0.84-1.38), 0.98 (95%CI 0.75-1.27) were observed for 3 years overall survival, 3 years progression-free survival, 2 years loco-regional failure-free survival and 2 years distant metastasis failure-free survival. There were no treatment-related deaths in either group in the 11 studies. Risk ratios of 1.90 (95%CI 1.24-2.92), 2.67 (95%CI 0.64-11.1), 1.04 (95%CI 0.79-1.37), 0.98 (95%CI 0.27-3.52) were found for grade 3-4 leukopenia, grade 3-4 thrombocytopenia, grade 3-4 mucous membrane, and grade 3-4 hepatic hematologic and gastrointestinal toxicity, the most significant toxicities for patients. CONCLUSION Compared with the control group, induction chemotherapy followed by concurrent chemoradiotherapy was well tolerated but could not significantly improve prognosis in terms of overall survival, loco-regional failure-free survival or distant metastasis failure-free survival.

Comparison of Concurrent Chemoradiotherapy Followed by Adjuvant Chemotherapy Versus Concurrent Chemoradiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma: a Meta-analysis of 793 Patients from 5 Randomized Controlled Trials

PURPOSE The main objective of the present study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy followed by adjuvant chemotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. METHODS The search strategy included Pubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, Chinese Biomedical Database and Wanfang Database. We also searched reference lists of articles and the volumes of abstracts of scientific meetings. Randomized controlled trials (RCTs) that compared concurrent chemoradiotherapy followed by adjuvant chemotherapy with concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma were included. Meta-analysis was performed with RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence. RESULTS Five studies were included. Risk ratios of 1.02 (95%CI 0.89-1.15), 0.93 (95%CI 0.72-1.21), 1.07 (95%CI 0.87-1.32), 0.95 (95%CI 0.80-1.13) were observed for 3 years overall survival, 5 years failure-free survival, 5 years loco- regional failure-free survival and 5 years distant metastasis failure-free survival. There were no treatment-related deaths in both groups of five studies. Hematologic and gastrointestinal toxicity were the most significant for patients during adjuvant chemotherapy. The level of evidence was low. CONCLUSION Compared with concurrent chemoradiotherapy alone, concurrent chemotherapy followed by adjuvant chemotherapy did not improve prognosis. More toxicity was found during adjuvant chemotherapy.

Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy and intensity-modulated radiotherapy alone for stage II nasopharyngeal carcinoma

Objective This study aimed to explore whether concurrent chemoradiotherapy (CCRT) with or without Adjuvant Chemotherapy (AC) could improved the survival in stage II nasopharyngeal carcinoma (NPC). Methods Patients with stage II NPC treated with CCRT (n=80) or CCRT+AC (n=40) or IMRT alone (n=42) between January 2007 and September 2014 were retrospectively analyzed. The three patient groups were matched based on prognostic factors. All patients were treated with IMRT. The endpoints were overall survival (OS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS), and failure-free survival (FFS). The treatment-related acute toxicity reactions between the three groups were compared also. Results The three groups indicated similar outcomes: survival of the CCRT group, CCRT+AC group and RT alone group were (93.9%, 95.0%, 95.2%, P=0.937) for OS, (96.8%, 94.9%, 93.0%, P=0.756) for LRRFS, (91.1%, 97.5%, 100%, P=0.185) for DMFS and (84.9%, 92.5%, 93.0%, P=0.597) for FFS. Both the univariate and multivariate analysis indicated that older age predicted lower LRRFS and FFS. The CCRT and CCRT+AC groups showed more acute toxicity reactions, especially in bone marrow suppression, Liver dysfunction, gastrointestinal reactions (nausea/vomiting) and weight loss. Conclusion CCRT with/without AC could not improve the survival conditions of patients with stage II NPC, but remarkably increased treatment-associated acute toxic reactions when compared with IMRT alone.

Systematic review and meta-analysis of the efficacy of breast conservation therapy followed by radiotherapy in four breast cancer subtypes

The different molecular subtypes of breast cancer are associated with distinct outcomes. We assessed the efficacy of breast conservation therapy (BCT) followed by radiotherapy for patients with different breast cancer subtypes. We searched the MEDLINE, EMBASE, and Cochrane Library databases to identify studies published prior to April 30, 2016 that assessed the efficacy of BCT followed by radiotherapy in breast cancer patients with different molecular subtypes. A meta-analysis of seven studies that included 3,798 luminal A, 770 luminal B, 344 human epidermal growth factor receptor 2 (Her-2), and 767 triple-negative breast cancer (TNBC) patients was performed. The pooled odds ratio [OR] for local relapse-free survival in luminal A compared to Her-2 patients was 0.1960 (95% confidence interval [CI]: 0.0440–0.8728, p = 0.0325) at 5 years and 0.2592 (95% CI: 0.1301–0.5167, p = 0.0001) at 10 years. The pooled OR for local-regional relapse-free survival in luminal A compared to TNBC patients was 0.1381 (95% CI: 0.0565–0.3374, p = 0.0000) at 5 years and 0.1221 (95% CI: 0.0182–0.8192, p = 0.0304) at 10 years. Thus, the rate of local-regional control is higher in luminal A patients than in Her-2 or TNBC patients.The different molecular subtypes of breast cancer are associated with distinct outcomes. We assessed the efficacy of breast conservation therapy (BCT) followed by radiotherapy for patients with different breast cancer subtypes. We searched the MEDLINE, EMBASE, and Cochrane Library databases to identify studies published prior to April 30, 2016 that assessed the efficacy of BCT followed by radiotherapy in breast cancer patients with different molecular subtypes. A meta-analysis of seven studies that included 3,798 luminal A, 770 luminal B, 344 human epidermal growth factor receptor 2 (Her-2), and 767 triple-negative breast cancer (TNBC) patients was performed. The pooled odds ratio [OR] for local relapse-free survival in luminal A compared to Her-2 patients was 0.1960 (95% confidence interval [CI]: 0.0440-0.8728, p = 0.0325) at 5 years and 0.2592 (95% CI: 0.1301-0.5167, p = 0.0001) at 10 years. The pooled OR for local-regional relapse-free survival in luminal A compared to TNBC patients was 0.1381 (95% CI: 0.0565-0.3374, p = 0.0000) at 5 years and 0.1221 (95% CI: 0.0182-0.8192, p = 0.0304) at 10 years. Thus, the rate of local-regional control is higher in luminal A patients than in Her-2 or TNBC patients.

Secondary malignancies after partial versus whole breast irradiation: a systematic review and meta-analysis.

Secondary malignancies are a common complication for patients receiving radiotherapy. Here, we compared rates of secondary malignancies after partial breast irradiation (PBI) and whole breast irradiation (WBI). The MEDLINE, EMBASE, and the Cochrane Library databases were systematically searched to identify relevant randomized clinical trials comparing PBI with WBI in breast cancer patients treated with breast-conserving therapy. Four studies including 2,185 patients were selected. Compared to WBI, the pooled odds ratios (OR) for contralateral breast cancer were 0.86 (95% confidence interval (CI) 0.31–2.42; p = 0.78) after 5 years and 1.15 (95% CI 0.43-3.09; p = 0.78) after 10 years for PBI. The pooled ORs for secondary non-breast cancer were 0.91 (95% CI 0.49-1.67; p = 0.77) after 5 years and 1.20 (95% CI 0.39-3.66; p = 0.75) after 10 years for PBI compared to WBI. These results demonstrate that the risk of secondary malignancies is similar for PBI and WBI after breast-conserving radiotherapy.

Triple Negative Breast Cancer versus Non-Triple Negative Breast Cancer Treated with Breast Conservation Surgery Followed by Radiotherapy: A Systematic Review and Meta-Analysis

Background: The aim of this study was to compare the efficacy of breast conservation surgery (BCS) followed by radiotherapy (RT) in triple negative breast cancer (TNBC) versus non-TNBC. Methods: We searched the MEDLINE and EMBASE databases from inception through March 31, 2014, using search terms related to TNBC, BCS, and RT. Studies comparing the efficacy of BCS followed by RT in TNBC versus non-TNBC were reviewed. Results: 5 studies including 2,922 non-TNBC and 510 TNBC cases were selected. The overall quality of included studies was deemed moderate to high. Compared with non-TNBC, the pooled relative risk of 5-year local relapse-free survival was 1.315 (95% confidence interval (CI) 0.967-1.789; p = 0.008) for TNBC, and that of 5-year overall survival, regional relapse-free survival, and distant metastasis-free survival was 1.929 (95% CI 1.392-2.674; p = 0.000), 3.052 (95% CI 1.629-5.715; p = 0.000), and 2.407 (95% CI 1.910-3.034; p = 0.000), respectively. Conclusion: The local control rate of TNBC treated with BCS plus RT is similar to that of non-TNBC.

Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in intensity modulated radiation therapy for nasopharyngeal carcinoma

Background Inflammatory response markers plays an important role in tumor progression. The aim of this analysis was to evaluate whether the neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) could predict the prognosis of nasopharyngeal carcinoma(NPC). Materials and Methods 247 patients who underwent Intensity Modulated Radiation Therapy( IMRT )were enrolled from January 2012 and December 2012. NLR, and PLR were calculated from peripheral blood cell counts taken at pre-treatment. Optimal cutoff values of NLR and PLR were determined on the basis of receiver operating characteristic curve analysis. Overall survival (OS), progression-free survival(PFS), distant metastasis-free survival (DMFS) and loco-regional recurrence-free survival ( LRFS) rates were compared according to NLR and PLR level respectively. Multivariate analysis was performed to assess the prognostic value of NLR and PLR. Results The 5-year estimated OS, PFS, LRFS and DFS were 87.2, 77.8, 96.9, and 86.2%, respectively. Our results shows that the NLR was significantly associated with T-stage (P < 0.05), N-stage (P < 0.05) and tumor stage(P < 0.05). PLR was significantly associated with T-stage (P < 0.05) and tumor stage(P < 0.05). NLR was an independent prognostic indicator for OS (HR: 3.259, P = 0.004), PFS (HR:7.093, P < 0.001), DMFS (HR: 6.576, P = 0.003), except for PLR. In subgroup analysis, adjuvant chemotherapy had no significantly improved survival for patients with high NLR. Conclusions NLR is a strong prognostic factor for NPC patients. NLR might not be a useful indicator for selection of treatment strategies for loco-regionally advanced NPC.

Comparison of the efficacy between intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in stage II nasopharyngeal carcinoma

We compared treatment outcomes in patients with stage II nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) or two-dimensional conventional radiotherapy (2D-CRT). Stage II (2010 UICC/AJCC staging system) NPC patients treated with IMRT (n = 178) or 2D-CRT (n = 73) between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity score-matching method. The primary endpoint was overall survival (OS). Secondary endpoints were local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Acute and late toxicity reactions to IMRT and 2D-CRT were also compared. In an unmatched cohort of 251 patients, no significant survival differences were found between those receiving IMRT and those receiving 2D-CRT (5-year OS, 95.67% vs 94.44%, P = 0.0556; LRFS, 97.34% vs 98.59%, P = 0.6656; RRFS, 99.26% vs 100%, P = 0.6785; DMFS, 96.5% vs 98.63%, P = 0.7910; DFS, 92.2% vs 97.24%, P = 0.8719). In the propensity-matched cohort of 146 patients, 5-year OS (97.06% vs 94.44%, P = 0.1325), LRFS (96.75% vs 98.59%, P = 0.8869), RRFS (100% vs 100%, P = 1.0000), DMFS (98.63% vs 98.63%, P = 0.4225), and DFS (95.37% vs 97.24%, P = 0.5634) were similar between patients treated with IMRT or 2D-CRT. However, IMRT correlated with fewer acute and late toxicity reactions. Thus although IMRT provides no survival advantage, it has a lower incidence of toxicity than 2D-CRT in stage II NPC patients.We compared treatment outcomes in patients with stage II nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) or two-dimensional conventional radiotherapy (2D-CRT). Stage II (2010 UICC/AJCC staging system) NPC patients treated with IMRT (n = 178) or 2D-CRT (n = 73) between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity score-matching method. The primary endpoint was overall survival (OS). Secondary endpoints were local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Acute and late toxicity reactions to IMRT and 2D-CRT were also compared. In an unmatched cohort of 251 patients, no significant survival differences were found between those receiving IMRT and those receiving 2D-CRT (5-year OS, 95.67% vs 94.44%, P = 0.0556; LRFS, 97.34% vs 98.59%, P = 0.6656; RRFS, 99.26% vs 100%, P = 0.6785; DMFS, 96.5% vs 98.63%, P = 0.7910; DFS, 92.2% vs 97.24%, P = 0.8719). In the propensity-matched cohort of 146 patients, 5-year OS (97.06% vs 94.44%, P = 0.1325), LRFS (96.75% vs 98.59%, P = 0.8869), RRFS (100% vs 100%, P = 1.0000), DMFS (98.63% vs 98.63%, P = 0.4225), and DFS (95.37% vs 97.24%, P = 0.5634) were similar between patients treated with IMRT or 2D-CRT. However, IMRT correlated with fewer acute and late toxicity reactions. Thus although IMRT provides no survival advantage, it has a lower incidence of toxicity than 2D-CRT in stage II NPC patients.

Intensity-modulated radiotherapy provides better quality of life than two-dimensional conventional radiotherapy for patients with stage II nasopharyngeal carcinoma

Two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) are effective for control of nasopharyngeal carcinoma (NPC). The purpose of this study was to compare the quality of life (QoL) of stage II NPC patients treated with 2D-CRT versus IMRT. We conducted a cross-sectional study of 106 patients with stage II NPC treated with 2D-CRT (n = 47) versus IMRT (n = 59) between June 2008 and June 2013. For all subjects, disease-free survival was more than 3 years. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questions and the Head and Neck 35 (EORTC QLQ-H&N35) questions. Patients receiving IMRT with or without concurrent chemotherapy had better outcomes in head and neck related symptoms and general aspects of QoL than those receiving 2D-CRT with or without concurrent chemotherapy. Thus, IMRT improves the QoL of patients with stage II NPC as compared to 2D-CRT.

Concurrent chemoradiotherapy degrades the quality of life of patients with stage II nasopharyngeal carcinoma as compared to radiotherapy

The purpose of this study was to compare the quality of life (QoL) of stage II nasopharyngeal carcinoma (NPC) patients treated with radiotherapy (RT) versus concurrent chemoradiotherapy (CCRT). In a cross-sectional study, these patients were treated with RT (n = 55) or CCRT (n = 51) between June 2008 and June 2013. For all subjects, disease-free survival was more than 3 years. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questions and the Head and Neck 35 (EORTC QLQ-H&N35) questions. RT had better outcomes than CCRT for global QoL, functional scales, symptom scales of fatigue and insomnia, financial problems, and weight gain. Survivors receiving 1 cycle of concurrent chemotherapy had worse QoL outcomes than survivors receiving 2 cycles of concurrent chemotherapy. Patients receiving 3 cycles of concurrent chemotherapy had the best QoL outcomes. Thus, CCRT adversely affects the QoL of patients with stage II NPC as compared to radiotherapy.