A Nomogram for the Determination of the Necessity of Concurrent Chemotherapy in Patients With Stage II-IVa Nasopharyngeal Carcinoma

• Published in: Frontiers in oncology Vol. 11; p. 640077
• Main Authors: Yang, Kaixuan, Zhang, Qian, Zhang, Mengxi, Xie, Wenji, Li, Mei, Zeng, Lei, Wang, Qiang, Zhao, Jianling, Li, Yiping, Li, Guangjun
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 06.09.2021
• Subjects: chemoradiotherapy; concurrent chemotherapy; intensity-modulated radiotherapy; nasopharyngeal carcinoma; nomogram; Oncology; chemoradiotherapy; concurrent chemotherapy; intensity-modulated radiotherapy; nasopharyngeal carcinoma; nomogram
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2021.640077

The efficiency of concurrent chemotherapy (CC) remains controversial for stage II-IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). Therefore, we aimed to propose a nomogram to identify patients who would benefit from CC. A total of 434 NPC patients (stage II-IVa) treated with IC followed by IMRT between January 2010 and December 2015 were included. There were 808 dosimetric parameters extracted by the in-house script for each patient. A dosimetric signature was developed with the least absolute shrinkage and selection operator algorithm. A nomogram was built by incorporating clinical factors and dosimetric signature using Cox regression to predict recurrence-free survival (RFS). The C-index was used to evaluate the performance of the nomogram. The patients were stratified into low- and high-risk recurrence according to the optimal cutoff of risk score. The nomogram incorporating age, TNM stage, and dosimetric signature yielded a C-index of 0.719 (95% confidence interval, 0.658-0.78). In the low-risk group, CC was associated with a 9.4% increase of 5-year locoregional RFS and an 8.8% increase of 5-year overall survival (OS), whereas it was not significantly associated with an improvement of locoregional RFS (LRFS) and OS in the high-risk group. However, in the high-risk group, patients could benefit from adjuvant chemotherapy (AC) by improving 33.6% of the 5-year LRFS. The nomogram performed an individualized risk quantification of RFS in patients with stage II-IVa NPC treated with IC followed by IMRT. Patients with low risk could benefit from CC, whereas patients with high risk may require additional AC.