TOPLINE:
In stage N0-1 nasopharyngeal cancer, elective upper-neck irradiation provides outcomes on par with whole-neck irradiation and with significantly lower rates of long-term toxicity, according to long-term data from a randomized clinical trial.
METHODOLOGY:
- Radiotherapy is a standard treatment option for nasopharyngeal carcinoma with radiotherapy traditionally targeting the entire neck. However, treating such an extensive area can increase toxicity and impair patients’ quality of life.
- The current noninferiority trial compared 5-year overall survival among patients receiving elective upper-neck or standard whole-neck chemoradiation for N0-N1 nonkeratinizing nasopharyngeal cancer.
- Overall, 222 received whole-neck irradiation (bilateral levels II-VB), and 224 received upper-neck irradiation with lower-neck nodes IV and VB omitted for patients who did not have cervical lymph node metastases in that area.
- The 3-year trial results revealed that upper-neck irradiation provided comparable regional relapse–free survival; decreased late toxicity, including neck tissue damage, dysphagia, and hypothyroidism; as well as better quality of life, such as less dysphagia and fatigue.
- In the current publication, the team reported the prespecified 5-year survival outcomes and other secondary endpoints.
TAKEAWAY:
- At a median follow-up of 74 months, the researchers found no significant difference in overall survival between the upper-neck irradiation group (95.9%) and the whole-neck irradiation group (93.1%; hazard ratio [HR], 0.63; 95% CI, 0.30-1.35; P = .24).
- Regional relapse–free survival between the groups was also similar (95% vs 94.9%; HR, 0.96; P = .91), as were distant metastasis-free survival (91.5% vs 90.9%) as well as local relapse–free survival (92.2% vs 94.0%) rates.
- Among 5-year disease-free survivors, patients undergoing less-extensive radiotherapy had lower rates of hypothyroidism (34% vs 48%), dysphagia (14% vs 27%), neck tissue damage (29% vs 46%), and lower-neck common carotid artery stenosis (15% vs 26%).
- The upper-neck irradiation group also had higher postradiotherapy circulating lymphocyte counts (median of 400 cells/mL vs 335 cells/mL).
IN PRACTICE:
“These updated data confirmed that [upper-neck irradiation] of the uninvolved neck is a standard of care in N0-1 [nasopharyngeal cancer], providing outstanding efficacy and reduced long-term toxicity, and might retain more immune function,” the authors concluded.
SOURCE:
The study, led by Cheng-Long Huang, MD, Sun Yat-sen University Cancer Center in Guangzhou, China, was published on March 20 in the Journal of Clinical Oncology.
LIMITATIONS:
This was an open-label study, and late toxicities were derived mainly from clinical interrogation, which means some observer or grading bias when assessing late toxicities cannot be excluded.
DISCLOSURES:
The study had no commercial funding. Disclosures for authors were available with the original article.
Source link : https://www.medscape.com/viewarticle/less-neck-radiation-effective-early-nasopharyngeal-cancer-2024a10006f5?src=rss
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Publish date : 2024-04-04 11:11:27
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