Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy
| Autor: | Horace Cheuk Wai Choi, Dora L.W. Kwong, Varut Vardhanabhuti, Anne Wing-Mui Lee, Sum-Yin Chan, Ka-On Lam, Victor Ho-Fun Lee, Mai-Yee Luk, To-Wai Leung, Sik-Kwan Chan, Chi-Chung Tong |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Cancer Research medicine.medical_specialty medicine.medical_treatment lcsh:RC254-282 Gastroenterology 03 medical and health sciences 0302 clinical medicine half-life clearance Internal medicine Medicine Original Research Proportional hazards model business.industry nasopharyngeal carcinoma Half-life Cancer Intensity-modulated radiation therapy lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Radiation therapy Clinical trial 030104 developmental biology Oncology Nasopharyngeal carcinoma 030220 oncology & carcinogenesis Biomarker (medicine) intensity-modulated radiation therapy prognostication business plasma Epstein–Barr virus deoxyribonucleic acid |
| Zdroj: | Frontiers in Oncology, Vol 10 (2020) Frontiers in Oncology |
| ISSN: | 2234-943X |
| DOI: | 10.3389/fonc.2020.01417 |
| Popis: | Introduction: The prognostic role of plasma Epstein–Barr virus (EBV) DNA clearance when intensity-modulated radiotherapy (IMRT) and the 8th edition of American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM Staging Classification are fully implemented remains undeciphered. We investigated if its half-life clearance during radical treatment for non-metastatic nasopharyngeal carcinoma (NPC) was an early prognosticator.Patients and methods: Patients with previously untreated non-metastatic NPC were prospectively treated with radical IMRT and concurrent chemotherapy +/– induction/adjuvant chemotherapy from 2014 to 2018. Their plasma EBV DNA was measured immediately before treatment followed by weekly schedules until 0 copy/ml in two consecutive measurements. Cox regression models were employed to identify prognostic factors.Results: Forty-five patients were prospectively recruited and analyzed. After a median follow-up of 30.3 months, 2 (4.5%), 1 (2.3%), and 6 (13.6%) patients experienced local, regional, and distant relapses, respectively. The median half-life clearance of plasma EBV DNA was 7.92 days. Those with half-life clearance of >15 days had a worse 3-years progression-free survival (PFS) (79.5 vs. 25.0%, p = 0.005), distant metastasis-free survival (DMFS) (85.0 vs. 31.3%, p = 0.009), and overall survival (OS) (91.3 vs. 75.0%, p = 0.024) when compared to those with a shorter half-life. Multivariable analyses demonstrated that only half-life (>15 days) was prognostic of DMFS [HR (95% CI): 4.91 (1.31; 18.39), p = 0.01] and OS [HR (95% CI): 5.24 (1.06; 26.05)] while half-life (>15 days) [HR (95% CI): 5.14 (1.28; 22.73), p = 0.02] and sum of pretreatment gross tumor volumes of the primary nasopharyngeal tumor and the radiologically positive neck nodes (GTV_P+N) [HR (95% CI): 1.01 (1.00; 1.03), p = 0.02] were prognostic of PFS.Conclusion: The half-life clearance of plasma EBV DNA was prognostic in non-metastatic NPC staged and treated in the contemporary era. Earlier biomarker surveillance during treatment should be considered.Clinical Trial Registration: This study has been registered with ClinicalTrials.gov (Identifier: NCT03830996). |
| Databáze: | OpenAIRE |
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