Cargando…
Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy
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 unde...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472777/ https://www.ncbi.nlm.nih.gov/pubmed/32974150 http://dx.doi.org/10.3389/fonc.2020.01417 |
_version_ | 1783579052209078272 |
---|---|
author | Chan, Sik-Kwan Chan, Sum-Yin Choi, Horace Cheuk-Wai Tong, Chi-Chung Lam, Ka-On Kwong, Dora Lai-Wan Vardhanabhuti, Varut Leung, To-Wai Luk, Mai-Yee Lee, Anne Wing-Mui Lee, Victor Ho-Fun |
author_facet | Chan, Sik-Kwan Chan, Sum-Yin Choi, Horace Cheuk-Wai Tong, Chi-Chung Lam, Ka-On Kwong, Dora Lai-Wan Vardhanabhuti, Varut Leung, To-Wai Luk, Mai-Yee Lee, Anne Wing-Mui Lee, Victor Ho-Fun |
author_sort | Chan, Sik-Kwan |
collection | PubMed |
description | 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). |
format | Online Article Text |
id | pubmed-7472777 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74727772020-09-23 Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy Chan, Sik-Kwan Chan, Sum-Yin Choi, Horace Cheuk-Wai Tong, Chi-Chung Lam, Ka-On Kwong, Dora Lai-Wan Vardhanabhuti, Varut Leung, To-Wai Luk, Mai-Yee Lee, Anne Wing-Mui Lee, Victor Ho-Fun Front Oncol Oncology 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). Frontiers Media S.A. 2020-08-21 /pmc/articles/PMC7472777/ /pubmed/32974150 http://dx.doi.org/10.3389/fonc.2020.01417 Text en Copyright © 2020 Chan, Chan, Choi, Tong, Lam, Kwong, Vardhanabhuti, Leung, Luk, Lee and Lee. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Chan, Sik-Kwan Chan, Sum-Yin Choi, Horace Cheuk-Wai Tong, Chi-Chung Lam, Ka-On Kwong, Dora Lai-Wan Vardhanabhuti, Varut Leung, To-Wai Luk, Mai-Yee Lee, Anne Wing-Mui Lee, Victor Ho-Fun Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title | Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title_full | Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title_fullStr | Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title_full_unstemmed | Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title_short | Prognostication of Half-Life Clearance of Plasma EBV DNA in Previously Untreated Non-metastatic Nasopharyngeal Carcinoma Treated With Radical Intensity-Modulated Radiation Therapy |
title_sort | prognostication of half-life clearance of plasma ebv dna in previously untreated non-metastatic nasopharyngeal carcinoma treated with radical intensity-modulated radiation therapy |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472777/ https://www.ncbi.nlm.nih.gov/pubmed/32974150 http://dx.doi.org/10.3389/fonc.2020.01417 |
work_keys_str_mv | AT chansikkwan prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT chansumyin prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT choihoracecheukwai prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT tongchichung prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT lamkaon prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT kwongdoralaiwan prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT vardhanabhutivarut prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT leungtowai prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT lukmaiyee prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT leeannewingmui prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy AT leevictorhofun prognosticationofhalflifeclearanceofplasmaebvdnainpreviouslyuntreatednonmetastaticnasopharyngealcarcinomatreatedwithradicalintensitymodulatedradiationtherapy |