Multimodality Therapy for Locoregional Nasopharyngeal Carcinoma—A Decision Tool for Treatment Optimization
Menée en Chine à partir de données portant sur 8 093 patients atteints d'un carcinome rhinopharyngé non métastatique (âge médian au diagnostic : 45 ans ; 70,3 % d'hommes), cette étude évalue la performance d'un nomogramme, basé sur 6 paramètres clinicopathologiques (âge, stade T, stade N, niveaux sériques de la lactate déshydrogénase et de l'albumine, niveau plasmatique de l'ADN du virus d'Epstein-Barr), pour estimer la survie globale après traitement
Locoregional nasopharyngeal cancer (NPC) is a heterogeneous disease with variable epidemiological, clinical, and biological characteristics. Radiotherapy (RT) has become the therapeutic backbone of this disease; however, the optimal combined modality therapeutic approach remains an area of controversy. In this setting, National Comprehensive Cancer Network guidelines offer multiple treatment options that include clinical trial enrollment, concurrent systemic therapy and RT followed by adjuvant chemotherapy, induction chemotherapy followed by systemic therapy and RT, or concurrent systemic therapy and RT without adjuvant chemotherapy. Using a large cohort study of locoregional nasopharyngeal carcinoma, Zhang and colleagues attempted to develop and validate a prognostic nomogram that was subsequently explored as a tool to assist with selecting an optimal combined modality therapeutic approach. The authors identified a cohort of 8093 patients with nonmetastatic NPC who were treated with RT with or without chemotherapy. This cohort was randomly allocated using a 2:1 ratio into a training cohort (n = 5398) or a validation cohort (n = 2695). Using multivariate analysis, Zhang and colleagues identified 6 clinical prognostic markers, including T stage, N stage, Epstein-Barr virus DNA, lactate dehydrogenase level, and albumin level, and subsequently incorporated them into a prognostic nomogram for overall survival. The nomogram demonstrated excellent accuracy for overall survival and managed to outperform the eighth edition American Joint Committee on Cancer/Union for International Cancer Control TNM staging staging system. The authors subsequently stratified patients by quartiles based on percentile score values estimated from the established nomogram to characterize risk groups. Various multimodality treatment approaches (RT alone, chemoradiotherapy [CRT], or induction chemotherapy followed by CRT) were assessed within each risk group to suggest that a nomogram-based approach could help clinicians as a guide to optimally select a multimodal therapeutic strategy for treatment of locoregional NPC.
JAMA Network Open , éditorial en libre accès, 2019