xRead - Nasal Obstruction (September 2024) Full Articles

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297

ICAR SINONASAL TUMORS

TABLE XXV.8 Evidence surrounding adjuvant chemotherapy in NPC treatment.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

1. CRT + AC, CRT, and IC + CRT had highest effect on OS 2. Addition of AC to CRT ranked better than CRT alone but only PFS was statistically significant. 3. No statistically significant difference between IC + CRT andCRT + AC in all parameters 4. CRT + ACandRT + ACare the most toxic regimens, potential toxicity of AC 1. CRT + AC and CRT were both significantly better than RT alone in terms of OS and DMFS 2. Ranking probabilities showed CRT + AC was ranked superior to CRT for OS, LRFS, and DMFS, yet no significant differences were found between the two for all outcomes 3. Severe adverse events occurred more often following CRT compared with RT alone 4. No significant differences of severe adverse event existed 1. AC does not appear to improve survival following CRT 2. Number and breadth of adverse events are considerably greater in patients who received chemotherapy 1. 3-year FFS was significantly higher in AC arm than observation arm 2. 3-year OS, DMFS, and LRFS were significantly higher in AC arm than observation group 3. Benefit from metronomic capecitabine was observed irrespective of receipt of induction chemotherapy 4. Grade 3 adverse events in 17% in AC group and 6% observation arm 5. No meaningful deterioration of QOL associated with AC arm (Continues) between the CRT + ACandCRT arms in the initial phase

1. 5-year OS 2. PFS, LRC and DMFS 3. Severe acute toxicity

Ribassin-Majed et al. 1696

2017 1

Network meta analysis

5144 patients from 20 trials (91% are stage III/IV) RT alone versus IC + RTversus RT + ACversus IC + RT + AC versus CRT versus IC + CRTversus CRT + AC 2144 patients in eight studies RT versus CRT with or withoutAC

Chenet al. 1695

2015 1

Network meta analysis

1. OS 2. LRFS, DMFS 3. Severe acute toxicity ( ≥ grade 3)

Yanet al. 1697

1. OS 2. Grade 3 and

2015 1

Network meta analysis

5576 patients with stage III/IV,

above adverse events

nonmetastatic NPC, in25RCTs

Chenet al. 1698

2021

2

Phase III RCT 406 patients with stage III/IVA NPC

1. 3-year FFS 2. 3-year OS, DMFS, and LRFS 3. Safety and QOL

(excluding T3-4N0 and T3N1 disease) CRT with or without IC + AC

Adjuvant chemotherapy (AC) was proposed as an attempt to curb distant failures in advanced-stage nonmetastatic NPC (stage III–IVB) (Table XXV.8). Traditionally, cisplatin and its derivatives were the drug of choice. However, most

patients are heavily exposed to platinum agents during CRT treatment and potentially during IC as well. This limits the tolerability of additional adjuvant platinum based chemotherapy. A large phase III RCT comparing