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Background: To assess the efficacy of Nimotuzumab in combination with first-line chemoradiotherapy treatment in Chinese patients with primary III-IVb stage nasopharyngeal carcinoma.Methods: Patients with primary locoregionally advanced nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy (IMRT) and concurrent cisplatin-based chemotherapy between January 2008 and December 2013 at a single institution were retrospectively reviewed. Group A received at least 6 doses of Nimotuzumab, while Group B did not receive Nimotuzumab. A propensity score matching method was used to match patients from each group in a 1:3 ratio.Results: In total, 730 eligible patients were propensity matched, with 184 patients in Group A and 546 patients in Group B. Significant differences were not observed in the patient and tumor characteristics between Group A and Group B. At a median follow-up of 74.78 months (range 3.53-117.83 months), locoregional recurrence, distant failure and death were observed in 10.68, 11.10 and 16.03% of all patients, respectively. The estimated 5-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival and overall survival in the Group A versus Group B were 85.34% versus 89.79% (P = 0.156), 93.09% versus 85.61% (P = 0.012), 79.96% versus 77.99% (P = 0.117) and 88.91% versus 78.30% (P = 0.006), respectively.Conclusions: This nimotuzumab-containing regimen resulted in improved long-term survival of III-IVb stage NPC patients and warrants further prospective evaluation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the long-term outcome and toxicities in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated by concurrent chemoradiotherapy (CCRT) with/without adding cetuximab.Methods: A total of 62 patients treated with CCRT plus cetuximab were matched with 124 patients treated with CCRT alone by age, sex, pathological type, T category, N category, disease stage, radiotherapy (RT) technique, Epstein-Barr virus (EBV) DNA levels, and Eastern Cooperative Oncology Group (ECOG). Overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and log-rank test. Treatment toxicities were clarified and compared between two groups.Results: A total of 186 well-balanced stage II to IV NPC patients were retrospectively analyzed (median follow-up, 76 months). Compared to CCRT alone, adding cetuximab resulted in more grade 3 to 4 radiation mucositis (51.6% vs. 23.4%; P < 0.001). No differences were found between the CCRT + cetuximab group and the CCRT group in 5-year OS (89.7% vs. 90.7%, P = 0.386), 3-year PFS (83.9% vs. 88.7%, P = 0.115), the 3-year LRFS (95.0% vs. 96.7%, P = 0.695), and the 3-year DMFS (88.4% vs 91.9%, P = 0.068). Advanced disease stage was the independent prognostic factor predicting poorer OS and PFS.Conclusion: Adding cetuximab to CCRT did not significantly improve benefits in survival in stage II to IV NPC and exacerbated acute mucositis and acneiform rash. Further investigations are warranted. [ABSTRACT FROM AUTHOR]

Background: Accurate prognostication of locally advanced nasopharyngeal carcinoma (NPC) will benefit patients for tailored therapy. Here, we addressed this issue by developing a mathematical algorithm based on support vector machine (SVM) through integrating the expression levels of multi-biomarkers. Methodology/Principal Findings: Ninety-seven locally advanced NPC patients in a randomized controlled trial (RCT), consisting of 48 cases serving as training set and 49 cases as testing set of SVM models, with 5-year follow-up were studied. We designed SVM models by selecting the variables from 38 tissue molecular biomarkers, which represent 6 tumorigenesis signaling pathways, and 3 EBV-related serological biomarkers. We designed 3 SVM models to refine prognosis of NPC with 5-year follow-up. The SVM1 displayed highly predictive sensitivity (sensitivity, specificity were 88.0% and 81.9%, respectively) by integrating the expression of 7 molecular biomarkers. The SVM2 model showed highly predictive specificity (sensitivity, specificity were 84.0% and 94.5%, respectively) by grouping the expression level of 12 molecular biomarkers and 3 EBV-related serological biomarkers. The SVM3 model, constructed by combination SVM1 with SVM2, displayed a high predictive capacity (sensitivity, specificity were 88.0% and 90.3%, respectively). We found that 3 SVM models had strong power in classification of prognosis. Moreover, Cox multivariate regression analysis confirmed these 3 SVM models were all the significant independent prognostic model for overall survival in testing set and overall patients. Conclusions/Significance: Our SVM prognostic models designed in the RCT displayed strong power in refining patient prognosis for locally advanced NPC, potentially directing future target therapy against the related signaling pathways. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the clinical outcomes of nasopharyngeal carcinoma (NPC) patients with post-radiation nasopharyngeal necrosis (PRNN) and construct a new risk classification system for predicting survival of PRNN.Methods: A total of 276 patients with PRNN were consecutively enrolled. Complete magnetic resonance (MR) images of the nasopharynx and neck were available for all patients and were used to assess nasopharyngeal necrosis status. After 2010, patients with PRNN were initially treated by radical endoscopic necrectomy followed by reconstruction with nasal flap (ENNF).Results: The 1-year and 2-year overall survival (OS) was 65.0% and 51.6%, respectively. Three variables affected survival: osteoradionecrosis, re-irradiation, and internal carotid artery (ICA) exposure, and only two variables were found to be independent prognostic factors: re-irradiation (hazard ratio [HR] 1.75, P=0.001) and internal carotid artery (ICA) exposure (hazard ratio [HR] 1.80, P=0.001). These two variables were combined to create a new risk classification system for PRNN. 131 (47.5%), 110 (39.9%), and 35 (12.7%) patients were classified into low-, intermediate- and high-risk group, with the 2-year OS rates of 64.8%, 45.1%, and 22.5%, respectively (P<0.001). ENNF was associated with a better OS in these three group patients compared with conservative management with statistical or marginal statistical significance (2-year OS low-risk group, 90.9% vs 61.1%, p=0.081; intermediate-risk group: 100% vs 37.8%, P=0.001; and high-risk group, 57.1% vs 20.8%, p=0.066).Conclusion: The new risk classification system provides accurate estimates of prognosis. ENNF surgery may lead to better survival outcome than conservative management in PRNN patients. [ABSTRACT FROM AUTHOR]