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A phase II study of adaptive two-step intensity-modulated radiation therapy (IMRT) with chemotherapy for loco-regionally advanced nasopharyngeal cancer (JCOG1015)

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Abstract

Background

A phase II study of adaptive two-step intensity-modulated radiotherapy (IMRT) with chemotherapy for nasopharyngeal cancer (NPC) (JCOG1015) was conducted to evaluate the efficacy and safety.

Methods

Patients aged 20–75 years with stages II–IVB NPC were enrolled. As adaptive two-step IMRT, computed tomography planning was performed twice before IMRT for the initial plan of 46 Gy/23 fractions and during treatment for the boost plan of 24 Gy/12 fractions with a total dose of 70 Gy. Chemotherapy (cisplatin 80 mg/m2/3-weeks × 3 courses) was administered concurrently with IMRT, followed by adjuvant chemotherapy (cisplatin at 70 mg/m2 with 5-FU 700 at mg/m2 for 5 days/4 weeks × 3 courses).

Results

Between 2011 and 2014, 75 patients were enrolled from 12 institutions. The 3-year overall survival (OS) for the 75 patients was 88%, and the upper and lower limits of the 95% CI of 78%–94% were higher than the expected 3-year OS of 75% for the target population adjusted by the actual proportion of stage II:III:IV = 21%:44%:35%. The 3-year progression-free survival (PFS) and loco-regional PFS were 71% [59–80%] and 77% [66–85%], respectively. Although no grade 4–5 late toxicities were observed, 15 patients (20%) developed grade 3 late toxicities. Grade 2 xerostomia was noted in 26%, 12%, and 9% at 1, 2, and 3 years after starting IMRT, respectively.

Conclusions

Adaptive two-step IMRT for NPC demonstrated an excellent 3-year OS with acceptable toxicities. This method may be one treatment option for locally advanced NPC.

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Acknowledgements

We would like sincerely thank all participating patients, the 12 participating institutions from the JCOG Radiation Therapy Study Group, Data and Safety Monitoring Committee, Audit Committee of JCOG, and JCOG Data Center/Operations Office. JCOG Data Center and Operation Office: H. Fukuda (Data Center Director), R. Machida (Statistical Section), C. Aibara and M. Murai (Data Management Section), and J. Eba and Y. Takahashi (Operations Office).

Funding

This study was supported by Health Sciences Research Grants for the Grant-in-Aid for Cancer Research (H23-009) from the Ministry of Health, Labour and Welfare of Japan, the Japan Agency for Medical Research and Development under Grant number JP16ck0106093, and the National Cancer Center Research and Development Funds (26-A-4, 29-A-3).

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Yasumasa Nishimura & Kazuki Ishikawa

  2. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan

    Satoshi Ishikura

  3. JCOG Data Center/Operations Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Taro Shibata & Kenichi Nakamura

  4. Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Takeshi Kodaira & Hidetoshi Shimizu

  5. Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yoshinori Ito

  6. Department of Radiation Oncology, Hokkaido University Hospital, Kita14 Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Kazuhiko Tsuchiya

  7. Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuji Murakami

  8. Department of Radiation Oncology, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Jun-ichi Saitoh

  9. Department of Radiation Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Tetsuo Akimoto

  10. Department of Radiology, Sapporo Medical University, S1W17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan

    Kensei Nakata

  11. Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Michio Yoshimura

  12. Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Teruki Teshima

  13. Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Takashi Toshiyasu

  14. Department of Radiation Oncology, Hyogo Cancer Center, 13-70 Kitaouji, , Akashi, Hyogo, 673-8558, Japan

    Yosuke Ota

  15. Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Toshiyuki Minemura

  16. Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-Dori, Wakayama, 640-8558, Japan

    Masahiro Hiraoka

Authors
  1. Yasumasa Nishimura
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  2. Satoshi Ishikura
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  3. Taro Shibata
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  4. Takeshi Kodaira
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  5. Yoshinori Ito
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  8. Jun-ichi Saitoh
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  10. Kensei Nakata
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  11. Michio Yoshimura
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  13. Takashi Toshiyasu
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  14. Yosuke Ota
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  15. Kazuki Ishikawa
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  18. Kenichi Nakamura
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  19. Masahiro Hiraoka
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Corresponding author

Correspondence to Yasumasa Nishimura.

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Nishimura, Y., Ishikura, S., Shibata, T. et al. A phase II study of adaptive two-step intensity-modulated radiation therapy (IMRT) with chemotherapy for loco-regionally advanced nasopharyngeal cancer (JCOG1015). Int J Clin Oncol 25, 1250–1259 (2020). https://doi.org/10.1007/s10147-020-01665-2

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  • DOI: https://doi.org/10.1007/s10147-020-01665-2

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