Skip to main content

Advertisement

SpringerLink
Log in

Tumor volume reduction after induction chemotherapy with gemcitabine plus cisplatin in nasopharyngeal carcinoma

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the tumor volume reduction after induction chemotherapy (IC) with gemcitabine plus cisplatin (GP) and to build prediction models for tumor volume reduction in nasopharyngeal carcinoma (NPC).

Methods

NPC patients who received GP IC were retrospectively enrolled. The gross tumor volume of the nasopharynx and lymph nodes (GTVnx and GTVnd) were contoured before and after IC. Univariate and multivariate analyses were performed to identify associated factors. Nomogram models were constructed to predict the possibility of tumor volume reduction.

Results

A total of 192 patients were enrolled. The mean relative volume reduction for GTVnx and GTVnd was 29.66% and 31.75%, respectively. The volume reduction of GTVnx and GTVnd had a weak association (r = 0.229, p < 0.001). For GTVnx volume reduction, pre-treatment neutrophil count (p = 0.043), lymphocyte count (p = 0.026), LDH level (p = 0.005), and BMI (p = 0.020) were independently associated factors. For GTVnd volume reduction, pre-treatment EBV–DNA (p = 0.029), GTVnd volume (p < 0.001), eosinophil count (p = 0.043), NLR (p = 0.039), LDH level (p = 0.026), and serum potassium level (p = 0.027) were independently associated factors. For the GTVnx nomogram model, areas under the receiver-operating characteristic curve (AUC) were 0.702 and 0.698 for the training and validation cohorts, respectively. For the GTVnd nomogram model, the AUC was 0.872 and 0.758 for the training and validation cohorts, respectively.

Conclusions

Tumor volumes reduce significantly after GP induction chemotherapy. Nomogram models for predicting the possibility of tumor volume reduction are built.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The raw data required to reproduce these findings cannot be shared at this time as the data also forms part of an ongoing study.

References

  1. Zhang Y, Chen L, Hu GQ, Zhang N, Zhu XD, Yang KY et al (2019) Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N Engl J Med 381(12):1124–1135. https://doi.org/10.1056/NEJMoa1905287

    Article  CAS  PubMed  Google Scholar 

  2. Hui EP, Ma BB, Leung SF, King AD, Mo F, Kam MK et al (2009) Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol 27(2):242–249. https://doi.org/10.1200/jco.2008.18.1545

    Article  CAS  PubMed  Google Scholar 

  3. Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY et al (2016) Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol 17(11):1509–1520. https://doi.org/10.1016/s1470-2045(16)30410-7

    Article  CAS  PubMed  Google Scholar 

  4. Liu T, Dai S, Zhang H, Zhong X, Ding Z, Ma X (2022) The best choice of induction chemotherapy for patients with locally advanced nasopharyngeal carcinoma: Bayesian network meta-analysis. Head Neck 44(2):518–529. https://doi.org/10.1002/hed.26932

    Article  PubMed  Google Scholar 

  5. Guan H, He Y, Su Y, Wei Z, Liu Z, Wang J et al (2021) Assessment of different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma: meta-analysis. Head Neck 43(8):2332–2341. https://doi.org/10.1002/hed.26699

    Article  PubMed  Google Scholar 

  6. Tang M, Jia Z, Zhang J (2022) The safety and efficacy of gemcitabine and cisplatin (GP)-based induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis. Eur Arch Otorhinolaryngol 279(3):1561–1572. https://doi.org/10.1007/s00405-021-06940-0

    Article  PubMed  Google Scholar 

  7. Chan SK, Chan SY, Tong CC, Lam KO, Kwong DL, Leung TW et al (2021) Comparison of efficacy and safety of three induction chemotherapy regimens with gemcitabine plus cisplatin (GP), cisplatin plus fluorouracil (PF) and cisplatin plus capecitabine (PX) for locoregionally advanced previously untreated nasopharyngeal carcinoma: a pooled analysis of two prospective studies. Oral Oncol 114:105158. https://doi.org/10.1016/j.oraloncology.2020.105158

    Article  CAS  PubMed  Google Scholar 

  8. Zhang CD, Li M, Hong YJ, Cai ZM, Huang KC, Lin ZX et al (2021) Development and validation of prognostic nomograms based on gross tumor volume and cervical nodal volume for nasopharyngeal carcinoma patients with concurrent chemoradiotherapy. Front Oncol 11:682271. https://doi.org/10.3389/fonc.2021.682271

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen QY, Guo SY, Tang LQ, Lu TY, Chen BL, Zhong QY et al (2018) Combination of tumor volume and Epstein-Barr virus DNA improved prognostic stratification of stage II nasopharyngeal carcinoma in the intensity modulated radiotherapy era: a large-scale cohort study. Cancer Res Treat 50(3):861–871. https://doi.org/10.4143/crt.2017.237

    Article  CAS  PubMed  Google Scholar 

  10. Yang H, Liu Y, Zhang R, Ye Y, Chen Q, Qin Q et al (2020) Prognostic value of the tumor volume reduction rate after neoadjuvant chemotherapy in patients with locoregional advanced nasopharyngeal carcinoma. Oral Oncol 110:104897. https://doi.org/10.1016/j.oraloncology.2020.104897

    Article  CAS  PubMed  Google Scholar 

  11. Lee H, Ahn YC, Oh D, Nam H, Noh JM, Park SY (2016) Tumor volume reduction rate during adaptive radiation therapy as a prognosticator for nasopharyngeal cancer. Cancer Res Treat 48(2):537–545. https://doi.org/10.4143/crt.2015.081

    Article  CAS  PubMed  Google Scholar 

  12. Zheng L, Liao W, Xu P, Li B, Wen H, Zhang S (2018) Tumor volume reduction after gemcitabine plus cisplatin induction chemotherapy in locally advanced nasopharyngeal cancer: comparison with paclitaxel and cisplatin regimens. Med Sci Monit 24:8001–8008. https://doi.org/10.12659/msm.909736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Wang L, Wu Z, Xie D, Zeng R, Cheng W, Hu J et al (2019) Reduction of target volume and the corresponding dose for the tumor regression field after induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma. Cancer Res Treat 51(2):685–695. https://doi.org/10.4143/crt.2018.250

    Article  CAS  PubMed  Google Scholar 

  14. Li S, Shen L (2021) The change in tumor volume after induction chemotherapy with docetaxel plus cisplatin in 259 nasopharyngeal carcinoma patients. Eur Arch Otorhinolaryngol 278(8):3027–3035. https://doi.org/10.1007/s00405-020-06477-8

    Article  PubMed  Google Scholar 

  15. Li PJ, Mo HY, Luo DH, Hu WH, Jin T (2018) The efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma in intensity modulated radiotherapy era. Oral Oncol 85:95–100. https://doi.org/10.1016/j.oraloncology.2018.08.016

    Article  CAS  PubMed  Google Scholar 

  16. Lee AW, Lau KY, Hung WM, Ng WT, Lee MC, Choi CW et al (2008) Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma. Radiother Oncol 87(2):204–210. https://doi.org/10.1016/j.radonc.2008.02.003

    Article  CAS  PubMed  Google Scholar 

  17. Blank A, Roberts DE 2nd, Dawson H, Zlobec I, Lugli A (2018) Tumor heterogeneity in primary colorectal cancer and corresponding metastases. Does the apple fall far from the tree? Front Med (Lausanne) 5:234. https://doi.org/10.3389/fmed.2018.00234

    Article  PubMed  Google Scholar 

  18. Baumeister P, Zhou J, Canis M, Gires O (2021) Epithelial-to-mesenchymal transition-derived heterogeneity in head and neck squamous cell carcinomas. Cancers (Basel). https://doi.org/10.3390/cancers13215355

    Article  PubMed  PubMed Central  Google Scholar 

  19. Liu YH, Lin YS (2019) Platelet-lymphocyte and neutrophil-lymphocyte ratios: predictive factors of response and toxicity for docetaxel-combined induction chemotherapy in advanced head and neck cancers. J Chin Med Assoc 82(11):849–855. https://doi.org/10.1097/jcma.0000000000000178

    Article  PubMed  Google Scholar 

  20. Ghebeh H, Elshenawy MA, AlSayed AD, Al-Tweigeri T (2022) Peripheral blood eosinophil count is associated with response to chemoimmunotherapy in metastatic triple-negative breast cancer. Immunotherapy 14(4):189–199. https://doi.org/10.2217/imt-2021-0149

    Article  CAS  PubMed  Google Scholar 

  21. Tan R, Phua SKA, Soong YL, Oon LLE, Chan KS, Lucky SS et al (2020) Clinical utility of Epstein-Barr virus DNA and other liquid biopsy markers in nasopharyngeal carcinoma. Cancer Commun (Lond) 40(11):564–585. https://doi.org/10.1002/cac2.12100

    Article  PubMed  Google Scholar 

  22. Floris G, Richard F, Hamy AS, Jongen L, Wildiers H, Ardui J et al (2021) Body mass index and tumor-infiltrating lymphocytes in triple-negative breast cancer. J Natl Cancer Inst 113(2):146–153. https://doi.org/10.1093/jnci/djaa090

    Article  CAS  PubMed  Google Scholar 

  23. Huang L, Sim AYL, Wu Y, Liang Z, Li K, Du Y et al (2020) Lactate dehydrogenase kinetics predict chemotherapy response in recurrent metastatic nasopharyngeal carcinoma. Ther Adv Med Oncol 12:1758835920970050. https://doi.org/10.1177/1758835920970050

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Li Y, Zhang J, Wang B, Zhang H, He J, Wang K (2021) A nomogram based on clinicopathological features and serological indicators predicting breast pathologic complete response of neoadjuvant chemotherapy in breast cancer. Sci Rep 11(1):11348. https://doi.org/10.1038/s41598-021-91049-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Maruhashi T, Kajikawa M, Kishimoto S, Takaeko Y, Yamaji T, Harada T et al (2021) Serum potassium levels of 4.5 to less than 5.0 mmol/L are associated with better vascular function. J Atheroscler Thromb. https://doi.org/10.5551/jat.63285

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhou J, Bai J, Yue Y, Chen X, Lange T, You D et al (2021) Association of hypokalemia incidence and better treatment response in NSCLC patients: a meta-analysis and systematic review on anti-EGFR targeted therapy clinical trials. Front Oncol 11:757456. https://doi.org/10.3389/fonc.2021.757456

    Article  PubMed  Google Scholar 

  27. Ghoshal A, Garmo H, Hammar N, Jungner I, Malmström H, Walldius G et al (2018) Can pre-diagnostic serum levels of sodium and potassium predict prostate cancer survival? BMC Cancer 18(1):1169. https://doi.org/10.1186/s12885-018-5098-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. (1993) A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med, 329(14): 987–94. https://doi.org/10.1056/nejm199309303291402

  29. Zhou GQ, Ren XY, Mao YP, Chen L, Sun Y, Liu LZ et al (2016) Prognostic implications of dynamic serum lactate dehydrogenase assessments in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Sci Rep 6:22326. https://doi.org/10.1038/srep22326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Long G, Tang W, Fu X, Liu D, Zhang L, Hu G et al (2019) Pre-treatment serum lactate dehydrogenase predicts distant metastasis and poor survival in nasopharyngeal carcinoma. J Cancer 10(16):3657–3664. https://doi.org/10.7150/jca.32716

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Zhang M, Wei S, Su L, Lv W, Hong J (2016) Prognostic significance of pretreated serum lactate dehydrogenase level in nasopharyngeal carcinoma among Chinese population: a meta-analysis. Medicine (Baltimore) 95(35):e4494. https://doi.org/10.1097/md.0000000000004494

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Oncology, Xiangya Hospital, Central South University, Changsha, China

    Qian Chen, Liangfang Shen & Shan Li

  2. National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China

    Qian Chen, Liangfang Shen & Shan Li

Authors
  1. Qian Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liangfang Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SL and LS conceived and designed the study; QC and SL collected the data and performed the analysis; QC and SL wrote the paper.

Corresponding author

Correspondence to Shan Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of the Xiangya Hospital of Central South University prior to commencement [IRB number: 202208191] and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Fig. 1.

(A) Typical cases with GTVnx volume reduction (upper row) and non-reduction (lower row) after GP induction chemotherapy. (B) Typical cases with GTVnd volume reduction (upper row) and non-reduction (lower row) after GP induction chemotherapy. (TIFF 3223 KB)

Supplementary Fig. 2.

(A) GTVnx volumes of patients with different T stages; (B) GTVnd volumes of patients with different T stages; (C) GTVnd volumes of patients with different N stages; (D) GTVnx volumes of patients with different N stages. Error bars represent the mean ± SEM. (TIFF 3819 KB)

Supplementary Fig. 3.

(A) Calibration plot for the GTVnx nomogram model; (B) calibration plot for the GTVnd nomogram model. (TIFF 7102 KB)

Supplementary Fig. 4.

(A) Correlation of pre-treatment LDH level and pre-treatment GTVnd volume. Pearson correlation coefficient, r = 0.425, p < 0.001. (B) Correlation of pre-treatment LDH level and GTVnd volume reduction. Pearson correlation coefficient, r = 0.552, p < 0.001. (TIFF 4378 KB)

Supplementary file5 (DOCX 43 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Q., Shen, L. & Li, S. Tumor volume reduction after induction chemotherapy with gemcitabine plus cisplatin in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 280, 2497–2509 (2023). https://doi.org/10.1007/s00405-022-07809-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07809-6

Keywords

Search

Navigation