Chemotherapy, Radiation Therapy, and Nasopharyngeal Carcinoma

To the Editor A recent randomized clinical trial reported that after induction chemotherapy (IC), patients with stages III to IVB (American Joint Committee on Cancer Staging Manual, 7th Edition) nasopharyngeal carcinoma (NPC) receiving radiation therapy alone had noninferior oncologic outcomes and fewer acute adverse events, compared with those receiving concurrent chemoradiotherapy (CCRT). We have several comments about this impactful study.

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Settembre 2024

Chemotherapy, Radiation Therapy, and Nasopharyngeal Carcinoma

To the Editor We read the article by Dai et al with great interest. Omitting chemotherapy in patients receiving induction chemotherapy (IC) is a hot topic in nasopharyngeal carcinoma treatment, particularly in the intensity-modulated radiotherapy era. Yet, concurrent cisplatin is still recommended in advanced-stage disease, and the cumulative dose of concurrent cisplatin recommended is at least 200 mg/m2 in the latest American Society of Clinical Oncology/Chinese Society of Clinical Oncology guidelines. The authors in the current study gave 30-mg/m2 cisplatin per week and only 12.1% of patients had received 7 weeks of cisplatin, which makes a total 210 mg/m2. For patients receiving IC, at least a total 160-mg/m2 dose of cisplatin is recommended, which had been received by 85.8% of patients. Could the inadequate cumulative concurrent cisplatin dose be the reason why the IC in combination with radiotherapy (IC-RT) arm was noninferior to the IC with induction chemotherapy combined with chemoradiotherapy (IC-CCRT) arm? Therefore, we would kindly like the authors to separately analyze the results of patients receiving adequate doses of concurrent cisplatin.

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Settembre 2024