Top Line: Chemoradiation improves overall survival in patients with metastatic nasopharyngeal carcinoma who respond to initial systemic therapy compared to systemic therapy alone.
The Study: This small randomized phase 2 trial asked whether these patients could have similar outcomes with a slightly shorter course of radiation. Twenty-eight patients with metastatic NPC received 3 cycles of induction cisplatin and paclitaxel. They then received chemoradiation and were randomized to either 69.96Gy/59.4Gy/54Gy in 33 fractions or 60Gy/50Gy/45Gy in 25 fractions. At 2 years, there were no differences in the rates of OS (62.5% v 66.7%), local recurrence free survival (100% v 88.9%), or distant metastasis free survival (35% v 45.8%).There were also no major differences in acute toxicity between groups. The only acute grade 3 events were hematologic. One patient in the hypofractionated arm had late grade 3 hearing loss.
TBL: This small phase 2 trial found that 60 Gy in 25 fractions resulted in survival outcomes and toxicity that was comparable to standard 70 Gy in 33 fractions. Because standard CRT improves survival in this population, a larger randomized trial would be helpful to feel confident that this approach is a safe and effective alternative. | Liu, Radiother Oncol 2023
The Study: This small randomized phase 2 trial asked whether these patients could have similar outcomes with a slightly shorter course of radiation. Twenty-eight patients with metastatic NPC received 3 cycles of induction cisplatin and paclitaxel. They then received chemoradiation and were randomized to either 69.96Gy/59.4Gy/54Gy in 33 fractions or 60Gy/50Gy/45Gy in 25 fractions. At 2 years, there were no differences in the rates of OS (62.5% v 66.7%), local recurrence free survival (100% v 88.9%), or distant metastasis free survival (35% v 45.8%).There were also no major differences in acute toxicity between groups. The only acute grade 3 events were hematologic. One patient in the hypofractionated arm had late grade 3 hearing loss.
TBL: This small phase 2 trial found that 60 Gy in 25 fractions resulted in survival outcomes and toxicity that was comparable to standard 70 Gy in 33 fractions. Because standard CRT improves survival in this population, a larger randomized trial would be helpful to feel confident that this approach is a safe and effective alternative. | Liu, Radiother Oncol 2023