Reviewer: Neha Vapiwala, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 8 de junio del 2004
Presenter: Langer, Corey
Presenter's Affiliation: Fox Chase Cancer Center
Type of Session: Scientific
The standard of care in the management of nasopharynx cancer (NPC) has been defined by several randomized phase III trials using concurrent chemoradiation with or without additional adjuvant chemotherapy. Two of these studies (Lin et al from Taiwan and Wee et al from Singapore) included endemic populations, but the US Intergroup report from Al-Sarraf first presented in 1996 is truly the landmark study in this field of research. This trial demonstrated a 40% progression-free and a 30% overall survival improvement with the use of cisplatin-based concurrent chemotherapy and radiation therapy, as compared to radiotherapy alone. The researchers behind the present abstract sought to measure the impact of these data supporting concurrent chemoradiation on actual clinical management of NPC patients in the US. They specifically focused on the effect of Al-Sarraf's data, using the year of its publication in 1998 as an inflection point and comparing practice patterns before and after
Materials and Methods
|Stage III (n=1235)||57.5%||58.5%|
|Stage IV (n=4201)||44.7%||48.4%|
|RT only (n=2157)||45.9%||46.1%|
This patterns of care study is an important follow-up assessment on the impact of clinical data on clinical practice. The growing acceptance of CTRT in the management of NPC patients is apparent in the database query comparing pre- and post-data presentation time periods (namely, 1998). It is interesting to note that younger and Asian patients are more likely to be offered CTRT, as shown in the data here. These patient subgroups also happen to have better corresponding 5-year survival rates as compared to their older and non-Asian counterparts, respectively. While it may not be surprising that younger patients are offered what is typically considered "more aggressive" therapy, it remains to be seen if there is also an effect of younger age on patient outcome, independent of therapy. Unfortunately, this study does not have basic data on the baseline comorbidities of the patients. Similarly, does the patient's ethnicity, specifically Asian heritage, have an impact on long-term outcome that is independent of therapy? It is well recognized that Asian NPC patients have a different histology and a different type of NPC with unique clinical behavior, but this distinction of degree of tumor differentiation is not clearly examined here. Furthermore, this database query has limited utility in that no details are available on the specific treatments (ie: radiation and chemotherpy doses, schedules, etc.) themselves. Nonetheless, several questions for continued research in this area have been raised, and hopefully these will be answered in the future. In the meantime, this study reassures clinicians and patients that rclinical research data does in fact correlate to clinical reality.
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