title: Pretreatment Epstein-Barr virus DNA load and cumulative cisplatin dose intensity affect long-term outcome of nasopharyngeal carcinoma treated with concurrent chemotherapy: experience of an institute in an endemic area.
abstract: BACKGROUND
  We retrospectively compared the long-term efficacy of concurrent chemoradiotherapy (CCRT) regimens (docetaxel vs. cisplatin), total dose intensity of cisplatin (> 200 vs. ≤ 200 mg/m2) and pretreatment plasma levels of Epstein-Barr virus (EBV) DNA for nasopharyngeal carcinoma (NPC), and investigated the prognostic factors.
  
  
  METHODS
  We enrolled 214 patients diagnosed with NPC and treated with CCRT. 41 patients received weekly docetaxel and 173 weekly cisplatin. 62 received cumulative cisplatin of ≤ 200 mg/m2 and 111, > 200 mg/m2. Pretreatment levels of EBV DNA were available for 155 patients.
  
  
  RESULTS
  Patients receiving concurrent weekly docetaxel and cisplatin had similar 5-year rates for overall survival (OS) (p = 0.306), progression-free survival (PFS) (p = 0.133), distant failure-free survival (DFS) (p = 0.110), and locoregional failure-free survival (LFS) (p = 0.452). Cumulative cisplatin of > 200 mg/m2 improved the 5-year rates of PFS (p = 0.018) and DFS (p = 0.042) significantly in comparison with cumulative cisplatin of ≤ 200 mg/m2. EBV DNA levels of ≥ 1,500 copies/ml was closely associated with poor DFS (p = 0.011), PFS (p = 0.006), and OS (p = 0.004).
  
  
  CONCLUSIONS
  Weekly cisplatin was well tolerated in CCRT, during which cumulative cisplatin of > 200 mg/m2 improved PFS and DFS. The long-term efficacy of concurrent docetaxel was similar to that of concurrent cisplatin. The EBV DNA level was the most significant prognostic factor.
authors.affiliation: Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, Guangzhou, China.
authors.forename: Weihong
authors.initials: W
authors.lastname: Wei
authors.forename: Zeli
authors.initials: Z
authors.lastname: Huang
authors.forename: Shaoen
authors.initials: S
authors.lastname: Li
authors.forename: Hemei
authors.initials: H
authors.lastname: Chen
authors.forename: Guoyi
authors.initials: G
authors.lastname: Zhang
authors.forename: Shuxia
authors.initials: S
authors.lastname: Li
authors.forename: Weihan
authors.initials: W
authors.lastname: Hu
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D059248:Chemoradiotherapy; D002681:China / Q000453:epidemiology; D002945:Cisplatin / Q000008:administration & dosage*; D004279:DNA, Viral / Q000097:blood*; D000077143:Docetaxel; D004305:Dose-Response Relationship, Drug; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000821:virology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin