A recent study published in Scientific Reports investigates the optimal cumulative cisplatin dose (CCD) for patients with nasopharyngeal carcinoma (NPC) undergoing concurrent chemoradiotherapy (CCRT). The retrospective analysis of 765 patients aims to refine treatment strategies by identifying subgroups that benefit most from specific cisplatin dosages, potentially improving survival rates and reducing adverse effects.
The research, led by investigators at a major cancer center, highlights the importance of personalized treatment approaches in NPC. By integrating risk stratification with tailored chemotherapy regimens, the study seeks to optimize the balance between therapeutic efficacy and toxicity.
Risk Stratification and Treatment Outcomes
The study utilized recursive partitioning analysis (RPA) to stratify patients into high-, intermediate-, and low-risk groups based on pre-treatment plasma Epstein-Barr virus (EBV) DNA levels and clinical stage. The 5-year overall survival (OS) rates for these groups in the IMRT alone cohort were 86.5%, 71.6%, and 54.7%, respectively (p < 0.001).
CCRT demonstrated significant benefits in the high- and intermediate-risk groups. Specifically, the 5-year OS for the CCRT group versus the IMRT alone group was 60.1% vs 46.6% (p = 0.02) in the high-risk group and 77.8% vs 64.6% (p = 0.03) in the intermediate-risk group. No significant difference was observed in the low-risk group (86.2% vs 85.0%, p = 0.81).
Impact of Cumulative Cisplatin Dose
Further analysis explored the prognostic implications of different CCDs within each risk group. In the high-risk group, patients receiving a CCD between 80 and 160 mg/m2 showed a significantly improved 5-year OS compared to those receiving no cisplatin (73.4% vs 45.2%, p = 0.029). Similarly, in the intermediate-risk group, a CCD between 160 and 300 mg/m2 was associated with better survival outcomes (83.6% vs 64.6%, p = 0.038).
The study also examined the hazard ratios for death across different CCD categories. In the high-risk group, compared to CCD = 0 mg/m2, the death hazard ratios for 0 < CCD ≤ 80, 80 < CCD ≤ 160, and 160 < CCD ≤ 300 mg/m2 after weighting were 1.00 (95% CI 0.39–2.57) (p = 0.996), 0.46 (95% CI 0.26–0.82) (p = 0.008), and 0.48 (95% CI 0.24–0.96) (p = 0.037), respectively.
Nephrotoxicity Analysis
The study also assessed the incidence of nephrotoxicity, a common side effect of cisplatin. Overall, 21.2% of patients undergoing CCRT developed nephrotoxicity, with the majority experiencing Grade 1 toxicity. No patients developed Grade 3-4 nephrotoxicity, and renal function typically returned to normal within two weeks. There was no statistically significant difference in the probability of nephrotoxicity across the different CCD groups (p = 0.407).
Clinical Implications
These findings suggest that optimizing the cumulative cisplatin dose based on risk stratification can significantly improve treatment outcomes for NPC patients undergoing CCRT. The identification of specific CCD ranges that maximize survival benefits in different risk groups provides valuable guidance for clinicians seeking to personalize treatment strategies. Further prospective studies are warranted to validate these findings and refine the risk-adapted approach to cisplatin dosing in NPC.
