The impact of the overall radiotherapy time on the clinical outcome of patients with nasopharyngeal carcinoma in Yogyakarta, Indonesia.

Rijntjes, F. J. F. (2014) The impact of the overall radiotherapy time on the clinical outcome of patients with nasopharyngeal carcinoma in Yogyakarta, Indonesia. thesis, Medicine.

Text RijntjesF.pdf Restricted to Registered users only Download (796kB)

Abstract

Introduction: Head and neck cancer is an uncommon entity compared to lung-, breast- and intestinal cancer. Nasopharyngeal Carcinoma (NPC) is with 85.000 cases annually worldwide a prevalent form of head and neck cancer. But NPC has a distinctive demographic and geographic predisposition. In the Netherlands there are annually 60-70 cases of NPC diagnosed compared to approximately 14.000 cases annually in Indonesia. The 3-year overall survival (OS) of 30% in Yogyakarta compared to 80% in literature stresses the importance of improving the health care for NPC patients in Indonesia. The difference in OS is thought to be attributable to several factors. One of them is the prolonged diagnose to treatment interval (DTI). When finally being treated for NPC, patients don’t receive the optimal treatment. For squamous cell carcinoma of the head and neck the optimal treatment of 66-70Grey (Gy) radiotherapy (RT) should be attributed in 45-47 days. In Yogyakarta the mean overall treatment time (OTT) is around 10 days prolonged. NPC treatment and OTT in specific is a relatively easily adjustable factor compared to the other factors mentioned. Therefore it is important to investigate the actual burden of a prolonged OTT. Objectives: The objective of this study was to evaluate the effect of a prolonged OTT on the treatment outcome, the OS and disease free survival (DFS). Additionally we aim to investigate confounders as DTI, stage at presentation and treatment plan. Moreover we observed trends over the years in OTT and DTI. Patients and methods: We included 147 patients diagnosed with histologically proven NPC who completed the initially planned treatment, receiving 66-70Gy of RT and visited the ear-nose-throat department (ENT) for therapy assessment (TA) two to three months after treatment. The response to therapy was monitored by means of a CT-scan, chest X-ray, bone survey, an ultrasound of abdomen and physical examination including nasal endoscopy. In addition, a biopsy of where the primary tumour was located, was taken. Treatment outcome was evaluated by means of Complete Response (CR) or Partial Response (PR). The OS was measured from date of diagnosis until date of last follow up death or alive. DFS analysis was only performed in patients with complete response. The multivariate logistic regression model and cox-regression model were used to evaluate the association between OTT and treatment outcome (CR vs PR), OS and DFS. To estimate OS and DFS we used the Kaplan-Meijer technique. Results: The median overall survival in this study was 25 months (95%: 19-33) and the median disease free survival was 29 months (95%: 29-40). The effect of a prolonged OTT on the treatment outcome was insignificant (p= 0.382). No other significant predictive variables were found using the multivariable models. Using the Kaplan Meijer model the DTI>120days does predict a worse OS. Conclusion: In conclusion, there is no significant association found between the prolongation of OTT and the treatment outcome, OS or DFS in NPC patients in Yogyakarta. DTI has shown to be an important prognosticator in this study, stressing the need for more RT units to reduce DTI.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijholt, Dr. I.M. and Antoni van Leeuwenhoek Hospital and Amsterdam
Supervisor name:	Tan, Prof. dr. I.B. and Stoker, S. and Faculty of Medicine Gadjah Mada University, Dr. Sardjito Hos and Yogyakarta, Indonesia;
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:40
Last Modified:	25 Jun 2020 10:40
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/221

Actions (login required)

View Item