Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on induction chemotherapy response.

BACKGROUND AND PURPOSE: Nasopharyngeal carcinoma (NPC) patients can be separated into two risk subgroups according to tumor responses to induction chemotherapy (IC). We aimed to elucidate the optimal cumulative cisplatin dose (CCD) of concurrent chemoradiotherapy (CCRT) for different NPC patient subgroups. PARTICIPANTS AND METHODS: A total of 990 patients with incident NPC diagnosed between 2008 and 2017 treated with IC plus CCRT were included in our observational study. The clinicopathological features of patients with different tumor responses were compared using the Chi-square test or Fisher's exact test. Prognosis was assessed using a multivariate Cox proportional hazards model. In addition, acute and late toxicities were compared between different CCD groups. RESULTS: After IC, 761/990 (76.9%) patients had a complete tumor response (CR)/partial response (PR) and 229 (23.1%) had stable disease (SD)/disease progression (PD). An unsatisfactory tumor response (SD/PD) after IC correlated with poor clinical outcome (3-year PFS 61.4% vs. 83.2%, P < 0.001 and 3-year LRFS 80.9% vs. 94.5%, P < 0.001). Patients who achieved CR/PR after IC received a CCD >200 mg/m2 and showed higher 3-year PFS and DMFS rates than those receiving a CCD <100 mg/m2 (PFS: 85.4% vs. 77.9%, P = 0.045; DMFS: 89.4% vs. 77.9%, P = 0.015). Multivariate analysis also showed that CCD was an independent prognostic factor for PFS and DMFS in CR/PR subgroup. Moreover, the medium dose group showed similar efficacy as high dose group but was associated with fewer grade 1-4 acute toxicities. However, application of different CCD didn't result in significantly different survival outcomes in SD/PD subgroup. CONCLUSIONS: Tumor response to IC was an independent prognostic factor for patients with NPC. For the patients who achieved CR/PR after IC, patients receiving high CCD showed significantly improved 3-year PFS and DMFS compared with patients receiving low CCD. Balancing toxicity and efficacy, 200 mg/m2 seemed to be the optimal dose in the CR/PR groups. However, enhancement of CCD did not provide survival benefit for patients who achieved SD/PD after IC, and treatment options for these patients require further consideration.

Endorsement of the CONSORT statement by Chinese journals of Traditional Chinese Medicine: a survey of journal editors and review of journals' instructions for authors.

BACKGROUND: We aimed to assess the endorsement of the Consolidation Standards of Reporting Trials (CONSORT) statement by Chinese journals of Traditional Chinese Medicine (TCM) and its incorporation into their editorial processes. METHODS: PubMed, Embase and major Chinese databases were searched to identify journals of TCM from China for inclusion. The latest 'instruction for authors' (IFA) of each included journal was obtained and any text mentioning CONSORT or CONSORT extension papers was extracted. Subsequently, the editor of each of the included journals was surveyed about their journal's endorsement of the CONSORT recommendations and their incorporation into editorial and peer review processes. RESULTS: Sixty-three journals of TCM from China were examined. Of these, only three (5%) and one (2%) of the 63 journals mentioned the CONSORT statement and extension papers, respectively, in their IFA. Fifty-four of 63 (86%) of surveyed journals responded, with the majority of respondents being editors. Only 20% (11/54) of the respondents reported that they had any knowledge of the CONSORT statement. Only 6% (3/54) of the editors reported that they required authors to comply with the CONSORT statement or that they incorporated it into their peer review and editorial processes. CONCLUSIONS: TCM journals in China endorsing the CONSORT statement constituted a small percentage of the total. The majority of editors surveyed were not familiar with the content of the CONSORT statement and extension papers. We strongly recommend that the China Periodicals Association issue a policy to promote the endorsement of the CONSORT statement and conduct relevant training for journal editors in China.