Cancer Res Treat.  2022 Jan;54(1):118-129. 10.4143/crt.2021.101.

Long-term Survivals, Toxicities and the Role of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiation Therapy: A Retrospective Study with 15-Year Follow-up

• Wang L
• Miao J
• Huang H
• Chen B
• Xiao X
• Zhu M
• Liang Y
• Xiao W
• Huang S
• Peng Y
• Deng X
• Lv X
• Xia W
• Xiang Y
• Guo X
• Han F
• Zhao C

• KMID: 2524593
• DOI: http://doi.org/10.4143/crt.2021.101

Abstract

Purpose
This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients.
Materials and Methods
Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010.
Results
With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p < 0.001); Charlson comorbidity index < 3 points could predict DSS (p=0.011); age > 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p < 0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%), and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p > 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group.
Conclusion
Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.

Keyword

Early-stage; Nasopharyngeal carcinoma; Intensity-modulated radiation therapy; Chemotherapy; Long-term outcomes; Toxicity

Figure

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  Fig. 1 Trial profile. BMI, body mass index; CCI, Charlson comorbidity index; GTVnx, gross tumor volume of nasopharynx; IMRT, intensity-modulated radiation therapy; KPS, Karnofsky performance status; LDH, lactate dehydrogenase; NLR, neutrophil to lymphocyte ratio; NPC, nasopharyngeal carcinoma; PNI, prognostic nutritional index; SYSUCC, Sun Yat-sen University Cancer Center. a)Restaged according to the American Joint Committee on Cancer, 8th edition.

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  Fig. 2 Survival curves of the whole cohort: locoregional recurrence-free survival (LRRFS) (A), distant metastasis-free survival (DMFS) (B), disease-specific survival (DSS) (C), and overall survival (OS) (D).

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  Fig. 3 Survival curves of IMRT+CT vs. IMRT alone in the stage II nasopharyngeal carcinoma patients: locoregional recurrence-free survival (LRRFS) (A), distant metastasis-free survival (DMFS) (B), disease-specific survival (DSS) (C), and overall survival (OS) (D). CI, confidence interval; CT, chemotherapy; HR, hazard ratio; IMRT, intensity-modulated radiation therapy.

Reference

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