Abstract
BackgroundTo determine whether concurrent chemotherapy is necessary during locoregional radiotherapy (RT) after palliative chemotherapy (PCT) in patients with de novo metastatic nasopharyngeal carcinoma (mNPC).MethodsA total of 746 patients with mNPC from 2000 to 2017 at our hospital were retrospectively reviewed. Among them, 355 patients received PCT followed by RT. Overall survival (OS) and progression-free survival (PFS), including locoregional progression-free survival (LRPFS) and distant progression-free survival (DPFS) were estimated with the Kaplan–Meier method and log-rank test. Cox proportional-hazards models, landmark analyses, propensity score matching, and subgroup analyses were used to address confounding.ResultsOf the patients included in our study, 192 received radiotherapy alone after PCT (PCT + RT), and 163 received concurrent chemoradiotherapy after PCT (PCT + CCRT). The prognosis of PCT + CCRT was significantly better than that of PCT + RT (5 year OS, 53.0 vs 36.2%; P = 0.004). After matching, the 5 year OS rates of the two groups were 55.7 and 39.0%, respectively (P = 0.034) and the median DPFS were 29.4 and 18.7 months, respectively (P = 0.052). Multivariate Cox regression analysis indicated that PCT + CCRT was an independent favorable prognostic factor (P = 0.009). In addition, conducting concurrent chemoradiotherapy after 4–6 cycles of PCT or conducting concurrent chemotherapy with single-agent platinum was associated with significant survival benefit in the matched cohort (5 year OS rate, 60.4 or 57.4%, respectively). The survival difference between groups remained significant when evaluating patients who survived for ≥ 1 year (P = 0.028).ConclusionsThe optimal treatment strategy of mNPC is the combination of PCT followed by concurrent chemoradiotherapy. More specifically, concurrent chemoradiotherapy with single-agent platinum after 4–6 cycles of PCT is suggested.
Highlights
To determine whether concurrent chemotherapy is necessary during locoregional radiotherapy (RT) after palliative chemotherapy (PCT) in patients with de novo metastatic nasopharyngeal carcinoma
A phase III trial comparing the survival of patients with or without RT in endemic regions demonstrated that RT added to PCT significantly improved overall survival (OS) in chemotherapy-sensitive patients with metastatic nasopharyngeal carcinoma (mNPC) (24-month OS, 76.4% vs 54.5%; hazard ratio [Hazard ratio (HR)], 0.42 (0.23–0.77); P = 0.004) [11]
The eligibility criteria for this study were as follows: (1) biopsy-proven Nasopharyngeal carcinoma (NPC) according to the pathological classification system of the World Health Organization (WHO); (2) pathologically or radiologically confirmed distant metastasis at initial diagnosis; (3) treated with PCT followed by RT with or without concurrent chemotherapy; and (4) the absence of other malignant diseases
Summary
To determine whether concurrent chemotherapy is necessary during locoregional radiotherapy (RT) after palliative chemotherapy (PCT) in patients with de novo metastatic nasopharyngeal carcinoma (mNPC). According to the current National Comprehensive Cancer Network (NCCN) guidelines, platinum-based palliative chemotherapy (PCT) with or without locoregional radiotherapy (RT) is the cornerstone of treatment for patients with mNPC [5]. A phase III trial comparing the survival of patients with or without RT in endemic regions demonstrated that RT added to PCT significantly improved OS in chemotherapy-sensitive patients with mNPC (24-month OS, 76.4% vs 54.5%; hazard ratio [HR], 0.42 (0.23–0.77); P = 0.004) [11]. The details related to combining chemotherapy and radiotherapy, such as whether concurrent chemotherapy is still necessary after PCT or whether the number of PCT cycles can be decreased when RT is applied, remain unclear.
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