Abstract
We compared treatment outcomes in patients with stage II nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) or two-dimensional conventional radiotherapy (2D-CRT). Stage II (2010 UICC/AJCC staging system) NPC patients treated with IMRT (n = 178) or 2D-CRT (n = 73) between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity score-matching method. The primary endpoint was overall survival (OS). Secondary endpoints were local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Acute and late toxicity reactions to IMRT and 2D-CRT were also compared. In an unmatched cohort of 251 patients, no significant survival differences were found between those receiving IMRT and those receiving 2D-CRT (5-year OS, 95.67% vs 94.44%, P = 0.0556; LRFS, 97.34% vs 98.59%, P = 0.6656; RRFS, 99.26% vs 100%, P = 0.6785; DMFS, 96.5% vs 98.63%, P = 0.7910; DFS, 92.2% vs 97.24%, P = 0.8719). In the propensity-matched cohort of 146 patients, 5-year OS (97.06% vs 94.44%, P = 0.1325), LRFS (96.75% vs 98.59%, P = 0.8869), RRFS (100% vs 100%, P = 1.0000), DMFS (98.63% vs 98.63%, P = 0.4225), and DFS (95.37% vs 97.24%, P = 0.5634) were similar between patients treated with IMRT or 2D-CRT. However, IMRT correlated with fewer acute and late toxicity reactions. Thus although IMRT provides no survival advantage, it has a lower incidence of toxicity than 2D-CRT in stage II NPC patients.
Highlights
Nasopharyngeal carcinoma (NPC) is an endemic disease in Southern China
178 were treated with intensity-modulated radiotherapy (IMRT), 73 patients were treated with two-dimensional conventional radiotherapy (2D-CRT), 94 received radiotherapy alone, 103 received concurrent chemoradiotherapy, and 54 received concurrent chemoradiotherapy with adjuvant chemotherapy
No grade 4 acute or late toxicity reactions were found in any patients, but grade 3 toxicity reactions were observed in some patients
Summary
Nasopharyngeal carcinoma (NPC) is an endemic disease in Southern China. Radiotherapy is the primary treatment modality for NPC, and two-dimensional conventional radiotherapy (2D-CRT) is effective in the control of NPC. 2D-CRT has been widely replaced by intensity-modulated radiotherapy (IMRT) because of the technical and dosimetric superiority of IMRT. IMRT is expected to improve patient survival and reduce toxicity, but superiority of IMRT over 2D-CRT is not conclusively proved. A meta-analysis [1] suggested that IMRT is correlated with better 5-year overall survival (OS) and local relapse-free survival (LRFS) and a lower incidence of late toxicities. A retrospective study [4] with long-term follow-up reported that IMRT improved OS in stage II NPC patients, but IMRT was reported in other studies to provide improved OS in stage III NPC patients [5] and not in stage II NPC patients [5, 6]
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