Abstract
To report the distant metastasis (DM) risk and patterns for nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) and to analyze the benefits of chemotherapy based on DM risk. 576 NPC patients were analyzed. The DM rates were calculated using the Kaplan-Meier method, and the log-rank test was used to compare differences. The patients were divided into different risk subclassifications according to DM hazard ratios. 91 patients developed DM after treatment, with bone as the most common metastatic sites. 82.4% of DMs occurred within 3 years of treatment. Patients were classified as low-risk, intermediate-risk and high-risk, and the corresponding 5-year DM rates were 5.1%, 13.1% and 32.4%, respectively (P < 0.001). Chemotherapy failed to decrease the DM rate in the low-risk subclassification, but decreased the DM risk in the intermediate-risk subclassification (P = 0.025). In the high-risk subclassification, the DM rate was 31.9% though chemotherapy was used, which was significantly higher than that of other two subclassifications. DM is the dominant treatment failure in NPC treated by IMRT, with similar occurrence times and distributions to those that occurred in the era of conventional radiotherapy. Further studies on treatment optimization are needed in high-risk patients.
Highlights
Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, but it is more common in Southeast Asia, among the Southern Chinese population [1]
distant metastasis (DM) is the dominant treatment failure in NPC treated by intensity-modulated radiotherapy (IMRT), with similar occurrence times and distributions to those that occurred in the era of conventional radiotherapy
IMRT alone is applied in the treatment of early stage NPC, whereas concurrent chemoradiotherapy (CCRT) with or without neoadjuvant chemotherapy (NACT) or adjuvant www.impactjournals.com/oncotarget chemotherapy (ACT) is recommended for locoregionally advanced NPC according to NCCN guidelines
Summary
Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, but it is more common in Southeast Asia, among the Southern Chinese population [1]. NPC is highly sensitive to radiotherapy, and intensity-modulated radiotherapy (IMRT) has replaced 2-dimensional radiotherapy (2DRT) as the first choice for non-disseminated NPC patients. With the dose superiority of intensity-modulated radiotherapy (IMRT) technology, excellent locoregional control has been achieved compared with 2D-RT, even in locoregionally advanced patients, with a relatively low incidence of severe complications [2]. This improvement in locoregional control has not been accompanied by an increase in long-term overall survival. Reports from other centers have shown persistently high distant metastasis (DM) rates in patients who received IMRT, resulting in a predominant failure pattern [3,4,5,6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
