Abstract
BackgroundAlbeit intensity-modulated radiotherapy (IMRT) is currently the recommended radiation technique in treating nasopharyngeal carcinoma, the effect of IMRT versus two-dimensional conventional radiotherapy (2DCRT) alone is still contradictory.ResultsIn the original unmatched cohort of 1198 patients, IMRT obtained comparable 5-year overall survival (OS) (91.3% vs 87.1%, P = 0.120), locoregional relapse-free survival (LRFS) (92.3% vs 90.4%, P = 0.221) and distant metastasis-free survival (DMFS) (92.9% vs 92.1%, P = 0.901) to 2DCRT. In the propensity-matched cohort of 604 patients, no significant survival differences were observed between the two arms (5-year OS 90.9% vs 90.5%, P = 0.655; LRFS 92.5% vs 92.4%, P = 0.866; DMFS 92.5% vs 92.9%, P = 0.384). In multivariate analysis, IMRT did not significantly lower the risk of death, locoregional relapse or distant metastasis, irrespective of tumor stage.MethodsOverall, 1198 patients who underwent IMRT (316 patients) or 2DCRT (882 patients) without any chemotherapy was retrospectively analyzed. Patients in both arms were matched at equal ratio using propensity-score matching method. OS, LRFS and DMFS were assessed with Kaplan-Meier method, log-rank test and Cox regression.ConclusionsIn this propensity-matched study, IMRT showed no survival advantage over 2DCRT alone in nasopharyngeal carcinoma.
Highlights
Nasopharyngeal carcinoma (NPC) is a distinct type of head and neck cancer, relatively rare in Europe and the United States [1] but highly endemic in Southern China [2] and Hong Kong [3]
In the original unmatched cohort of 1198 patients, intensity-modulated radiotherapy (IMRT) obtained comparable 5-year overall survival (OS) (91.3% vs 87.1%, P = 0.120), locoregional relapse-free survival (LRFS) (92.3% vs 90.4%, P = 0.221) and distant metastasis-free survival (DMFS) (92.9% vs 92.1%, P = 0.901) to 2DCRT
In the propensity-matched cohort of 604 patients, no significant survival differences were observed between the two arms (5-year OS 90.9% vs 90.5%, P = 0.655; LRFS 92.5% vs 92.4%, P = 0.866; DMFS 92.5% vs 92.9%, P = 0.384)
Summary
Nasopharyngeal carcinoma (NPC) is a distinct type of head and neck cancer, relatively rare in Europe and the United States [1] but highly endemic in Southern China [2] and Hong Kong [3]. Radiotherapy is the cornerstone of initial treatment. Over the past few years, a shift toward the adoption of novel radiation techniques has been witnessed. Intensity-modulated radiotherapy (IMRT) rapidly replaced two-dimensional conventional radiotherapy (2DCRT), and it represents the most commonly used radiation option for NPC. It is expected to lower the rates of treatment-related toxicity and simultaneously improve survival, irrespective of a concomitant substantial increase in expenditures. Albeit intensity-modulated radiotherapy (IMRT) is currently the recommended radiation technique in treating nasopharyngeal carcinoma, the effect of IMRT versus two-dimensional conventional radiotherapy (2DCRT) alone is still contradictory
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