Abstract
BackgroundThis study directs to evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy in intermediate-risk NPC (stage II and T3N0M0).MethodsA total of 124 patients with stage II and T3N0M0 NPC were pair-matched (1:1 ratio) to form two groups: an IMRT-alone group and an IMRT/chemotherapy group. Survival outcomes (overall survival [OS], disease–free survival [DFS], locoregional relapse–free survival [LRRFS], distant metastasis–free survival [DMFS]) and treatment-related grade 3–4 acute toxicity events were compared between the groups.ResultsSurvival outcomes for patients with stage II and T3N0M0 NPC were quiet comparable between patients treated with IMRT alone versus patients treated with IMRT/chemotherapy: 5-year OS was 91.9% vs. 90.3%, respectively (P = 0.727); DFS was 87.1% vs. 88.7%, respectively (P = 0.821); LRFFS was 96.8% vs. 95.2%, respectively (P = 0.646), and DMFS was 91.9% vs. 91.5%, respectively (P = 0.955). Grade 3 acute toxicities were significantly higher with IMRT/chemotherapy than with IMRT alone: mucositis, 15% vs. 5% (P = 0.004); leukopenia/neutropenia, 8% vs. 1% (P < 0.015); and nausea/vomiting, 22% vs. 3% (P < 0.001).ConclusionFor intermediate-risk (stage II and T3N0M0) NPC patients, the addition of chemotherapy to IMRT does not appear to provide any survival benefit. Moreover, grade 3 acute toxicities are also more common in patients receiving IMRT plus chemotherapy.
Highlights
This study directs to evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy in intermediate-risk Nasopharyngeal carcinoma (NPC)
All patients were restaged according to the 7th edition AJCC/UICC staging system; 22 patients were reclassified as T1, 75 were reclassified as T2, and 17 as T3
Our results are in line with a retrospective study by Xu et al that demonstrated similar overall survival (OS), locoregional relapse–free survival (LRRFS), and distant metastasis–free survival (DMFS) in stage II NPC patients treated with IMRT alone and with IMRT plus chemotherapy
Summary
This study directs to evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy in intermediate-risk NPC (stage II and T3N0M0). In the era of two-dimensional radiotherapy (2D-RT), chemoradiotherapy was the standard treatment for intermediate-risk NPC (stage II and T3N0M0). Concurrent chemoradiotherapy (CCRT) was shown to provide a considerable survival benefit for patients with stage II NPC [3, 4]. “three-dimensional conformal radiotherapy (3DCRT) and the more advanced intensity-modulated radiotherapy (IMRT) have largely replaced 2D-RT, which enable the delivery of a higher and more accurate dose to a tumor target while sparing organs at risk [5], but CCRT is still considered the most suitable treatment for locoregionally advanced NPC [6]. We included stage II and T3N0M0 disease as intermediate-risk NPC in our study, which would help in establishing individualized IMRT treatment protocols for stage II and T3N0M0 NPC
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