Abstract
BackgroundThe prognostic value of gender and age in the survival of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) is unclear. Several studies have suggested a female advantage in the prognosis of solid tumors. We investigated the relationship between gender differences and disease outcome in NPC patients treated with IMRT in South China.MethodsA total of 299 patients with non-disseminated NPC were analyzed retrospectively. IMRT was delivered with a simultaneous modulated, accelerated radiotherapy boost technique at prescribed doses of 70 Gy/30 fractions/6 weeks to the primary tumor (GTVp) and positive neck nodes (GTVn), 60Gy (2.0 Gy/day) to the clinical target volume (CTV) and upper neck region and 54 Gy (1.8 Gy/day) to the clinically negative low neck. A median boost dose of 9.2 Gy (4–20 Gy) was administered to patients with persistent disease at the primary site.ResultsWith a median follow-up of 52 months, the male patients had a significantly unfavorable 5-year OS (70.7% compared to 94.1%, P < 0.001), DPFS (71.5% compared to 87.3%, P = 0.029) and DMFS (77.2% compared to 89.7%, P = 0.036) than the female patients. In patients younger than 45, the male patients had a poorer 5-year OS (66.8% compared to 91.2%, P = 0.008), DPFS (59.9% compared to 91.2%, P = 0.005) and DMFS (66.4% compared to 94.0%, P = 0.004) than the female patients. For patients older than 45, only the 5-year OS (72.2% compared to 96.0%, P = 0.001) was significantly different.ConclusionsGender and age are strong independent prognostic factors for NPC in this study. We are the first to report that younger male patients were more likely to have distant metastases and exhibited inferior overall survival and disease progression-free survival rates compared to other patients.
Highlights
The prognostic value of gender and age in the survival of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) is unclear
The male patients had a significantly unfavorable 5-year overall survival (OS) (70.7% compared to 94.1%, P < 0.001, X2 = 16.816), disease progression-free survival (DPFS) (71.5% compared to 87.3%, P = 0.029, X2 = 4.743) and distant metastasis-free survival (DMFS) (77.2% compared to 89.7%, P = 0.036, X2 = 4.383) compared to female patients (Figure 1)
For patients younger than 45, the male patients had a significantly unfavorable 5-year OS than female patients (66.8% compared to 91.2%, P = 0.008, X2 = 7.067), DPFS (59.9% compared to 91.2%, P = 0.005, X2 = 7.724) and DMFS (66.4% compared to 94.0%, P = 0.004, X2 = 8.461)
Summary
Patient characteristics Between December 2003 and November 2010, there were 314 consecutive, newly diagnosed NPC patients in our Hospital. The gross tumor volume (GTV) was defined as all gross disease detected by the imaging studies and physical examination and included the primary tumor (GTVp) and all enlarged neck nodes (GTVn). Planning target volume 1 (PTV1) encompassed the GTVp with a 5–10 mm margin and GTVn with a 2–3 mm margin of adjacent tissue, ensuring that the high-dose zone would irradiate the tumor. Planning target volume 2 (PTV2) consisted of the clinic target volume (CTV) and included the entire nasopharynx, retropharyngeal lymph node regions, parapharyngeal space, posterior nasal cavity, skull base, clivus, inferior sphenoid sinus and bilateral upper deep jugular nodes, with a margin to account for patient motion and setup error.
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