Abstract
BackgroundThe National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients. Endoscopic nasopharyngectomy (ENPG) was successfully applied in recurrent NPC with radiation free and relatively low medical costs. In this study, we examined whether ENPG could be an effective treatment for localized stage I NPC.MethodsTen newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. Simultaneously, the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort. The survival outcomes, quality of life (QOL), and medical costs between two groups were compared.ResultsAfter a median follow-up of 59.0 months (95% CI 53.4–64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 patients treated with ENPG. The 5-year overall survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P > 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs ($ 4090.42 ± 1502.65 vs. $ 12620.88 ± 4242.65, P < 0.001) and improved QOL scores including dry mouth (3.3 ± 10.5 vs. 34.4 ± 25.8, P < 0.001) and sticky saliva (3.3 ± 10.5 vs. 32.6 ± 23.3, P < 0.001).ConclusionsENPG alone was associated with promising long-term survival outcomes, low medical costs, and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy. However, the application of ENPG should be prudent, and prospective clinical trials were needed to further verify the results.
Highlights
The National Comprehensive Cancer Network guidelines recommend intensity-modulated radio‐ therapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients
The inclusion and exclusion criteria for applying Endoscopic nasopharyngectomy (ENPG) were as follows: Inclusion criteria: (1) all patients were previously untreated, pathologically diagnosed with undifferentiated or differentiated, keratinizing or nonkeratinizing NPC; (2) staged as T1N0M0 classification; stage I according to the 8th edition staging system of the American Joint Committee on Cancer [AJCC], referring to primary tumors confined in the nasopharyngeal cavity, and the retropharyngeal lymph nodes (RPLN) and cervical lymph node (CLN) were no more than 0.5 cm and 1.0 cm respectively
Patients who refused radiotherapy or preferred surgery were treated with ENPG alone if they fit the inclusion criteria, and the rest were treated with IMRT (Fig. 1)
Summary
The National Comprehensive Cancer Network guidelines recommend intensity-modulated radio‐ therapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients. Endoscopic nasopharyngectomy (ENPG) was successfully applied in recurrent NPC with radiation free and relatively low medical costs. We examined whether ENPG could be an effective treatment for localized stage I NPC. Radiotherapy is currently regarded as the only curative option for stage I NPC according to National Comprehensive Cancer Network (NCCN) guidelines. We developed a novel endoscopic nasopharyngectomy (ENPG) [9,10,11] and applied this technique in recurrent NPC (rNPC) in 2004 [12,13,14]. Our previous studies have shown that salvage ENPG resulted in better overall survival (OS) and less posttreatment complications and medical costs than salvage IMRT [13]
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