Multimodality Treatment May Improve the Survival Rate of Patients with Metastatic Nasopharyngeal Carcinoma with Good Performance Status.

Wei Zheng,Jingfeng Zong,Jianji Pan,Juhui Chen,Chuanben Chen,Chaobin Huang,Junxin Wu,Shaojun Lin,Jung Weon Lee

doi:10.1371/journal.pone.0146771

Wei Zheng, Jingfeng Zong + Show 7 more

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https://doi.org/10.1371/journal.pone.0146771

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Abstract

The aim of the present study was to evaluate the benefit of chemotherapy, combined with palliative radiotherapy (PRT) and other local treatments to the metastatic sites, for patients with metastatic nasopharyngeal carcinoma (NPC) who had a performance status 0–2. We conducted a retrospective review of available data from 197 biopsy-proven NPC patients who developed metastasis after their initial definitive treatment. These patients were grouped into three categories according to the different treatment paths that were followed: the best supportive care (64 patients), chemotherapy alone (55 patients), and multimodality treatment with chemotherapy combined with PRT and other local treatments to metastatic sites (78 patients). The 2-year metastatic survival rate of patients in the multimodality treatment group was 57.7%, which was significantly better than that of the patients in both the chemotherapy alone group and the best supportive care group (32.7% and 1.6%, respectively). The independent significant factors affecting survival were the disease-free interval prior to the detection of metastatic disease, the number of metastases, the number of chemotherapy cycles and the biological effective dose of PRT. In conclusion, multimodality treatment may improve survival of select patients with recurrent NPC with distant metastases.

Highlights

Chemoradiotherapy is the mainstay treatment for nasopharyngeal carcinoma (NPC) [1]
12.2% of the metastatic tumors were detected after three years
The results showed that patients in the multimodality treatment group presented with the best survival compared to those in the chemotherapy alone or best supportive care group among both oligometastasis and multimetastasis patients (Fig 3), with improved outcomes in patients with fewer metastases

Summary

Introduction

Chemoradiotherapy is the mainstay treatment for nasopharyngeal carcinoma (NPC) [1]. Despite the ability of chemoradiotherapy using intensity modulated radiotherapy (IMRT) technology to achieve locoregional control in over 90% of patients with non-metastatic NPC at PLOS ONE | DOI:10.1371/journal.pone.0146771 January 12, 2016Multimodality Treatment for Metastatic NPC presentation, the distant failure rate following initial definitive IMRT is as high as 14.1% [2] and is the foremost reason for treatment failure for patients with NPC [3].Chemotherapy is considered an effective treatment method for patients who develop distant metastasis, due to the high objective response rates and a substantial proportion of durable complete responses [4]. Chemoradiotherapy is the mainstay treatment for nasopharyngeal carcinoma (NPC) [1]. Despite the ability of chemoradiotherapy using intensity modulated radiotherapy (IMRT) technology to achieve locoregional control in over 90% of patients with non-metastatic NPC at PLOS ONE | DOI:10.1371/journal.pone.0146771. Multimodality Treatment for Metastatic NPC presentation, the distant failure rate following initial definitive IMRT is as high as 14.1% [2] and is the foremost reason for treatment failure for patients with NPC [3]. Chemotherapy is considered an effective treatment method for patients who develop distant metastasis, due to the high objective response rates and a substantial proportion of durable complete responses [4]. Several small-sample studies have indicated that patients may achieve long-term disease-free survival if given aggressive chemotherapy [5,6]. The reported median survival times were only 11–22 months, and patients seldom survived longer than three years [4]

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