Abstract
ObjectivesTo investigate the optimal treatment pattern in patients with de novo metastatic nasopharyngeal carcinoma (NPC).MethodsWe assessed 502 consecutive and unselected de novo metastatic NPC patients in Sun Yat-sen University Cancer Center (SYSUCC) from November 2006 to October 2016 in our study. All patients were treated with palliative chemotherapy (PCT) and 308 patients received locoregional radiotherapy (LRRT) subsequently. Our primary study endpoint was overall survival (OS).ResultsThe patients treated with LRRT were associated with improved survival on univariate analysis (3-year OS rate 63.7% vs. 31.8%, P < 0.001) and multivariate analysis (HR 0.52, 95%CI 0.40–0.68, P < 0.001). The overall survival benefit of more than 4 PCT cycles was significant in female (HR 0.45, 95% CI 0.24–0.86, P = 0.016) and patients with multiple metastatic sites (HR 0.42, 95% CI 0.26–0.66, P < 0.001). The application of concurrent chemotherapy (CCT) was not associated with better survival among patients receiving LRRT (HR 1.31, 95% CI 0.92–1.86, P = 0.141).ConclusionLRRT prolonged survival in de novo metastatic NPC. For patients treated with multiple metastatic sites, more than 4 cycles of PCT is necessary. CCT does not improve survival in de novo metastatic NPC patients.
Highlights
Nasopharyngeal carcinoma (NPC) is uncommon in most countries but is an endemic malignancy in Southeastern Asia and South China, especially Guangdong province
Radiotherapy is the fundamental treatment modality and concurrent chemo-radiotherapy (CCRT) is recommended for locoregional advanced NPC according to the National Comprehensive Cancer Network (NCCN) Guidelines [3, 4]
257 patients died of tumor progression and three patients died of other reasons
Summary
Nasopharyngeal carcinoma (NPC) is uncommon in most countries but is an endemic malignancy in Southeastern Asia and South China, especially Guangdong province. It has been reported that up to approximately 15% of NPC patients are diagnosed with de novo metastatic cancer before any treatment has begun [6]. The overall survival period for NPC patients with distant metastasis at initial diagnosis varies from months to years [7, 8]. Studies have been conducted to explore the optimal treatment modality for de novo metastatic NPC patients. The effect of courses and accumulated doses of palliative chemotherapy (PCT) and concurrent chemotherapy (CCT) on clinical outcomes of de novo metastatic nasopharyngeal carcinoma patients is largely unknown. We conducted a study to investigate the optimal treatment pattern in patients with de novo metastatic nasopharyngeal carcinoma
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