Abstract
PurposeTo analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases.Methods and MaterialsInstitutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included.ResultsMedian latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1–36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN.ConclusionsSex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.
Highlights
Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, but it is one of the most common types of cancer in Southern China with an annual incidence of 25 to 50 cases per 100,000 persons [1]
We report on the analyses of the clinicopathological characteristics, treatment outcomes, and potential prognostic factors of second malignant neoplasm (SMN) in a large group of NPC cases from endemic regions
Patients treated for NPC before 1986 were staged according to the Changsha staging system, while patients treated after 1986 were restaged according to the 2002 American Joint Committee on Cancer (AJCC) staging system
Summary
Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, but it is one of the most common types of cancer in Southern China with an annual incidence of 25 to 50 cases per 100,000 persons [1]. Over the past 30 years, advances in the RT technique, imaging technology, and chemotherapy have led to a marked improvement in the survival of NPC patients. The increasing incidences of second malignant neoplasms (SMNs) attributable to RT have become a major concern among long-term survivors. The studies that have been performed on this topic are mainly on small series of patients or include a mix of different primary tumor entities, making it difficult to evaluate the optimal treatment strategy and prognostic factors [10,11,12,13,14,15,16,17]. We report on the analyses of the clinicopathological characteristics, treatment outcomes, and potential prognostic factors of SMN in a large group of NPC cases from endemic regions
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