Abstract
PurposeTo evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors.MethodsA total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed.ResultsThe median follow-up time for the whole group was 31.5 months (range 5–138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60 (50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61 (51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p < 0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p = 0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, p < 0.001) and OS (HR = 0.518, p = 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFS.ConclusionTaxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.
Highlights
IntroductionThe incidence of de novo metastatic Nasopharyngeal carcinoma (NPC) (mNPC) in endemic region ranges from 6 to 8% at the time of presentation [1]
Nasopharyngeal carcinoma (NPC) is prevalent in southeastern Asia
No randomized evidence has showed an improvement in survival using chemotherapy compared with best supportive care alone, Chen et al found a 53.2% reduction in the risk of death in patients undergoing chemotherapy compared to patients undergoing supportive treatment in respective study [16]
Summary
The incidence of de novo metastatic NPC (mNPC) in endemic region ranges from 6 to 8% at the time of presentation [1]. There is no consensus on the therapeutic strategy for patients with mNPC because of the heterogeneity of synchronous metastatic NPC. In a recently published randomized trial [2], patients with mNPC who responded to cisplatin and 5-fluorouracil (PF regimen) were randomized to chemotherapy plus radiotherapy or chemotherapy alone. It is revealed that the addition of radiotherapy to primary tumor and nodal region significantly improved overall survival (OS). According to this randomized trial, we could select the subgroup of patients who can benefit
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