Abstract
Nasopharyngeal carcinoma (NPC) patients with N2–3 diseases are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy (CCRT). Our study is aim to determine the optimal treatment strategy of these patients. Patients with histologically proven NPC were retrospectively analyzed according to the AJCC 2002 stage classification system. A total of 547 patients who had N2–3 diseases were enrolled. They were all treated with Intensity-modulated radiation therapy (IMRT) combined with systemic treatments, including radiotherapy alone (RT alone), neoadjuvant chemotherapy followed by radiotherapy (NACT+RT), CCRT, NACT+CCRT, NACT followed by radiotherapy and adjuvant chemotherapy (NACT+RT+AC), CCRT+AC and NACT+CCRT+AC. A subgroup analysis was also conducted. With a median follow-up time of 53.8 months, adjuvant chemotherapy significantly decreased the risk of distant metastasis (HR 0.413, 95% CI 0.194–0.881, p = 0.022) as well as significantly increased the OS (HR 0.398, 95% CI 0.187–0.848, p = 0.017) in patients with N3 disease. The addition of adjuvant chemotherapy seemed to provide benefits to patients with N3 stage NPC and the current study may indicate the need for further randomized investigation.
Highlights
Platinum-based concurrent chemoradiotherapy represents the gold standard in the treatment of locally advanced nasopharyngeal carcinoma (NPC) [1, 2] in the era of 2D radiotherapy
On the basis of this background, we retrospectively explored the possible treatment option and hypothesized that patients with bulky lymph nodes would benefit from additional chemotherapy other than the concurrent modality
It was not difficult to understand that the benefit of locoregional control derived from concurrent chemotherapy would be weakened by the modern radiotherapy technique (IMRT)
Summary
Platinum-based concurrent chemoradiotherapy represents the gold standard in the treatment of locally advanced nasopharyngeal carcinoma (NPC) [1, 2] in the era of 2D radiotherapy. Intensity-modulated radiation therapy (IMRT) has greatly improved the local control rate to above 90% [3] but failed to further reduce the distant metastases of patients with bulky lymph nodes (N2–3) [4]. Up to 30–40% patients with of N3 stage will develop distant failures after radical treatment [3, 5]. It is crucial to choose proper chemotherapeutic modality to maximally reduce distant invasion. All studies had failed to demonstrate significant advantage in whole population of locally advanced disease without risk stratification
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
