Efficacy of concurrent chemoradiotherapy alone for loco-regionally advanced nasopharyngeal carcinoma: long-term follow-up analysis

• Published in: Radiation oncology (London, England) Vol. 18; no. 1; pp. 63 - 10
• Main Authors: Xu, An-An, Miao, Jing-Jing, Wang, Lin, Li, An-Chuan, Han, Fei, Shao, Xun-Fan, Mo, Zhi-Wen, Huang, Shao-Min, Yuan, Ya-Wei, Deng, Xiao-Wu, Zhao, Chong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.04.2023; BioMed Central; BMC
• Subjects: Biopsy; Brain damage; Cancer; Care and treatment; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Cisplatin; Clinical trials; Concurrent chemotherapy; Deafness; Death; Diagnosis; Distribution; Failure; Follow-Up Studies; Health hazards; Heterogeneity; Humans; Intensity-modulated radiotherapy; Magnetic resonance imaging; Medical prognosis; Metastasis; Methods; Mortality; Nasopharyngeal cancer; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - radiotherapy; Nasopharyngeal Neoplasms - radiotherapy; Neck; Otitis; Patient outcomes; Patients; Peripheral neuropathy; Prognosis; Prognostication; Radiation therapy; Radiotherapy; Radiotherapy, Intensity-Modulated - methods; Rank tests; Retrospective Studies; Risk; Risk groups; Soft tissues; Statistical analysis; Statistical models; Statistical tests; Subgroups; Survival; Temporal lobe; Throat cancer; Tomography; Toxicity; Tumor staging; Xerostomia; China; Nasopharyngeal carcinoma; Intensity-modulated radiotherapy; Prognostication; Toxicity; Concurrent chemotherapy
• DOI: 10.1186/s13014-023-02247-y
• ISSN: 1748-717X

To analysis the clinical outcomes of concurrent chemoradiotherapy (CCRT) alone based on 10-year results for loco-regionally advanced nasopharyngeal carcinoma (LANPC), so as to provide evidence for individualized treatment strategy and designing appropriate clinical trial for different risk LANPC patients. Consecutive patients with stage III-IVa (AJCC/UICC 8th) were enrolled in this study. All patients received radical intensity-modulated radiotherapy (IMRT) and concurrent cisplatin chemotherapy (CDDP). The hazard ratios (HRs) of death risk in patients with T3N0 was used as baseline, relative HRs were calculated by a Cox proportional hazard model to classify different death risk patients. Survival curves for the time-to-event endpoints were analyzed by the Kaplan-Meier method and compared using the log-rank test. All statistical tests were conducted at a two-sided level of significance of 0.05. A total of 456 eligible patients were included. With 12-year median follow-up, 10-year overall survival (OS) was 76%. 10-year loco-regionally failure-free survival (LR-FFS), distant failure-free survival (D-FFS) and failure-free survival (FFS) were 72%, 73% and 70%, respectively. Based on the relative hazard ratios (HRs) of death risk, LANPC patients were classified into 3 subgroups, low-risk group (T1-2N2 and T3N0-1) contained 244 patients with HR < 2; medium-risk group (T3N2 and T4N0-1) contained 140 patients with HR of 2 - 5; high-risk group (T4N2 and T1-4N3) contained 72 patients with HR > 5. The 10-year OS for patients in low-, medium-, and high-risk group were 86%, 71% and 52%, respectively. Significantly differences of OS rates were found between each of the two groups (low-risk group vs. medium-risk group, P < 0.001; low-risk group vs. high-risk group, P < 0.001; and medium-risk group vs. high-risk group, P = 0.002, respectively). Grade 3-4 late toxicities included deafness/otitis (9%), xerostomia (4%), temporal lobe injury (5%), cranial neuropathy (4%), peripheral neuropathy (2%), soft tissue damage (2%) and trismus (1%). Our classification criteria demonstrated that significant heterogeneity in death risk among TN substages for LANPC patients. IMRT plus CDDP alone maybe suitable for low-risk LANPC (T1-2N2 or T3N0-1), but not for medium- and high-risk patients. These prognostic groupings provide a practicable anatomic foundation to guide individualized treatment and select optimal targeting in the future clinical trials.