Efficacy of Concurrent Chemoradiotherapy In Subgroups of Stage III Nasopharyngeal Carcinoma: An Analysis Based On 10-Year Follow-Up

Abstract

PurposeTo evaluate the efficacy of concurrent chemoradiotherapy (CCRT) in subgroups of stage III nasopharyngeal carcinoma (NPC) in the context of intensity-modulated radiotherapy (IMRT).Methods272 patients with stage III NPC who underwent IMRT with or without concurrent chemotherapy (CCT) were retrospectively reviewed. Clinicopathological features were evaluated by a Cox regression model to identify independent prognostic factors. Survival outcomes were assessed using Kaplan-Meier method and log-rank test.ResultsThe median follow-up time was 108 months. The 10-year locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 87.8%, 80.7%, 68.8%, and 74.9%, respectively. Multivariate analysis showed that the N classification was significantly associated with DMFS (hazard ratio [HR] 3.616, 95% confidence interval [CI] 1.387-9.428, P=0.009), DFS (HR 2.417, 95% CI 1.291-4.423, P=0.006), and OS (HR 3.024, 95% CI 1.385-6.602, P=0.005). In patients with T1-3N2 disease, CCRT was associated with improved 10-year LRFS (89.6% vs. 65.4%, P=0.005), DFS (71.9% vs. 39.4%, P=0.001) and OS (80.0% vs. 50.5%, P=0.004) compared with IMRT alone. However, in patients with T3N0-1 disease, no significant survival differences were observed between patients treated with IMRT alone and CCRT (P>0.05). ConclusionCCRT is an effective therapy in stage III NPC, especially for patients with N2 disease but N0-1 disease. Individualized treatment strategies are essential for patients with varying disease risks.

Development and validation of prognostic nomograms in patients with ascending type of nasopharyngeal carcinoma: Retrospective study based on SEER database

“…Previous studies discover that, patients with T3N0M0 NPC could not gain benefit from chemotherapy 13,14 . Wang et al reported that chemotherapy did not improve the long‐term survival of patients at T3N0‐1M0 stage 22 . Our previous study based on the SEER database also found that, chemotherapy did not improve the OS or CSS of patients with T3‐4N0M0 NPC 15 .…”

“…13,14 Wang et al reported that chemotherapy did not improve the long-term survival of patients at T3N0-1M0 stage. 22 Our previous study based on the SEER database also found that, chemotherapy did not improve the OS or CSS of patients with T3-4N0M0 NPC. 15 Chua et al discovered that, for patients with ascending type NPC at T3-4N0-1M0 classification, the OS, local failure-free survival and distant metastasis-free survival were not significantly different between patients receiving chemotherapy combined with radiotherapy and those who received radiotherapy alone.…”