Efficacy of local therapy to metastatic foci in nasopharyngeal carcinoma: large-cohort strictly-matched retrospective study

Abstract

Background: Studies of local therapy (LT) to metastatic foci from nasopharyngeal carcinoma (NPC) are inconsistent and controversial. Here, we aimed to explore the survival benefit of LT directed at metastatic foci from NPC. Methods: A retrospective analysis was conducted in NPC patients with liver, lung, and/or bone metastases. The postmetastatic overall survival (OS) rate was analyzed using the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis was performed using the Cox hazard model. Subgroup analyses evaluating the effect of LT were performed for prespecified covariates. Propensity score matching was applied to homogenize the compared arms. Results: Overall, 2041 of 2962 patients were eligible for analysis. At a median follow-up of 43.4 months, the 5-year OS improved by an absolute difference of 14.6%, from 46.2% in the LT group versus 31.6% in the non-LT group, which led to a hazard ratio of 0.634 for death ( p < 0.001). Matched-pair analyses confirmed that LT was associated with improved OS ( p = 0.003), and the survival benefits of LT remained consistent in the subcohorts of liver and lung metastasis ( p = 0.009 and p = 0.007, respectively) but not of bone metastasis (BoM; p = 0.614). Radiotherapy was predominantly used for BoM and biological effective dose (BED) >60 Gy was found to yield more survival benefit than that of BED ⩽ 60 Gy. Conclusions: The addition of LT directed at metastasis has demonstrated an improvement to OS compared with non-LT group in the present matched-pair study, especially for patients with liver and/or lung metastases.

The map of bone metastasis in nasopharyngeal carcinoma: A real‐world study

“…The study showed that these patients received more than 6 cycles of chemotherapy would have better survival and prognosis 24 . But after when these patients had been treated by palliative chemotherapy plus locoregional radiotherapy, further local radiotherapy to bone metastases would not significantly improve survival 25–27 . If performed radiotherapy to metastatic bones, the radiation dose should give radical dose rather than palliative dose 28 .…”

Long‐term outcomes of metastasis‐directed stereotactic body radiation therapy in metastatic nasopharyngeal carcinoma

“…2,4,5 The survival of patients with metastatic NPC (mNPC) is poor, with a median overall survival (OS) of 12-30 months despite multidisciplinary therapies. 1,6,7 Systemic chemotherapy with or without immunotherapy remains the main treatment for mNPC. Local treatment is also recommended for selected patients with limited metastases or a low tumor burden.…”

“…Local treatment is also recommended for selected patients with limited metastases or a low tumor burden 8,9 . Moreover, several studies have demonstrated that patients with mNPC can benefit from local radiotherapy, either alone or in combination with chemotherapy 7,8,10–12 . However, the optimal radiation modality for metastases remains to be elucidated.…”

A novel endoscopic nasopharyngectomy by low‐temperature plasma radiofrequency ablation in localized recurrent nasopharyngeal carcinoma

“…Nasopharyngeal carcinoma (NPC) is a frequent malignancy in Southeast Asia, especially in Guangdong Province of China. Radiotherapy is a fundamental treatment for NPC, with a 5‐year overall survival (OS) of 68.2%–87.4% for nonmetastatic NPC 1–3 . However, 5%–15% of patients develop residual or recurrent disease at the primary site 4–6 .…”

“…Radiotherapy is a fundamental treatment for NPC, with a 5-year overall survival (OS) of 68.2%-87.4% for nonmetastatic NPC. [1][2][3] However, 5%-15% of patients develop residual or recurrent disease at the primary site. [4][5][6] Surgery can directly resect primary failure and avoid sequelae caused by re-irradiation and chemotherapy.…”