Retrospective Analysis of 234 Nasopharyngeal Carcinoma Patients with Distant Metastasis at Initial Diagnosis: Therapeutic Approaches and Prognostic Factors

Abstract

PurposeThe purpose of this retrospective study was to identify the independent prognostic factors and optimize the treatment for nasopharyngeal carcinoma (NPC) patients with distant metastasis at initial diagnosis.MethodsA total of 234 patients referred between January 2001 and December 2010 were retrospectively analyzed. Among the 234 patients, 94 patients received chemotherapy alone (CT), and 140 patients received chemoradiotherapy (CRT). Clinical features, laboratory parameters and treatment modality were examined with univariate and multivariate analyses.ResultsThe median overall survival (OS) time was 22 months (range, 2-125 months), and the 1-year, 2-year, 3-year overall survival rates were 82.2%, 51.3% and 34.1%. The overall response and disease control rates of metastatic lesions after chemotherapy were 56.0% and 89.8%. The factors associated with poor response were karnofsky performance score (KPS) <80, liver metastasis, lactate dehydrogenase (LDH)>245 IU/L, and number of chemotherapy cycles <4. The 3-year OS of patients receiving CRT was higher than those receiving CT alone (48.2% vs. 12.4%, p<0.001). Subgroup analysis showed that significantly improved survival was also achieved by radiotherapy of the primary tumor in patients who achieved complete remission (CR)/partial remission (PR) or stable disease (SD) of metastatic lesions after chemotherapy. Significant independent prognostic factors of OS were KPS, liver metastasis, levels of LDH, and multiple metastases. Treatment modality, response to chemotherapy and chemotherapy cycles were also associated with OS.ConclusionA combination of radiotherapy and chemotherapy seems to have survival benefits for selected patients with distant metastases at initial diagnosis. Clinical and laboratory characteristics can help to guide treatment selection. Prospective randomized studies are needed to confirm the result.

Selective Radiotherapy after Distant Metastasis of Nasopharyngeal Carcinoma Treated with Dose-Dense Cisplatin plus Fluorouracil

“…Our study showed that the CR rate was 19.2% after dose-dense chemotherapy, which was higher than 15% reported by Jamshed (2014), and was significantly higher than that (3.9%) of traditional chemotherapy. The rate of CR (3.9%) and PR (53.0%) in control group was similar with 4.3% and 51.7% reported by Zeng (2014). The CR rate 85% of patients following radiotherapy was higher than 50.0% in control group and 64.3% reported in the literature (Kang et al 2013) after dose-dense chemotherapy.…”

Systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy yields prolonged survival in nasopharyngeal carcinoma patients with distant metastasis at initial diagnosis

“…Secondly, the application of definitive IMRT achieved excellent locoregional disease control, reducing the risk of death caused by local failure. Thirdly, as previous studies have suggested a possible correlation between improved local control and prolonged survival [9][10][11]21], it is possible that the advantage of IMRT in locoregional control may translate into further survival benefit for these patients.…”

“…Nevertheless, the primary bulky tumor, if left untreated, might result in severe symptoms and complications such as bleeding, visual and hearing impairment, severe headache and cranial nerve paralyses. It should not escape notice that despite the presence of metastatic disease, a subset of these patients eventually died of local failure [10]. Furthermore, evolution of radiation techniques in recent decades has allowed for the minimization of radiation-related toxicities and a significant improvement in local disease control.…”

“…In an analysis of 109 cases reported by Jin et al [9], patients' median OS approximated 25 months after receiving combined high-dose radiotherapy and systemic chemotherapy. Investigators of another retrospective review of 234 patients reported that locoregional radiotherapy significantly extended patients' overall survival when combined with chemotherapy versus chemotherapy alone (3yOS 48.3 vs. 12.4 %, P = 0.001), and the survival benefit was particularly prominent for patients who achieved CR or PR of metastatic lesions after systemic chemotherapy [10]. Similar results were also obtained in a third study which retrospectively evaluated the impact of different treatment strategies on patients' survival [11].…”

“…Recently, several retrospective studies demonstrated a survival benefit with the addition of locoregional definitive radiotherapy to systemic chemotherapy in patients with initially metastatic NPC [9][10][11]. However, in these studies, there were different combinations with respect to the timing of chemotherapy in relation to radiotherapy (i.e., induction, concurrent, adjuvant or other combination), which may have differential impact on treatment outcome.…”