Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy

Abstract

Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed. Herein, we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome. We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy, and classified all cases into the following prognostic categories according to different TNM stages: early stage group (T1–2N0–1M0), advanced local disease group (T3–4N0–1M0), advanced nodal disease group (T1–2N2–3M0), and advanced locoregional disease group (T3–4N2–3M0). The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were 83.0%, 90.4%, and 84.0% respectively. The early disease group had the lowest treatment failure rate, with a 5-year OS of 95.6%. The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625, respectively). The advanced locoregional disease group had the highest incidence of relapse and death, with a 5-year DMFS and OS of 62.3% and 62.2%, respectively, and a hazard ratio for death of 10.402. Comparing with IMRT alone, IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC. Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages, and that IMRT alone for early stage NPC patients can produce satisfactory results. However, for advanced local, nodal, and locoregional disease groups, a combination of chemotherapy and radiotherapy is recommended.

The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy

“…However, the prognostic value of PNI has rarely been investigated in NPC patients. Furthermore, the TNM staging system is the most important tool for predicting prognosis and guiding the NPC treatment strategy, but the heterogeneity of patients with different risk factors in the same stage has limited the ability of this system to distinguish patients with different prognoses and make accurate treatment choices (Su et al 2011;Li et al 2015). Therefore, it is necessary to identify other prognostic factors that can help predict the prognosis and aid in the treatment of NPC patients.…”

“…In recent years, intensity-modulated radiotherapy (IMRT) has replaced 2D-CRT as the first choice for the treatment of NPC. A large number of studies (Lee et al 2014, Su et al 2011Wang et al 2014;Li et al 2015) have shown that the 5-year loco-regional control rate has increased substantially to reach approximately 90% in NPC patients treated by IMRT with or without chemotherapy, but the distant metastasis rate remains high (14-26%) with no clear improvement in OS (77-84%). Thus, the treatment of NPC remains challenging, and it is of vital importance to identify factors that can predict the prognosis of NPC patients before IMRT to provide individual comprehensive therapy and improve treatment efficacy.…”

CT-diagnosed severe skull base bone destruction predicts distant bone metastasis in early N-stage nasopharyngeal carcinoma

“…In these regions, the pathological type was poorly differentiated and was characterized by invasive growth and distant metastases. Currently, the treatment for NPC is a comprehensive one that is based on radiotherapy, and there has been an increase in the 5-year overall survival rate from 40% (in 1960s–1970s) to more than 80% (in 2000s) 2. According to the clinical and biological behavior of NPC patients following chemoradiotherapy, NPC was subdivided into four types: type I (no primary and regional recurrence and no distant metastasis), type II (primary or regional recurrence and no distant metastasis), type III (no primary and regional recurrence and distant metastasis), and type IV (primary or regional recurrence and distant metastasis) 3.…”

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample

“…With the development of radiotherapy techniques, the 5-year overall survival (OS) rate of NPC has increased from 40% in the 1960s (2) to 75% by the end of the 1990s (3), and to >80% due to the introduction of intensity-modulation radiation therapy (IMRT) (4). As survival rates have increased, the concern of the late complications due to radiotherapy have also increased.…”