Long-term Survivals, Toxicities and the Role of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Patients Treated with Intensity-modulated Radiation Therapy: A Retrospective Study with 15-year Follow-up.

Abstract

Purpose\nTo investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients.\n\n\nMaterials and Methods\nTotally 187 patients with newly diagnosed NPC and restaged AJCC/UICC 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT) ± chemotherapy (CT) from 2001 to 2010.\n\n\nResults\nWith 15.7-year median follow-up, 10-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease specific survival (DSS) and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥52.0 could independently predict DMFS (p=0.036 and 0.011), DSS (p=0.014 and 0.026) and OS (p=0.002 and <0.001); Charlson comorbidity index <3 points could predict DSS (p=0.011); age >45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥240 U/L (p<0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%) and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p>0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity and cranial nerve injury (all p < 0.05) than IMRT alone group.\n\n\nConclusion\nSuperior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As chemotherapy would bring more toxicities, it should be carefully performed to stage II patients.