Long-term Therapeutic Outcome and Prognostic Factors of Patients with Nasopharyngeal Carcinoma Receiving Intensity-modulated Radiotherapy: An Analysis of 608 Patients from Low-endemic Regions of China

Abstract

Objective

To evaluate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma (NPC) from low-endemic regions of China who received definitive intensity-modulated radiation therapy (IMRT).

Methods

The clinical data from 608 patients with newly-diagnosed non-metastatic NPC who have received initial treatment at our cancer center from January, 2008 to December, 2013 were retrospectively reviewed. All patients received definitive IMRT, and 87.7% received platinum-based chemotherapy.

Results

The median follow-up duration was 51 months (follow-up rate, 98.5%; range, 10–106 months) for the entire cohort. The 5-year overall survival rate was 79.7%. The 5-year local relapse-free survival rate, regional relapse-free survival rate, distant metastasis-free survival rate and progression-free survival rate were 92.4%, 93.3%, 79.2% and 74.3%, respectively. A total of 153 patients had experienced treatment failure, with distant metastasis as the primary cause in 77.1% (118/153). Patients with T4 or N3 diseases had a significantly poorer prognosis than other subcategories. Stage T4 and N3 were closely associated with distant metastasis, with the metastatic rate of 29.3% and 45.5%, respectively.

Conclusion

IMRT provides patients with non-metastatic NPC with satisfactory long-term survival. Both T stage and N stage are important prognostic factors for NPC patients. Patients with T4 or N3 diseases have significantly increased distant metastatic rates and poor survival time.

Keywords

nasopharyngeal carcinoma / long-term therapeutic outcome / low-endemic regions of China / intensity-modulated radiation therapy

References

[1] SunX, SuS, ChenC, et al.. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiother Oncol, 2014, 110(3): 398-403

[2] LinS, LuJJ, HanL, et al.. Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: experience of 370 consecutive cases. BMC Cancer, 2010, 10(1): 39

[3] OuX, ZhouX, ShiQ, et al.. Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy: new insight into the value of total dose of cisplatin and radiation boost. Oncotarget, 2015, 6(35): 38 381-38 397

[4] ZhangMX, LiJ, ShenGP, et al.. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: A 10-year experience with a large cohort and long follow-up. Eur J Cancer, 2015, 51(17): 2587-2595

[5] ZhaoLN, ZhouB, ShiM, et al.. Clinical outcome for nasopharyngeal carcinoma with predominantly WHO II histology treated with intensity-modulated radiation therapy in non-endemic region of China. Oral Oncol, 2012, 48(9): 864-869

[6] ParkinD, WhelanS, FerlayJ, et al.. Cancer incidence in five continents. IARC Sci Publications, 2002, 155(3): 1-781

[7] ThompsonL. World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Ear Nose Throat J, 2006, 85(2): 74

[8] ChenY, SunY, LiangSB, et al.. Progress report of a randomized trial comparing long-term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China. Cancer, 2013, 119(2): 2230-2238

[9] ChenY, HuXF, WangY, et al.. Is maximum primary tumor diameter still a prognostic factor in patients with nasopharyngeal carcinoma treated using intensity-modulated radiotherapy?. BMC Cancer, 2015, 15(1): 305

[10] HwangJM, FuKK, PhillipsTL. Results and prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys, 1998, 41(5): 1099-1111

[11] Al-SarrafM, LeBlancM, GiriPG, et al.. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol, 1998, 16(4): 1310-1317

[12] ChengSH, YenKL, JianJJ, et al.. Examining prognostic factors and patterns of failure in nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy: impact on future clinical trials. Int J Radiat Oncol Biol Phys, 2001, 50(3): 717-726

[13] CheungF, ChanO, NgWT, et al.. The prognostic value of histological typing in nasopharyngeal carcinoma. Oral Oncology, 2012, 48(5): 429-433

[14] FariasTP, DiasFL, LimaRA, et al.. Prognostic factors and outcome for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg, 2003, 129(7): 794-799

[15] HengDM, WeeJ, FongKW, et al.. Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma. Cancer, 1999, 86(10): 1912-1920

[16] PerezCA, DevineniVR, Marcial-VegaV, et al.. Carcinoma of the nasopharynx: factors affecting prognosis. Int J Radiat Oncol Biol Phys, 1992, 23(2): 271-280

[17] Shanmugaratnam K. Histological typing of nasopharyngeal carcinoma. IARC Sci Publ, 1978, (20):3–12

[18] WangHY, ChangYL, ToKF, et al.. A new prognostic histopathologic classification of nasopharyngeal carcinoma. Chin J Cancer, 2016, 35(1): 41

[19] JemalA, BrayF, CenterMM, et al.. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90

[20] ChangKP, ChangYT, WuCC, et al.. Multiplexed immunobead-based profiling of cytokine markers for detection of nasopharyngeal carcinoma and prognosis of patient survival. Head Neck, 2011, 33(6): 886-897

[21] WangWY, TwuCW, ChenHH, et al.. Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma. Clinical Cancer Research, 2010, 16(3): 1016-1024

[22] ChenL, MaoYP, XieFY, et al.. The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity-modulated radiotherapy from an endemic area in China. Radiother Oncol, 2012, 104(3): 331-337

[23] ZongJ, LinS, LinJ, et al.. Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system. Oral Oncology, 2015, 51(3): 254-259

[24] KangM, ZhouP, WeiT, et al.. A new T staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results from a prospective multicentric clinical study. Am J Cancer Res, 2017, 7(2): 346-356

[25] GiulianoA E, ConnollyJ L, EdgeSB, et al.. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(2): 122-137

[26] KangM, ZhouP, LiG, et al.. Validation of the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Oncotarget, 2017, 8(41): 70586-70594

[27] LaiSZ, LiWF, ChenL, et al.. How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients?. Int J Radiat Oncol Biol Phys, 2011, 80(3): 661-668

[28] KangM, LongJ, LiG, et al.. A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results of a prospective multicentric clinical study. Oncotarget, 2016, 7(12): 15252-15261

[29] ZhouQ, HeY, ZhaoY, et al.. A Study of 358 Cases of Locally Advanced Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiation Therapy: Improving the Seventh Edition of the American Joint Committee on Cancer T-Staging System. Biomed Res Int, 2017, 2017: 1419676