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Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma

Clinical outcomes and patterns of failure in an endemic area in China

Intensitätsmodulierte Strahlentherapie beim nasopharyngealen Karzinom im Stadium IVA/IVB

Klinische Ergebnisse und Versagensmuster aus einem endemischen Gebiet in China

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Abstract

Purpose

The purpose of this study was to analyze the mode of relapse patterns and survival of 209 patients with stage IVA and IVB nasopharyngeal carcinoma (NPC).

Patients and materials

A total of 209 patients who underwent magnetic resonance imaging (MRI) and were subsequently histologically diagnosed with nondisseminated stage IV NPC received intensity-modulated radiotherapy (IMRT) as their primary treatment and were included in this retrospective study.

Results

Median follow-up time was 65 months (range, 3–108 months). The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates for patients with stage IVA and stage IVB NPC were 72.7 vs. 60.0 % (p = 0.319), 62.9 vs. 51.3 % (p = 0.070), 82.9 vs. 93.1 % (p = 0.070), 82.9 vs. 82.9 % (p = 0.897), 76.4 vs. 58.5 % (p = 0.003), respectively. Age older than 44 years was found to be a statistically significant adverse independent prognostic factor for OS. Patients with advanced N status had worse OS, DFS, and DMFS rates. Patients with a primary gross tumor volume (GTV-P) ≥ 55.11 ml had worse OS, DFS, and LRRFS rates.

Conclusion

The results of treating stage IVA NPC with IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for patients with stage IVA and IVB NPC, and more effective systemic chemotherapy should be explored.

Zusammenfassung

Ziel

Ziel dieser Studie war die Analyse der Rezidivmuster und des Überlebens von 209 Patienten mit nasopharyngealem Karzinom (NPC) im Stadium IVA und IVB.

Patienten und Methoden

Insgesamt 209 Patienten, die mittels MRT und anschließender histologischer Untersuchung mit nichtdisseminiertem NPC im Stadium IV diagnostiziert worden waren, erhielten eine intensitätsmodulierte Strahlentherapie (IMRT) als Primärbehandlung und wurden in diese retrospektive Studie aufgenommen.

Ergebnisse

Die mediane Follow-up-Dauer betrug 65 Monate (Bereich 3–108 Monate). Das 5-Jahres-Gesamtüberleben (OS), das krankheitsfreie (DFS), lokal rezidivfreie (LRFS), lokal-regionär rezidivfreie (LRRFS) und fernmetastasenfreie Überleben (DMFS) bei Patienten im Stadium IVA und IVB betrugen jeweils 72,7 vs. 60,0 % (p = 0,319), 62,9 vs. 51,3 % (p = 0,070), 82,9 vs. 93,1 % (p = 0,070), 82,9 vs. 82,9 % (p = 0,897), 76,4 vs. 58,5 % (p = 0,003) bzw. Ein Alter über 44 Jahre erwies sich als statistisch signifikanter, ungünstiger, unabhängiger prognostischer Faktor für OS. Patienten im fortgeschrittenen N-Stadium wiesen ein schlechteres OS, DFS und DMFS auf. Patienten mit einem primären makroskopischen Tumorvolumen (GTV-P) von mehr als 55.11 ml hatten ein schlechteres OS, DFS und LRRFS.

Schlussfolgerung

Die Ergebnisse der Behandlung von Patienten mit NPC im Stadium IVA mit IMRT waren ausgezeichnet. Fernmetastasen bleiben die schwierigste Herausforderung bei der Behandlung von Patienten mit NPC im Stadium IVA und IVB und es müssen wirksamere systemische Chemotherapien erforscht werden.

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Compliance with ethical guidelines

Conflict of interest

L. Zeng, Y-M. Tian, X-M. Sun, Y. Huang, C-Y. Chen, F. Han, S. Liu, M. Lan, Y. Guan, X-W. Deng, and T.X Lu state that there are no conflicts of interest.

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Authors and Affiliations

  1. State Key Laboratory Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China

    Lei Zeng M.D., Yun-Ming Tian M.D., Xue-Ming Sun M.D., Ying Huang M.D., Chun-Yan Chen M.D., Fei Han M.D., Shuai Liu M.D., Mei Lan M.D., Ying Guan M.D., Xiao-Wu Deng Ph.D. & Tai-Xiang Lu M.D.

  2. Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China

    Lei Zeng M.D., Yun-Ming Tian M.D., Xue-Ming Sun M.D., Ying Huang M.D., Chun-Yan Chen M.D., Fei Han M.D., Shuai Liu M.D., Mei Lan M.D., Ying Guan M.D., Xiao-Wu Deng Ph.D. & Tai-Xiang Lu M.D.

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  1. Lei Zeng M.D.
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  2. Yun-Ming Tian M.D.
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  4. Ying Huang M.D.
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  6. Fei Han M.D.
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  7. Shuai Liu M.D.
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  8. Mei Lan M.D.
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  9. Ying Guan M.D.
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  11. Tai-Xiang Lu M.D.
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Corresponding authors

Correspondence to Xiao-Wu Deng Ph.D. or Tai-Xiang Lu M.D..

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Zeng, L., Tian, YM., Sun, XM. et al. Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma. Strahlenther Onkol 190, 993–1000 (2014). https://doi.org/10.1007/s00066-014-0680-7

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  • DOI: https://doi.org/10.1007/s00066-014-0680-7

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