Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion

  • Shufang Liao
  • Yuan Xie
  • Yi Feng
  • Yuanyuan Zhou
  • Yufei Pan
  • Jinfang Fan
  • Jinglin Mi
  • Xiaoli Qin
  • Dacheng Yao
  • Wei JiangEmail author
Original Article – Clinical Oncology



To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion.


A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan–Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated.


IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group.


IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.


Skull-base invasion Intensity-modulated radiation therapy Nasopharyngeal carcinoma 



Two-dimensional conventional radiation therapy


Intensity-modulated radiation therapy


Nasopharyngeal carcinoma


Overall survival


Disease-free survival


Locoregional relapse-free survival


Distant metastasis-free survival


Radiation therapy


Planning target volume


Gross tumor volume of the primary


Nodal gross tumor volume


Induction chemotherapy


Concurrent chemoradiotherapy


Adjuvant chemotherapy


Hazard ratios


Response evaluation criteria in solid tumors


Complete remission


Author contributions

Study concept and design: SFL and WJ. Data acquisition and analysis: SFL, YX, YF, YYZ and WJ. Data interpretation: all authors. Drafting the manuscript: SFL and WJ. Critical revision of the manuscript for important intellectual content: all authors. Supervision: WJ. All authors read and approved the final manuscript.


This work was supported by the National Natural Science Foundation of China (Nos. 81560443, 81760546) and the Scientific Research and Technology Development Program of Guilin (No. 20170109-22), the Key Program of the Guangxi Natural Science Foundation of China (No. 2018JJD140054), the General Program of Guangxi Natural Science Foundation of China (No. 2018GXNSFAA138100).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Medical Ethics Committee of affiliated Hospital of Guilin Medical University, Wuzhou Red Cross Hospital, and Nanxishan Hospital of Guangxi Zhuang Autonomous Region.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

432_2019_3067_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyAffiliated Hospital of Guilin Medical UniversityGuilinPeople’s Republic of China
  2. 2.Department of NeurosurgeryGuilin People’s HospitalGuilinChina
  3. 3.Department of Radiation OncologyWuzhou Red Cross HospitalWuzhouChina
  4. 4.Department of Radiation OncologyNanxishan Hospital of Guangxi Zhuang Autonomous RegionGuilinChina
  5. 5.Department of OncologyPeople’s Hospital of Gongcheng Yao Autonomous CountyGuilinChina

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