Tumor Biology

, Volume 37, Issue 4, pp 4429–4438 | Cite as

Long-term outcomes of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma treated with IMRT: a retrospective study

  • Zhen Su
  • Yan-Ping Mao
  • Jie Tang
  • Xiao-Wen Lan
  • Pu-Yun OuYang
  • Fang-Yun Xie
Original Article


This study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) for stage II nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). A total of 249 patients were retrospectively reviewed. All patients were treated with IMRT. One hundred forty-three patients treated with CCRT and 106 patients treated with IMRT alone. With a median follow-up of 59.4 months, adding concurrent chemotherapy did not statistically significantly improve the 5-year overall survival (OS) (89.7 % vs 99.0 %, p = 0.278), locoregional relapse-free survival (LRFS) (94.8 % vs 89.3 %, p = 0.167), and distant metastases-free survival (DMFS) (93.4 % vs 97.5 %, p = 0.349). The patients with CCRT significantly experienced more acute toxic effects. The main grades 3–4 toxicity reactions were mucositis (26.6 % vs 15.1 %, p = 0.03) and leukopenia/neutropenia (9.1 % vs 0.9 %, p = 0.005). In subgroup analysis of patients with concurrent platinum single-agent chemotherapy the 5-year OS (98.4 % vs 81.9 %, p = 0.013) and DMFS (96.9 % vs 84.4 %, p = 0.043) of patients with platinum every 3 weeks (Q3W) were significantly higher than those with platinum weekly (QW) and no significant difference for LRFS (96.8 % vs 90.4 %, p = 0.150). CCRT did not improve the survival of patients with stage II NPC but increased the acute toxicity reactions. Patients with platinum Q3W improved the 5-year OS and DMFS, compared with those with platinum QW.


Concurrent chemotherapy Stage II nasopharyngeal carcinoma IMRT Survival Acute toxicity reactions Prognosis 


Compliance of ethical standards

This study was reviewed and approved by the institutional review board and ethics committee of Sun Yat-sen University Cancer Center. The study was retrospective. Patient records were anonymized and de-identified prior to analysis.

Conflicts of interest



  1. 1.
    Cao SM, Simons MJ, Qian CN. The prevalence and prevention of nasopharyngeal carcinoma in China. Chin J Cancer. 2011;30:114–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wee JT, Ha TC, Loong SL, Qian CN. Is nasopharyngeal cancer really a “Cantonese cancer”? Chin J Cancer. 2010;29:517–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Chan AT, Teo PM, Johnson PJ. Nasopharyngeal carcinoma. Ann Oncol. 2002;13:1007–15.CrossRefPubMedGoogle Scholar
  4. 4.
    Al-Sarraf M, Reddy MS. Nasopharyngeal carcinoma. Curr Treat Options Oncol. 2002;3:21–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, et al. Head and neck cancers, Version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2014;12:1454–87.PubMedGoogle Scholar
  6. 6.
    Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099. J Clin Oncol. 1998;16:1310–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, et al. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002;20:2038–44.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin JC. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21:631–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Kwong DLW. Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol. 2004;22:2643–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol. 2005;23:6966–75.CrossRefPubMedGoogle Scholar
  11. 11.
    Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005;23:6730–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Chan ATC, Leung SF, Ngan RKC, Teo PML, Lau WH, Kwan WH, et al. Overall survival after concurrent Cisplatin-Radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005;97:536–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol. 2004;22:4604–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Baujat B, Audry H, Bourhis J, Chan AT, Onat H, Chua DT, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006;64:47–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Chen QY, Wen YF, Guo L, Liu H, Huang PY, Mo HY, et al. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011;103:1761–70.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys. 2002;53:12–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Kam MK, Teo PM, Chau RM, Cheung KY, Choi PH, Kwan WH, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2004;60:1440–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Liu MT, Hsieh CY, Chang TH, Lin JP, Huang CC, Wang AY. Prognostic factors affecting the outcome of nasopharyngeal carcinoma. Jpn J Clin Oncol. 2003;33:501–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Tham IW, Hee SW, Yeo RM, Salleh PB, Lee J, Tan TW, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the national cancer centre singapore experience. Int J Radiat Oncol Biol Phys. 2009;75:1481–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Yi JL, Gao L, Huang XD, Luo JW, Xiao JP, Li SY, et al. Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: long-term results of 416 patients. Chin J Radiat Oncol. 2012;21:196–200 (in Chinese).Google Scholar
  21. 21.
    Feng M, Fang ZX, Li J, Zhang P, Li T, Wen H, et al. Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. Chin J Radiat Oncol. 2011;20:369–73 (in Chinese).Google Scholar
  22. 22.
    Zhao C, Xiao WW, Han F, Lu LX, Wu SX, Chen JZ, et al. Long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Chin J Radiat Oncol. 2010;19:191–6 (in Chinese).Google Scholar
  23. 23.
    Cao CN, Luo JW, Gao L, Yi JL, Huang XD, Wang K, et al. Concurrent chemotherapy for T4 classification nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy. PLoS One. 2015;10:e119101.Google Scholar
  24. 24.
    Sun X, Su S, Chen C, Han F, Zhao C, Xiao W, 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;110:398–403.CrossRefPubMedGoogle Scholar
  25. 25.
    Sun X, Zeng L, Chen C, Huang Y, Han F, Xiao W, et al. Comparing treatment outcomes of different chemotherapy sequences during intensity modulated radiotherapy for advanced N-stage nasopharyngeal carcinoma patients. Radiat Oncol. 2013;8:265.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lin S, Lu JJ, Han L, Chen Q, Pan J. Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: experience of 370 consecutive cases. BMC Cancer. 2010;10:39.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Su S, Han F, Zhao C, Chen C, Xiao W, Li J, et al. Long-term outcomes of early-stage nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy alone. Int J Radiat Oncol Biol Phys. 2012;82:327–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Tham IWK, Lin S, Pan J, Han L, Lu JJ, Wee J. Intensity-modulated radiation therapy without concurrent chemotherapy for stage IIB nasopharyngeal cancer. Am J Clin Oncol. 2010;1.Google Scholar
  29. 29.
    Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Su S, Han F, Zhao C, Huang Y, Chen C, Xiao W, et al. Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Chin J Cancer. 2011;30:565–73.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Cox JD, Stetz J, Pajak TF. Toxicity criteria of the radiation therapy oncology group (RTOG) and the european organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Cheng SH, Huang AT, Tsai SY, Yen KL, Jian JJ, Chu NMC, et al. Concomitant radiotherapy and chemotherapy for early-stage nasopharyngeal carcinoma. J Clin Oncol. 2000;18:2040–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Xu T, Hu C, Wang X, Shen C. Role of chemoradiotherapy in intermediate prognosis nasopharyngeal carcinoma. Oral Oncol. 2011;47:408–13.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee AW, Sze WM, Au JS, Leung SF, Leung TW, Chua DT, et al. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2005;61:1107–16.CrossRefPubMedGoogle Scholar
  35. 35.
    Luo S, Zhao L, Wang J, Xu M, Li J, Zhou B, et al. Clinical outcomes for early-stage nasopharyngeal carcinoma with predominantly WHO II histology treated by intensity-modulated radiation therapy with or without chemotherapy in nonendemic region of China. Head Neck. 2014;36:841–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Leung T, Tung SY, Sze W, Wong FC, Yuen K, Lui CM, et al. Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns. Head Neck. 2005;27:555–65.CrossRefPubMedGoogle Scholar
  37. 37.
    Zhang A, Fan Y, Wang X, Xie Q, Sun J, Chen Z, et al. Increased treatment-related mortality with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy. Radiother Oncol. 2012;104:279–85.CrossRefPubMedGoogle Scholar
  38. 38.
    Du CR, Ying HM, Kong FF, Zhai RP, Hu CS. Concurrent chemoradiotherapy was associated with a higher severe late toxicity rate in nasopharyngeal carcinoma patients compared with radiotherapy alone: a meta-analysis based on randomized controlled trials. Radiat Oncol. 2015;10:70.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Kim TH, Ko YH, Lee MA, Kim BS, Chung SR, Yoo I, et al. Treatment outcome of cisplatin-based concurrent chemoradiotherapy in the patients with locally advanced nasopharyngeal cancer. Cancer Res Treat. 2008;40:62–70.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Jagdis A, Laskin J, Hao D, Hay J, Wu J, Ho C. Dose delivery analysis of weekly versus 3-weekly cisplatin concurrent with radiation therapy for locally advanced nasopharyngeal carcinoma (NPC). Am J Clin Oncol. 2014;37:63–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Tao CJ, Lin L, Zhou GQ, Tang LL, Chen L, Mao YP, et al. Comparison of long-term survival and toxicity of cisplatin delivered weekly versus every three weeks concurrently with intensity-modulated radiotherapy in nasopharyngeal carcinoma. PLoS One. 2014;9:e110765.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Zhen Su
    • 1
    • 2
    • 3
  • Yan-Ping Mao
    • 1
    • 2
    • 3
  • Jie Tang
    • 1
    • 2
    • 3
  • Xiao-Wen Lan
    • 1
    • 2
    • 3
  • Pu-Yun OuYang
    • 1
    • 2
    • 3
  • Fang-Yun Xie
    • 1
    • 2
    • 3
  1. 1.Department of Radiation OncologySun Yat-sen University Cancer CenterGuangzhouChina
  2. 2.State Key Laboratory of Oncology in South ChinaGuangzhouChina
  3. 3.Collaborative Innovation Center for Cancer MedicineGuangzhouChina

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