Effect analysis of 847 nasopharyngeal carcinoma cases treated with intensity modulated radiation: Experience and suggestions

• Published in: Oral oncology 2024-11, Vol.158, p.107001, Article 107001
• Main Authors: Yin, Wen-Jing, Mao, Wu, Yang, Fang, Wang, Meng-Yao, Liu, Jin-Quan, Chen, Dong-Ping, Zhou, Li-Ping, Chen, Si-Da, Jiang, Xi-Zhen, Ou, Yu-Meng, Wu, Zheng, Qi, Bin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Failure pattern; Female; Humans; Intensity-modulated radiotherapy; Male; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - mortality; Nasopharyngeal Carcinoma - pathology; Nasopharyngeal Carcinoma - radiotherapy; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Neoplasm Recurrence, Local - radiotherapy; Prognosis; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Young Adult
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2024.107001

•The study provides the first details of key failure patterns of nasopharyngeal carcinoma (NPC).•The retrospective evaluation involved a large cohort of patients with NPC from an NPC endemic region at one hospital.•The results provide guidance for reducing distant metastasis and improving the quality of life. To identify the failure patterns and prognostic factors of nonmetastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era. Data on 847 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2012 and 2016 were retrospectively reviewed. Survival outcome, failure patterns and prognosis factors were analyzed. The 5-year local relapse-free survival, nodal relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 94.3%, 95.3%, 84.8%, 76.5% and 85.7%, respectively. The major local recurrence sites were the nasopharynx (91.5%, 43/47) and skull base (68.1%, 32/47); 39 patients had in-field failures, four had marginal failures, and four had out-field failures. Level IIb (62.2%, 23/37) was the most frequent regional recurrence site, followed by IIa (35.1%, 13/37) and retropharyngeal region (32.4%, 12/37); 35 cases had in-field failure alone, one had out-field failure alone, and one had both in- and out-field failure. TNM stage was the most significant factor for prognosis prediction. 402 (47.5%) patients had acute adverse events of grade 3 or 4; leukopenia (31.5%) and mucositis (26.7%) was the most common hematological and non-hematological event, respectively. Late complications were slight or moderate damages; xerostomia (647/847, 76.4%) and hearing impairment (422/847, 49.8%) remained the most troublesome. NPC patients treated with IMRT obtained satisfactory survival outcomes. The key failure pattern was distant metastasis. The main pattern of local–regional failure was in-field failure. Screening high risk patients with distant metastases and optimizing radiotherapy targets should be studied.