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

Xiaomin Ou, Xin Zhou, Qi Shi, Xing Xing, Youqi Yang, Tingting Xu, Chunying Shen, Xiaoshen Wang, Xiayun He, Lin Kong, Hongmei Ying, Chaosu Hu, Xiaomin Ou, Xin Zhou, Qi Shi, Xing Xing, Youqi Yang, Tingting Xu, Chunying Shen, Xiaoshen Wang, Xiayun He, Lin Kong, Hongmei Ying, Chaosu Hu

Abstract

This study was to report the long-term outcomes and toxicities of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). From 2009 to 2010, 869 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. With a median follow-up of 54.3 months, the 5-year estimated local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 89.7%, 94.5%, 85.6%, 76.3%, 84.0%, respectively. In locally advanced NPC, gender, T, N, total dose of cisplatin more than 300 mg/m(2) and radiation boost were independent prognostic factors for DMFS and DFS. Age, T, N and total dose of cisplatin were independent prognostic factors for OS. Radiation boost was an adverse factor for LRFS, RRFS, DMFS and DFS. Concurrent chemotherapy was not an independent prognostic factor for survival, despite marginally significant for DMFS in univariate analysis. Concurrent chemotherapy increased xerostomia and trismus, while higher total dose of cisplatin increased xerostomia and otologic toxicities. In conclusion, IMRT provided satisfactory long-term outcome for NPC, with acceptable late toxicities. Total dose of cisplatin was a prognostic factor for distant metastasis and overall survival. The role of concurrent chemotherapy and radiation boost in the setting of IMRT warrants further investigation.

Keywords: chemotherapy; intensity-modulated radiation therapy; late toxicity; nasopharyngeal carcinoma; radiation boost.

Conflict of interest statement

CONFLICTS OF INTEREST

There is no conflict of interest.

Figures

Figure 1. Kaplan-Meier estimate of distant metastasis–free…
Figure 1. Kaplan-Meier estimate of distant metastasis–free survival (A) and overall survival (B) stratified by concurrent chemotherapy
Figure 2. Kaplan-Meier estimate of distant metastasis-free…
Figure 2. Kaplan-Meier estimate of distant metastasis-free survival (A) and overall survival (B) stratified by total dose of cisplatin (total dose ≥ 300 mg/m2 vs. < 300 mg/m2)
Figure 3. Kaplan-Meier estimate of locoregional recurrence-free…
Figure 3. Kaplan-Meier estimate of locoregional recurrence-free survival (A) and disease-free survival (B) stratified by radiation boost

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