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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2021.101    [Accepted]
Long-term Survivals, Toxicities and the Role of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Patients Treated with Intensity-modulated Radiation Therapy: A Retrospective Study with 15-year Follow-up
Lin Wang1, Jingjing Miao1, Huageng Huang1, Boyu Chen1, Xiao Xiao1, Manyi Zhu1, Yingshan Liang1, Weiwei Xiao2, Shaomin Huang2, Yinglin Peng2, Xiaowu Deng2, Xing Lv1, Weixiong Xia1, Yanqun Xiang1, Xiang Guo1, Fei Han2, Chong Zhao1
1Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
2Department of Radiotherapy, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
Correspondence  Fei Han ,Tel: 86-13822113698, Email: hanfei@sysucc.org.cn
Chong Zhao ,Tel: 86-13902206160 , Email: gzzhaochong@hotmail.com
Received: January 21, 2021;  Accepted: June 4, 2021.  Published online: June 7, 2021.
*Lin Wang, Jingjing Miao and Huageng Huang contributed equally to this work.
ABSTRACT
Purpose
To investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients.
Materials and Methods
Totally 187 patients with newly diagnosed NPC and restaged AJCC/UICC 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT) ± chemotherapy (CT) from 2001 to 2010.
Results
With 15.7-year median follow-up, 10-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease specific survival (DSS) and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥52.0 could independently predict DMFS (p=0.036 and 0.011), DSS (p=0.014 and 0.026) and OS (p=0.002 and <0.001); Charlson comorbidity index <3 points could predict DSS (p=0.011); age >45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥240 U/L (p<0.001) predicted OS. No grade 4 late toxicity happened; grade 3 late toxicities included subcutaneous fibrosis (4.3%), deafness or otitis (4.8%), skin dystrophy (2.1%) and xerostomia (1.1%). No differences on survivals were shown between IMRT+CT vs. IMRT alone in stage II patients, even in T2N1M0 (p>0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity and cranial nerve injury (all p < 0.05) than IMRT alone group.
Conclusion
Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As chemotherapy would bring more toxicities, it should be carefully performed to stage II patients.
Key words: Early-stage, Nasopharyngeal carcinoma, Intensity-modulated radiation therapy, Chemotherapy, Long-term outcomes, Toxicity
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