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Systemic Chemotherapy with Loco-regional Radiotherapy

Objective: Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma at diagnosis (mNPC), but radiotherapy for primary tumor and its regional lymph nodes (loco-regional radiotherapy, LR-RT) is not routinely advocated. In current study, we evaluate the impact of LR-RT on survival of patients with mNPC. Method: A retrospective review of 385 mNPC patients at diagnosis recorded at San Yat-Sen University Cancer Center between 2001 and 2009. We compared mortality risks between patients who underwent different anticancer treatments including systemic chemotherapy, LR-RT, and local treatment of metastasis, alone or in combination, adjusted these risks for prognostic factors. Results: However, it presented a 50% reduced risk of death compared to those without any anticancer treatment (HR, 0.5; 95% CI, 0.2 to 1.0; P = .044) and 140% increase of death risk compared with those who underwent combination treatment of systemic chemotherapy and LR-RT (HR, 2.4; 95% CI, 1.3 to 4.5; P = .004). With analysis in the subgroup of patients who received combination treatment (n = 176), induction chemotherapy and LR-RT with high dose (≥66Gy) showed significant lower risk of death compared to concurrent and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.3 to 0.7; P = .001) and low-dose radiation (<66Gy) (HR, 0.6; 95% CI, 0.3 to 1.0; P = .033). Conclusion: LR-RT, particularly combined with systemic chemotherapy, improves survival of patients with mNPC at diagnosis. High dose LR-RT combined with induction chemotherapy is advocated based on current data. However, well-designed prospective studies are expected to further evaluate the impact of LR-RT.