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Locoregional Radiotherapy Combined with Systemic Chemotherapy Improves Survival of NPC Patients with Distant Metastases

Objectives: Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (mNPC) at diagnosis; however, the impact of locoregional radiotherapy (lrRT) targeting the primary and regional lymph nodes on the survival of mNPC patients remains unknown and will be evaluated here retrospectively. Methods: A total of 408 mNPC patients were included in this study. The mortality risks were compared between the untreated patients and the patients who underwent chemotherapy and lrRT delivered alone or in combination. Univariate and multivariate analyses were conducted. The contributions of independent factors were adjusted by other covariates with significant prognostic association (P < .05). Results: Both lrRT and systemic chemotherapy were found to be significant independent prognostic factors of overall survival (OS). The group receiving lrRT alone exhibited similar mortality risk compared to the group who underwent systemic chemotherapy alone (multiadjusted hazard ratio [HR], 0.9; P = .529) and 60% reduction compared to the untreated group (HR, 0.4; P = .004), but a 130% increase compared to those who received the combination treatment of systemic chemotherapy and lrRT (HR, 2.3; P < .001). In the subgroup of combination treatment (n = 176), induction chemotherapy and high-dose lrRT (≥66 Gy) showed a significant lower mortality risk compared with the noninduction chemotherapy (HR, 0.5; P = .007) and low-dose radiation (<66 Gy) (HR, 0.4; P = .001). Conclusions: Locoregional radiotherapy, particularly combined with systemic chemotherapy, was correlated with the improved survival of mNPC patients.