Wang Xiao-Li, Sun Da-Qing, Yang Hui, Li Yang, Li Xiu-Feng, Chang Xiao-Long, Meng Xiang-di, Zhang Ya-Nan, Zhang Yun-Xiang, Hao Fu-Rong, Li Jian-Wen
Department of Radiation Oncology, Weifang People's Hospital, No.151 Guang Wen Street, Kui Wen District, Weifang, 261041, China.
Department of Medical Imaging Center, Affiliated Hospital of Shandong Second Medical University, Weifang, 261041, China.
Discov Oncol. 2025 Jul 19;16(1):1378. doi: 10.1007/s12672-025-03230-7.
Concurrent chemoradiotherapy (CCRT) remains the cornerstone of treatment for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). However, data on long-term survival, particularly 10-year outcomes, are limited.
This retrospective study evaluated the clinical efficacy and acute hematologic toxicity of intensity-modulated radiation therapy (IMRT) in 177 newly diagnosed patients with locoregionally moderate or advanced NPC. Patients were categorized into three groups: IMRT alone; CCRT-including subgroups receiving neoadjuvant chemotherapy (NC) + CCRT, CCRT alone, and NC + CCRT + adjuvant chemotherapy (AC); and non-CCRT-including NC + IMRT + AC, and IMRT + AC.
The median follow-up duration was 48.4 months (range, 3.0-178.9 months). Acute hematologic toxicities were generally mild, with 86.4% (153/177) of patients experiencing only grade 0-2 toxicity. The 10-year OS, PFS, LRFS, and DMFS rates were 66.6%, 75.3%, 91.9%, and 81.2%, respectively. OS differed significantly among the three treatment groups (P = 0.01). Both the CCRT and non-CCRT regimens were associated with improved 10-year OS compared to IMRT alone, with absolute increases of 29.4% and 26.1%, respectively (P = 0.01 for both comparisons).
In the era of IMRT, chemoradiotherapy was associated with manageable acute hematologic toxicity in patients with NPC. Distant metastasis, particularly in those with N3 disease, remained the predominant pattern of failure. Compared with IMRT alone, both CCRT (CCRT, NC + CCRT + AC, NC + CCRT) and non-CCRT (NC + IMRT + AC, IMRT + AC) demonstrated a potential survival benefit in newly diagnosed patients with locoregionally moderate or advanced NPC. These findings warrant further validation in prospective randomized clinical trials.
同步放化疗（CCRT）仍是局部区域晚期鼻咽癌（NPC）患者治疗的基石。然而，关于长期生存的数据，尤其是10年结局的数据有限。
本回顾性研究评估了177例新诊断的局部区域中度或晚期NPC患者接受调强放射治疗（IMRT）的临床疗效和急性血液学毒性。患者分为三组：单纯IMRT组；CCRT组，包括接受新辅助化疗（NC）+CCRT、单纯CCRT以及NC+CCRT+辅助化疗（AC）的亚组；非CCRT组，包括NC+IMRT+AC和IMRT+AC。
中位随访时间为48.4个月（范围3.0 - 178.9个月）。急性血液学毒性一般较轻，86.4%（153/177）的患者仅经历0 - 2级毒性。10年总生存率（OS）、无进展生存率（PFS）、局部区域无复发生存率（LRFS）和远处转移无复发生存率（DMFS）分别为66.6%、75.3%、91.9%和81.2%。三组治疗的OS有显著差异（P = 0.01）。与单纯IMRT相比，CCRT和非CCRT方案均与10年OS改善相关，绝对增加分别为29.4%和26.1%（两组比较P均 = 0.01）。
在IMRT时代，放化疗在NPC患者中与可控制的急性血液学毒性相关。远处转移，尤其是N3期疾病患者的远处转移，仍然是主要的失败模式。与单纯IMRT相比，CCRT（CCRT、NC+CCRT+AC、NC+CCRT）和非CCRT（NC+IMRT+AC、IMRT+AC）在新诊断的局部区域中度或晚期NPC患者中均显示出潜在的生存获益。这些发现有待在前瞻性随机临床试验中进一步验证。
