Ten-year outcomes of IMRT with chemotherapy versus IMRT alone for stage II-IVa nasopharyngeal carcinoma: a retrospective study.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.