Identifying the optimal candidates for locoregional radiation therapy in patients with de novo metastatic nasopharyngeal carcinoma

Head & Neck ◽  
2021 ◽  
Author(s):  
Hanchuan Xu ◽  
Lihu Lu ◽  
Tianzhu Lu ◽  
Yun Xu ◽  
Jingfeng Zong ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
De Novo ◽  
Metastatic Nasopharyngeal Carcinoma

scholarly journals Optimizing the treatment mode for de novo metastatic nasopharyngeal carcinoma with bone-only metastasis

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng Lin ◽  
Sheng Lin ◽  
Lili Zhu ◽  
Shaojun Lin ◽  
Jianji Pan ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Bone Metastases ◽  
Protective Factor ◽  
Cox Regression ◽  
De Novo ◽  
Progression Free Survival ◽  
Rank Test ◽  
Bone Lesions ◽  
Metastatic Nasopharyngeal Carcinoma ◽  
The Difference

Abstract Background No standard radiotherapy regimens have been established for the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LRRT) with or without local radiotherapy (RT) for metastatic bone lesions in mNPC. Methods We retrospectively analysed 131 de novo patients with mNPC who had bone-only metastasis and received at least two cycles of PCT with LRRT. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analyses were performed by Cox regression. Results The median overall survival (OS) and progression-free survival (PFS) were 33.0 months and 24.0 months, respectively. Patients with five or fewer metastatic bone lesions had significantly longer OS (72.0 months vs. 23.0 months, Hazard ratios (HR) = 0.45, p <  0.001) and PFS (48.0 months vs. 15.0 months, HR = 0.52, p = 0.004) than those who had more than five metastatic bone lesions. Patients who received four or more cycles of chemotherapy were associated with significantly longer OS (unreached vs. 19.0 months, HR = 0.27, p <  0.001) and PFS (66 months vs. 16.0 months, HR = 0.32, p <  0.001). Multivariate analysis confirmed that fewer bone metastases (≤ 5) and more chemotherapy cycles (≥ 4) were favourable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bone lesions tended to prolong OS (83.0 months vs. 45.0 months) and PFS (60 months vs. 36.5 months) in patients with five or fewer metastatic bone lesions than in those without RT to metastatic bone lesions (p > 0.05). Patients who received a RT dose > 30 Gy had neither better OS (63.5 months vs. 32.0 months, p = 0.299) nor PFS (48.0 months vs. 28.0 months, p = 0.615) than those who received a RT dose ≤30 Gy. Conclusions Local RT to bone metastases may not significantly improve survival in patients with de novo mNPC with bone-only metastasis who have already received PCT plus LRRT. Receiving four or more cycles of chemotherapy can significantly prolong survival and is a favourable independent protective factor.

scholarly journals Optimizing the Treatment Mode for de Novo Metastatic Nasopharyngeal Carcinoma with Bone-Only Metastasis

2021 ◽  
Author(s):  
Cheng Lin ◽  
Sheng Lin ◽  
li Li Zhu ◽  
jun Shao Lin ◽  
ji Jian Pan ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Nasopharyngeal Carcinoma ◽  
Cox Regression ◽  
De Novo ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Rank Test ◽  
Bone Lesions ◽  
Metastatic Lesions ◽  
Metastatic Nasopharyngeal Carcinoma

Abstract Purpose: No standard radiotherapy regimens was established in the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LLRT) with or without local radiotherapy (RT) to bone metastatic lesions in mNPC, and identify the optimal candidates.Methods: We retrospectively analyzed 141 de novo mNPC patients with bone-only metastasis who received at least two cycles of PCT with or without LLRT and RT to bone metastasis. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analysis was made by Cox regression. Results: Patients who received PCT plus LLRT had significantly longer overall survival (OS) (45.0 months vs 13.5 months, HR = 0.30 , p = 0.001) and progression-free survival (PFS) (29.0 months vs 11.0 months, HR = 0.34, p = 0.014), especially in patients who had less than 3 metastatic bone lesions. Multivariate analysis confirmed that LRRT, more chemotherapy cycles (≥ 4) and limited number of bone metastasis (≤ 3) were favorable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bones had a tendency to prolong the survival time in the unselected population who received PCT plus LLRT (p > 0.05), while further data suggested that RT to metastatic bones dramatically improve OS (72.0 months vs 26.0 months, p = 0.002) and PFS (60.0 months vs 20.0 months, p = 0.006) for mNPC with less than 3 metastatic bone lesions.Conclusions: LLRT and RT to bone metastatic lesions followed by PCT in de novo mNPC with bone-only metastasis significantly prolonged survival in patients with less than 3 metastatic bone lesions.

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