Bone Metastasis in Endemic Nasopharyngeal Carcinoma

Purpose Bone metastasis occurs frequently in patients with endemic nasopharyngeal carcinoma (NPC). The main objective of this study is to evaluate positron emission tomography (PET) using fluorine-18–labeled fluorodeoxyglucose ([18F]FDG) and conventional skeletal scintigraphy (SS) for detecting bone metastasis at initial staging. Auxiliary objectives are to identify risk factors for bone metastasis and features associated with poor survival in patients with bone metastasis. Patients and Methods Patients with endemic NPC before initiation of treatment were enrolled. PET and SS were performed at initial staging and compared using McNemar's paired-sample test. Bone metastasis was considered to be present if there was any reliable evidence identified within 1 year after primary diagnosis. Multiple logistic regression and Cox's proportional hazards models were used for auxiliary objectives. Results Thirty (15%) of 202 eligible patients were found to have bone metastasis. [18F]FDG PET was found to be more sensitive than SS in the patient-based analysis (P = .006) and in the region-based analysis at the spine (P = .001). Advanced N stage was the only significant risk factor (P < .0001), and the coexistence of hepatic metastasis was a prognosticator of poor survival (P = .017). The survival was not significantly better for patients with bone metastasis undetected at primary staging than for those with initially detectable bone metastasis (P = .620). Conclusion [18F]FDG PET is more sensitive than SS for detecting bone metastasis in endemic NPC at initial staging, whereas SS can be considered as supplementary in this setting.

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

10.21203/rs.3.rs-685930/v1 ◽

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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