Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in Saudi Arabia

Abstract

BackgroundWe aimed to investigate the patterns of failure (locoregional and distant metastasis), associated factors, and treatment outcomes in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy (IMRT) combined with chemotherapy.Patients and methodsFrom April 2006 to December 2011, 68 nasopharyngeal carcinoma patients were treated with IMRT and chemotherapy at our hospital. Median radiation doses delivered to gross tumor volume and positive neck nodes were 66–70 Gy, 63 Gy to clinical target volume, and 50.4–56 Gy to clinically negative neck. The clinical toxicities, patterns of failures, locoregional control, distant metastasis control, disease-free survival, and overall survival were observed.ResultsThe median follow-up time was 52.2 months (range: 11–87 months). Epstein–Barr virus infection was positive in 63.2% of patients. Overall disease failure developed in 21 patients, of whom 85.8% belonged to stage III/IV disease. Among these, there were seven locoregional recurrences, three regional recurrences with distant metastases, and eleven distant metastases. The median interval from the date of diagnosis to failure was 26.5 months (range: 16–50 months). Six of ten (60%) locoregional recurrences were treated with reirradiation ± concurrent chemotherapy. The 5-year locoregional control, distant metastasis control, disease-free survival, and overall survival rates of whole cohort were 81.1%, 74.3%, 60.1%, and 73.4%, respectively. Cox regression analyses revealed that neoadjuvant chemotherapy, age, and Epstein–Barr virus were independent predictors for disease-free survival.ConclusionNeoadjuvant chemotherapy followed by IMRT with or without chemotherapy improves the long-term survival of Saudi patients with nasopharyngeal carcinoma. Distant metastasis was the main pattern of treatment failure. Neoadjuvant chemotherapy, age, and Epstein–Barr virus status before IMRT were important independent prognostic factors.

Comparison of Two Standard Treatment Approaches in Locoregionally Advanced Nasopharyngeal Carcinoma

“…For the whole cohort, our study revealed survival outcomes comparable to the published literature from the endemic region and favorable to previous studies from our region that used non-IMRT techniques or small series IMRT technique. 8 9 11 This study did not show a survival advantage for induction over the no-induction group; the 3-year OS and DFS were 92.7% and 79.67% in the induction group and 92.9% and 93.28% in the no-induction group, respectively. As shown in Table 1 , the majority of patients in the induction group had advanced T and N categories compared with the no-induction group.…”

“…There are limited data on survival outcomes, patterns of failure, acute and late toxicity from the Middle East region. 8 9 Herein, we retrospectively evaluated the clinical outcomes, patterns of failure, acute and late toxicities of NPC patients treated with CCRT with or without IC or AC at our institution.…”

Clinical characteristics of head and neck cancers at a tertiary care hospital

“…The problem is more challenging in patients with advanced stages. Maklad et al 29 reported an overall failure of treatment in 21 out of 68 Saudi patients with nasopharyngeal cancer. Out of 21, seven were locoregional, 3 were regional with DM, and 11 had DM.…”