Prognostic Factors and Survival in Patients with Radiation-Related Second Malignant Neoplasms Following Radiotherapy for Nasopharyngeal Carcinoma

Abstract

PurposeTo analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases.Methods and MaterialsInstitutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included.ResultsMedian latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1–36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN.ConclusionsSex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.

Risk, pattern and survival impact of second primary tumors in patients with nasopharyngeal carcinoma following definitive intensity‐modulated radiotherapy

“…With more long‐term survivors, the detrimental impact of late complications such as second malignancies also correspondingly increases. Almost all of the current existing data on post‐radiotherapy SPT incidence in NPC came from the 2D RT era, quoting estimates of 0.6–5.6% across variable follow‐up durations . Very few studies evaluated this risk in a uniform cohort of IMRT‐treated patients.…”

“…SPT is one of the most dreadful complications for survivors of head and neck cancers, accounting for 23% of deaths in patients with nonmetastatic diseases who survived at least 3 years after diagnosis . Incidences of SPT in NPC patients treated with definitive 2D RT have been reported in multiple series, quoting rates of 0.6–5.6% over variable follow‐up periods . However, data from cohorts treated with IMRT is scarce and of limited follow‐up duration .…”

Association between p53 codon 72 polymorphisms and clinical outcome of nasopharyngeal carcinoma

“…EpsteinBarr virus infection, tobacco smoking, alcohol consumption, and occupational exposure to wood dust, as well as high salt consumption, play an important role in NPC development (Hildesheim et al, 2001;Jia et al, 2010;Polesel et al, 2011;Fachiroh et al, 2012;Song and Yang, 2013). Because 80% of NPC cases are diagnosed late because of the deep location of the suspected tumor and non-specificity of initial symptoms, the survival of nasopharyngeal carcinoma is poor (Xi et al, 2013). For patients with stage II or III nasopharyngeal carcinoma, the 5-year overall survival (OS) rate is only approximately 45%, despite aggressive concurrent chemoradiation therapy (Sun et al, 2013); however, lesions often develop distant metastases despite local control.…”

“…For patients with stage II or III nasopharyngeal carcinoma, the 5-year overall survival (OS) rate is only approximately 45%, despite aggressive concurrent chemoradiation therapy (Sun et al, 2013); however, lesions often develop distant metastases despite local control. Radiotherapy is the main treatment for locoregional NPC, but patients in the same tumor stages show different responses to radiotherapy and varying survival time (Xi et al, 2013;Sun et al, 2013). Therefore, genetic factors may influence the toxicity of chemotherapy and outcome of NPC.…”

Effectiveness of chemoradiotherapy for radiation‐induced bilateral external auditory canal cancer: A case report and literature review

“…Although our patient has shown no signs of recurrence since completing these treatments, there have been reports of the potential adverse effects of repeated radiotherapy . Moreover, although several reports indicate that complete resection is preferable for cancer secondary to radiotherapy for nasopharyngeal carcinoma, radiotherapy is also a beneficial option . Therefore, radiotherapy or chemoradiotherapy may be useful for radiation‐induced cancer if late adverse events are taken into consideration.…”