Taxane/gemcitabine-Containing Chemotherapy Plus Locoregional IMRT for Patients With De Novo Metastatic Nasopharyngeal Carcinoma: The Treatment Outcomes and Prognostic Factors Analysis

Abstract

Objectives: To evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors.Materials and Methods: A total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed. Results: The median follow-up time for the whole group was 31.5 months (range, 5-138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60(50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61(51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p<0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p=0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, P < 0.001) and OS (HR=0.518, p= 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFSConclusion: Taxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.

Comprehensive treatment of recurrent and metastatic nasopharyngeal carcinoma: advances and future directions

“…However, in the era when gemcitabine combined with cisplatin (GP) has become the new standard first-line chemotherapy scheme, the benefit of local radiotherapy is still worth further study. In 2022, Du et al 13 analyzed 118 patients with metastatic NPC who received sequential local radiotherapy after systemic chemotherapy with a paclitaxel/gemcitabine regimen. After a median follow-up time of 31.5 months, the 5-year PFS, OS, and local recurrence-free survival rates were 34.2%, 44%, and 82.6%, respectively.…”