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Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients.

ABSTRACT: Objective: To compare the survival outcomes brought by different radiation dose schedules to bone lesions and different chemotherapy regimens in bone metastatic nasopharyngeal carcinoma (NPC). Background: The current treatment strategy for bone metastatic NPC patients was empirically given and poorly studied before. It is of necessity to optimize the treatment for bone metastasis to enhance the therapeutic effect and increase the proportion of long-term survived patients. Methods: Three hundred patients who received chemoradiotherapy from 2002 to 2018 were involved in the study. Demographics, laboratory results, and detailed treatment plans were recorded. Radiotherapy plans were classified into three categories based on the intensity, and the survival analysis was performed using log-rank test. Multivariable analysis was made by the Cox proportional regression model. Results: Patients who received 60-75 Gy/30-35 fractions of radiation to the metastatic bones had significantly longer bone relapse-free survival (BRFS) (HR, 0.53, 95% CI, 0.37-0.78, P = 0.003), overall survival (OS) (HR, 0.63, 95% CI, 0.46-0.84, P = 0.007), and progression-free survival (PFS) (HR, 0.80, 95% CI, 0.67-0.95, P = 0.041). The administration of paclitaxel, cisplatin and 5-fluorouracil regimen was also associated with better BRFS (HR, 0.27, 95% CI, 0.10-0.75, P = 0.007), PFS (HR, 0.60, 95% CI, 0.42-0.87, P = 0.007), and OS with borderline significance (HR, 0.54, 95% CI, 0.29-1.03, P = 0.058). In multivariable analysis, the post-treatment EBV DNA level and radical radiation dose were proved as independent prognostic factors for both BRFS and OS. Conclusions: Radiotherapy to metastatic bones with palliative dose prescription should not be considered in bone metastatic NPC patients. TPF chemotherapy regimen might help to improve the survivals in NPC patients but failed to be an independent protective factor.

SUBMITTER: Li XY

PROVIDER: S-EPMC7100272 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients.

Li Xiao-Yun XY Jia Guo-Dong GD Sun Xue-Song XS Guo Shan-Shan SS Liu Li-Ting LT Liu Sai-Lan SL Yan Jin-Jie JJ Luo Dong-Hua DH Sun Rui R Guo Ling L Mo Hao-Yuan HY Tang Lin-Quan LQ Chen Qiu-Yan QY Mai Hai-Qiang HQ

Frontiers in oncology 20200320

Objective: To compare the survival outcomes brought by different radiation dose schedules to bone lesions and different chemotherapy regimens in bone metastatic nasopharyngeal carcinoma (NPC). Background: The current treatment strategy for bone metastatic NPC patients was empirically given and poorly studied before. It is of necessity to optimize the treatment for bone metastasis to enhance the therapeutic effect and increase the proportion of long-term survived patients. Method ...[more]

PMID: 32266152

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Project description:BackgroundNo 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.MethodsWe 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.ResultsThe 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.ConclusionsLocal 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.

Dataset Information

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients.

Publications

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients.

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