Clinical course of longer than five years after definitive radiotherapy for nasopharyngeal carcinoma

Int J Clin Oncol. 2023 Dec;28(12):1607-1615. doi: 10.1007/s10147-023-02418-7. Epub 2023 Oct 5.

Abstract

Background: This study aimed to reveal the long-term outcomes and late toxicities (> 5 years) after definitive intensity-modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).

Methods: Data from 43 patients (median age, 55 years; range, 17-72 years) with NPC who underwent definitive IMRT between 2001 and 2018 were analyzed. All patients were alive and disease-free 5 years after IMRT. A total dose of 70 (range, 66-70) Gy was delivered in 35 (33-35) fractions with concurrent cisplatin chemotherapy.

Results: The median follow-up duration was 119 (range, 61.5-242.1) months. Three patients developed locoregional failure at 79, 92, and 149 months after IMRT, respectively. Of these, 2 patients died of disease progression at 136 and 153 months after IMRT. One patient died of aspiration pneumonia 141 months after IMRT, despite salvage of the recurrent tumor by re-irradiation. In addition, one patient died of aspiration pneumonia 62 months after the IMRT. Thus, the 10-year overall survival, progression-free survival, and locoregional control rates were 98%, 92%, and 94%, respectively. Grade ≥ 2 and ≥ 3 late toxicities were observed in 28 (65%) and 9 (21%) patients, respectively. Nine second primary cancers, including five tongue cancers and two external auditory canal carcinomas, were observed in seven (16%) patients.

Conclusion: Late recurrences, severe late toxicities, and second primary cancers were observed > 5 years after IMRT. A long-term follow-up of > 5 years is needed in patients with NPC.

Keywords: Dysphagia; Intensity-modulated radiation therapy; Long-term outcomes; Nasopharyngeal carcinoma; Second primary cancer.

MeSH terms

  • Disease Progression
  • Humans
  • Middle Aged
  • Nasopharyngeal Carcinoma / radiotherapy
  • Nasopharyngeal Neoplasms* / drug therapy
  • Nasopharyngeal Neoplasms* / pathology
  • Nasopharyngeal Neoplasms* / radiotherapy
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neoplasms, Second Primary* / pathology
  • Pneumonia, Aspiration* / etiology
  • Pneumonia, Aspiration* / pathology
  • Radiotherapy, Intensity-Modulated* / adverse effects