Systemic Chemotherapy with Loco‐regional Radiotherapy

Objective Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma at diagnosis (mNPC), but radiotherapy for primary tumor and its regional lymph nodes (loco‐regional radiotherapy, LR‐RT) is not routinely advocated. In current study, we evaluate the impact of LR‐RT on survival of patients with mNPC. Method A retrospective review of 385 mNPC patients at diagnosis recorded at San Yat‐Sen University Cancer Center between 2001 and 2009. We compared mortality risks between patients who underwent different anticancer treatments including systemic chemotherapy, LR‐RT, and local treatment of metastasis, alone or in combination, adjusted these risks for prognostic factors. Results However, it presented a 50% reduced risk of death compared to those without any anticancer treatment (HR, 0.5; 95% CI, 0.2 to 1.0; P =. 044) and 140% increase of death risk compared with those who underwent combination treatment of systemic chemotherapy and LR‐RT (HR, 2.4; 95% CI, 1.3 to 4.5; P =. 004). With analysis in the subgroup of patients who received combination treatment (n = 176), induction chemotherapy and LR‐RT with high dose (≥66Gy) showed significant lower risk of death compared to concurrent and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.3 to 0.7; P =. 001) and low‐dose radiation (<66Gy) (HR, 0.6; 95% CI, 0.3 to 1.0; P =. 033). Conclusion LR‐RT, particularly combined with systemic chemotherapy, improves survival of patients with mNPC at diagnosis. High dose LR‐RT combined with induction chemotherapy is advocated based on current data. However, well‐designed prospective studies are expected to further evaluate the impact of LR‐RT.