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Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion.

Methods

A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan–Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated.

Results

IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group.

Conclusions

IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.

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Abbreviations

2DRT:

Two-dimensional conventional radiation therapy

IMRT:

Intensity-modulated radiation therapy

NPC:

Nasopharyngeal carcinoma

OS:

Overall survival

DFS:

Disease-free survival

LRRFS:

Locoregional relapse-free survival

DFMS:

Distant metastasis-free survival

RT:

Radiation therapy

PTV:

Planning target volume

GTVnx:

Gross tumor volume of the primary

GTVnd:

Nodal gross tumor volume

IC:

Induction chemotherapy

CCRT:

Concurrent chemoradiotherapy

AC:

Adjuvant chemotherapy

HR:

Hazard ratios

RECIST:

Response evaluation criteria in solid tumors

CR:

Complete remission

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Funding

This work was supported by the National Natural Science Foundation of China (Nos. 81560443, 81760546) and the Scientific Research and Technology Development Program of Guilin (No. 20170109-22), the Key Program of the Guangxi Natural Science Foundation of China (No. 2018JJD140054), the General Program of Guangxi Natural Science Foundation of China (No. 2018GXNSFAA138100).

Author information

Author notes

  1. Shufang Liao, Yuan Xie, Yi Feng and Yuanyuan Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, People’s Republic of China

    Shufang Liao, Yuan Xie, Jinfang Fan, Jinglin Mi, Xiaoli Qin, Dacheng Yao & Wei Jiang

  2. Department of Neurosurgery, Guilin People’s Hospital, Guilin, 541001, China

    Yi Feng

  3. Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, 543002, China

    Yuanyuan Zhou

  4. Department of Radiation Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541004, China

    Yufei Pan

  5. Department of Oncology, People’s Hospital of Gongcheng Yao Autonomous County, Guilin, 542500, China

    Wei Jiang

Authors
  1. Shufang Liao
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  2. Yuan Xie
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  3. Yi Feng
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  4. Yuanyuan Zhou
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  5. Yufei Pan
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  6. Jinfang Fan
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  7. Jinglin Mi
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  8. Xiaoli Qin
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  9. Dacheng Yao
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  10. Wei Jiang
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Contributions

Study concept and design: SFL and WJ. Data acquisition and analysis: SFL, YX, YF, YYZ and WJ. Data interpretation: all authors. Drafting the manuscript: SFL and WJ. Critical revision of the manuscript for important intellectual content: all authors. Supervision: WJ. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wei Jiang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Medical Ethics Committee of affiliated Hospital of Guilin Medical University, Wuzhou Red Cross Hospital, and Nanxishan Hospital of Guangxi Zhuang Autonomous Region.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Liao, S., Xie, Y., Feng, Y. et al. Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion. J Cancer Res Clin Oncol 146, 429–439 (2020). https://doi.org/10.1007/s00432-019-03067-y

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  • DOI: https://doi.org/10.1007/s00432-019-03067-y

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