Ten-Year Outcomes of IMRT With Chemotherapy Versus IMRT Alone for Stage Ⅱ-Ⅳa Nasopharyngeal Carcinoma: A Retrospective Study

Background Concurrent chemoradiotherapy (CCRT) is the cornerstone of treatment for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). However, a 10-year survival rate was rarely reported. Methods Clinical efficacies and acute hematologic toxicities of 177 patients newly diagnosed with locoregionally moderate or advanced NPC and treated with intensity-modulated radiation therapy (IMRT) were analyzed retrospectively. The patients were divided into three groups: IMRT alone, CCRT [neoadjuvant chemotherapy (NC) + CCRT, CCRT, NC + CCRT + adjuvant chemotherapy (AC)], and non-CCRT (NC + IMRT + AC, IMRT + AC). Results The median follow-up time was 48.4 months (range, 3.0–178.9 months). The most common acute hematologic toxicities were limited to grade 0–2 (153 cases, 86.4%). The 10-year overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 66.6%, 77.9%, 92.9%, and 83.0%, respectively. A significant difference in OS among the three groups was observed (P = 0.01). CCRT and non-CCRT significantly improved OS compared with IMRT alone, with a 29.9% and 25.8% increase in 10-year OS (P = 0.01), respectively. Conclusions In the era of IMRT, acute hematologic toxicities were well tolerated with chemoradiotherapy for treating NPC, while distant metastasis was the most common failure pattern, especially for patients with N3 stage disease. Compared with IMRT alone, the CCRT scheme (CCRT, NC + CCRT + AC, NC + CCRT) may improve the OS of patients newly diagnosed with locoregionally moderate or advanced NPC, and non-CCRT (NC + IMRT + AC, IMRT + AC) may be an alternative scheme. Additional randomized trials are warranted to confirm the findings.