Objectives

To evaluate long-term outcomes of induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT) and adjuvant chemotherapy (AC) in nasopharyngeal carcinoma (NPC) patients with N3 disease.

Materials and methods

From September 2005 to August 2016, 143 patients confirmed NPC with the 8th AJCC/UICC staging criteria N3 were reviewed. All patients received IC followed by IMRT and AC.

Results

After a median follow-up of 67 months, the 5-year and 10-year overall survival (OS), progression-free survival (PFS), distant metastasis free survival (DMFS), local progression-free survival (LPFS) and regional progression-free survival (RPFS) were 75.7% and 61.6%, 61.2% and 53.4%, 73.1% and 72.1%, 92.4% and 87%, 88.9% and 81.8%, respectively. Multivariate analyses indicated that T stage (P = 0.001) appeared to be prognostic factors for OS. T stage (P = 0.001 and P = 0.002) and neck lymph node necrosis (P = 0.015 and P = 0.045) were independent predictors of PFS and DMFS. The acute toxicities were mainly grade 1/2 hematologic toxicities in patients treated with IC+IMRT+AC, and severe toxicities were uncommon.

Conclusions

IC followed by IMRT and AC achieved satisfactory long-term survival outcomes in NPC patients with N3 disease. Neck lymph node necrosis and late T stage served as predictors of poor prognosis for patients.

中文翻译：

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N3期鼻咽癌患者诱导化疗后调强放疗及辅助化疗的远期疗效

目标

评估诱导化疗 (IC) 后调强放疗 (IMRT) 和辅助化疗 (AC) 在 N3 鼻咽癌 (NPC) 患者中的长期结果。

材料和方法

从 2005 年 9 月至 2016 年 8 月，对 143 例符合 AJCC/UICC 第 8 分期标准 N3 确诊的 NPC 患者进行了审查。所有患者均接受 IC，随后接受 IMRT 和 AC。

结果

中位随访 67 个月后，5 年和 10 年总生存期（OS）、无进展生存期（PFS）、无远处转移生存期（DMFS）、局部无进展生存期（LPFS）和区域无进展生存期 (RPFS) 分别为 75.7% 和 61.6%、61.2% 和 53.4%、73.1% 和 72.1%、92.4% 和 87%、88.9% 和 81.8%。多变量分析表明 T 分期（P  = 0.001）似乎是 OS 的预后因素。T 分期（P  = 0.001 和P  = 0.002）和颈部淋巴结坏死（P  = 0.015 和P = 0.045) 是 PFS 和 DMFS 的独立预测因子。IC+IMRT+AC治疗患者的急性毒性主要为1/2级血液学毒性，严重毒性不常见。

结论

在患有 N3 疾病的 NPC 患者中，IC 继以 IMRT 和 AC 取得了令人满意的长期生存结果。颈部淋巴结坏死和晚期 T 分期是患者预后不良的预测指标。