Fate of patients with nasopharyngeal cancer who developed distant metastasis as first failure after definitive radiation therapy

Abstract

Background. No consensus has been reached on the optimal treatment for patients with nasopharyngeal cancer (NPC) who develop distant metastasis after initial radiation therapy (RT). Methods. Two hundred eighty-two patients with NPC received curative RT (+/- chemotherapy). Forty-six patients (16.3%) who developed distant metastasis as first failure formed the study group for the current analysis. Results. The median interval from initial RT until distant metastasis was 11.6 months. With a median follow-up of 30 months among survivors, overall survival (OS) rates at 2 and 5 years were 53.7% and 30.5%, respectively. On multivariate analyses, 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for initial staging, RT plus chemotherapy as initial treatment, metastatic lesion number <6, disease-free interval >9 months, distant metastasis only to lungs, and treatment with curative intent after distant metastasis were predictive of significantly better OS. Conclusion. Combined with FDG-PET/CT, an aggressive treatment approach using locoregional modalities might be beneficial to patients with NPC with favorable prognostic factors, even after distant metastasis. (C) 2015 Wiley Periodicals, Inc.