Radiotherapy added to chemotherapy showed significant improvement in overall survival (OS) in chemotherapy-sensitive patients with de novo metastatic nasopharyngeal carcinoma (mNPC), according to a randomised clinical trial reported in JAMA Oncology.
This phase 3 trial included 126 patients with biopsy-proven mNPC who demonstrated complete or partial response following 3 cycles of cisplatin and fluorouracil chemotherapy. Eligible patients were randomly assigned to receive either chemotherapy plus radiotherapy (n=63) or chemotherapy alone (n=63) and followed for a median period of 26.7 months. The primary outcome was OS, and secondary endpoints were progression-free survival (PFS) and safety.
Patients assigned to the chemotherapy plus radiotherapy group received intensity-modulated radiotherapy (IMRT) to the primary and nodal regions after chemotherapy.
The 24-month OS was 76.4% (95% confidence interval [CI], 64.4%-88.4%) in the chemotherapy plus radiotherapy group, compared with 54.5% (95%CI, 41.0%-68.0%) in the chemotherapy alone group, thus meeting the primary endpoint. PFS was also improved in the chemotherapy plus radiotherapy group compared with the chemotherapy-alone group. No significant differences in acute haematological or gastrointestinal toxic effects were observed between the treatment arms.
These findings suggest that local radiotherapy added to chemotherapy can improve survival in patients with chemotherapy-sensitive metastatic nasopharyngeal carcinoma.