The role of chemotherapy in the treatment of stage II nasopharyngeal carcinoma: Retrospective analysis of the national cancer database

The standard of care treatment for locally advanced nasopharyngeal carcinoma (NPC) includes both chemotherapy and definitive radiation. However, there are limited data on the optimal management of stage II NPC. We performed a retrospective analysis of the National Cancer Database to analyze the treatment patterns and role of chemotherapy in patients with stage II NPC. We identified 611 patients diagnosed with T1-2, N0-1, M0 NPC, from 2004 to 2013. Five-year survival was calculated using Kaplan Meier (KM) analysis. Multivariable analysis and propensity matched analysis were performed to analyze the impact of chemotherapy on overall survival. Of the 611 patients, 527 underwent concurrent chemoradiation (CCRT) and 84 received radiation only. Unadjusted KM analysis showed improved 5-year survival in the CCRT group compared to radiation only (80.5% vs 65.7%; P=0.0021). Multivariable analysis also showed improved survival with the addition of chemotherapy (Hazard ratio [HR] 0.59; 95 CI 0.39-0.89; P=0.0124). Propensity matched analysis confirmed a significant clinical benefit from the addition of chemotherapy to radiation. Age >= 65years (HR 2.41; 95% CI 1.71-3.4; P=<0.0001), Charlson-Deyo comorbidity index >1 (HR 2.82; 95% CI 1.49-5.31; P=0.0014) and positive lymph node status (HR 1.6; 95% CI 1.04-2.46; P=0.0340) were associated with worse survival. In this retrospective analysis, patients with stage II NPC had improved survival with CCRT compared to definitive radiation only. Elderly patients with comorbidities had worse outcomes.