Locoregional Treatment for De Novo Metastatic Nasopharyngeal Carcinoma

OBJECTIVE Optimal management of de novo metastatic nasopharyngeal carcinoma (NPC) is debatable. The aim of this study is to evaluate the patient characteristics, the impact of locoregional treatment on disease control and overall survival (OS) and to analyze the factors that correlate with the outcome of patients with de novo metastatic NPC patients treated between 2000 and 2018. METHODS Among 589 NPC patients referred to our clinic in the past 18 years, the cases of 36 de novo metastatic NPC patients who received radical locoregional radiotherapy (LR-RT) were analyzed retrospectively. After excluding one patient who had previously received chemotherapy for 12 courses in another clinic, the remaining 35 patients were analyzed in terms of population characteristics, OS, and possible confounding factors. RESULTS Seven of 35 patients were under the age of 16. The histology was World Health Organization (WHO) type 2-3 in 94.3%. All but two patients received 3-6 cycles of induction chemotherapy. The median dose of LR RT was 70 Gy. The median follow-up time was 25 months. Two and 4 year OS rate was 51% and 34%, respectively. Univariate analysis showed no significant effects of age (>6, <= 40), gender, oligometastatic disease, the existence of liver metastasis, or RT dose on the OS. CONCLUSION De novo metastatic NPC patients had highly prolonged survival with the use of LR-RT and this treatment approach should be validated by further multi-centric clinical studies.