Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in Saudi Arabia.
BACKGROUND
We aimed to investigate the patterns of failure (locoregional and distant metastasis), associated factors, and treatment outcomes in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy (IMRT) combined with chemotherapy.


METHODS
From April 2006 to December 2011, 68 nasopharyngeal carcinoma patients were treated with IMRT and chemotherapy at our hospital. Median radiation doses delivered to gross tumor volume and positive neck nodes were 66-70 Gy, 63 Gy to clinical target volume, and 50.4-56 Gy to clinically negative neck. The clinical toxicities, patterns of failures, locoregional control, distant metastasis control, disease-free survival, and overall survival were observed.


RESULTS
The median follow-up time was 52.2 months (range: 11-87 months). Epstein-Barr virus infection was positive in 63.2% of patients. Overall disease failure developed in 21 patients, of whom 85.8% belonged to stage III/IV disease. Among these, there were seven locoregional recurrences, three regional recurrences with distant metastases, and eleven distant metastases. The median interval from the date of diagnosis to failure was 26.5 months (range: 16-50 months). Six of ten (60%) locoregional recurrences were treated with reirradiation ± concurrent chemotherapy. The 5-year locoregional control, distant metastasis control, disease-free survival, and overall survival rates of whole cohort were 81.1%, 74.3%, 60.1%, and 73.4%, respectively. Cox regression analyses revealed that neoadjuvant chemotherapy, age, and Epstein-Barr virus were independent predictors for disease-free survival.


CONCLUSIONS
Neoadjuvant chemotherapy followed by IMRT with or without chemotherapy improves the long-term survival of Saudi patients with nasopharyngeal carcinoma. Distant metastasis was the main pattern of treatment failure. Neoadjuvant chemotherapy, age, and Epstein-Barr virus status before IMRT were important independent prognostic factors.
Clinical Oncology, Sohag University, Sohag, Egypt; Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Ahmed Marzouk
AM
Maklad
Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; Radiation Oncology, NCI, Cairo University, Cairo.
Yasser
Y
Bayoumi
Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; Radiation Oncology, Minia Oncology Center, Minia.
Mohamed Abdalazez
MA
Senosy Hassan
Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Medical Physics, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
AbuSaleh A
AA
Elawadi
Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Hussain
H
AlHussain
Medical Oncology, SECI-Assiut University, Assiut, Egypt; Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City.
Ashraf
A
Elyamany
Department of Otolaryngology, Head and Neck Surgery, King Saud University.
Saleh F
SF
Aldhahri
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University.
Khalid Hussain
KH
Al-Qahtani
Department of ENT, King Fahad Medical City.
Mubarak
M
AlQahtani
Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia.
Mutahir A
MA
Tunio
nasopharyngeal carcinoma; patterns of failures; prognostic factors; treatment outcomes