Efficacy of local-regional radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving chemo-immunotherapy: A multicenter, propensity score matching study

Shui-Qing He; Guo-Ying Liu; Ya-Hui Yu; Lin Wang; Guo-Yi Zhang; Ding-Sheng Peng; Wei-Xin Bei; Chun-Lan Chen; Shu-Hui Lv; Ze-Yu Zhao; Ying Huang; Yan-Qun Xiang

doi:10.1016/j.radonc.2024.110687

Efficacy of local-regional radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving chemo-immunotherapy: A multicenter, propensity score matching study

Radiother Oncol. 2024 Dec 19:203:110687. doi: 10.1016/j.radonc.2024.110687. Online ahead of print.

Authors

Shui-Qing He¹, Guo-Ying Liu², Ya-Hui Yu³, Lin Wang¹, Guo-Yi Zhang⁴, Ding-Sheng Peng⁵, Wei-Xin Bei¹, Chun-Lan Chen⁴, Shu-Hui Lv¹, Ze-Yu Zhao¹, Ying Huang⁶, Yan-Qun Xiang⁷

Affiliations

¹ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 510060, Guangzhou, China.
² Department of Oncology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
³ Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
⁴ Department of Radiation Oncology, Cancer Center, the First People's Hospital of Foshan, Foshan 528000, Guangdong, China.
⁵ Department of Radiation Oncology, Huizhou Central People's Hospital, No. 41, Eling North Road, Hui cheng District, Huizhou 516008, PR China.
⁶ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 510060 Guangzhou, China. Electronic address: huangying@sysucc.org.cn.
⁷ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 510060, Guangzhou, China. Electronic address: xiangyq@sysucc.org.cn.

PMID: 39709030
DOI: 10.1016/j.radonc.2024.110687

Abstract

Background: To evaluate the efficacy of local-regional radiotherapy (LRRT) in de novo metastatic nasopharyngeal carcinoma (dm NPC) patients receiving chemo-immunotherapy as first-line treatment and select the beneficiaries from LRRT.

Methods and materials: M1-NPC patients receiving platinum-based chemo-immunotherapy with or without LRRT from four centers were included in this study. The propensity score matching (PSM) analysis was employed to balance the baseline characteristics between the LRRT and non-LRRT groups.

Results: 546 dm NPC patients (140 patients in the non-LRRT group and 406 patients in the LRRT group) were incorporated. Patients receiving LRRT demonstrated significantly improved progression-free survival (3-year PFS rate, 53.2 % vs 31.2 %, p < 0.001). After PSM analysis, there were 244 patients in the LRRT group and 122 patients in the non-LRRT group. Multivariable analysis indicated that LRRT was not an independent prognostic factor in the matched cohort (HR, 1.25, 95 % CI, 0.92-1.69, p = 0.156). Subgroup analysis among the matched cohort showed a significant increase in PFS for patients with oligo metastatic disease (OMD) who received LRRT (3-year PFS rate, 70.6 % vs 49.3 %, p = 0.043). In contrast, no such benefit was observed in patients with poly metastatic disease (PMD, 3-year PFS rate, 35.8 % vs 27.8 %, p = 0.17). Furthermore, LRRT significantly enhanced survival in patients with undetectable EBV DNA_{2-6 cycles} (3-year PFS rate, 57.9 % vs. 43.4 %, p = 0.043), whereas no survival improvement was noted in patients with detectable EBV DNA_{2-6 cycles} (16.2 % vs. 20.3 %, p = 0.21).

Conclusion: LRRT could prolong PFS in M1-NPC patients. OMD and undetectable EBV DNA_{2-6 cycles} are potential indicators for selecting beneficiaries from LRRT.