A retrospective study comparing the outcomes and toxicities of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy for the treatment of children and adolescent nasopharyngeal carcinoma

Purpose To compare the clinical outcomes and toxicities of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) for the treatment of children and adolescent nasopharyngeal carcinoma (NPC). Methods A total of 176 children with non-metastatic NPC treated at Su...

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Bibliographic Details
Published in:Journal of cancer research and clinical oncology 2017-08, Vol.143 (8), p.1563-1572
Main Authors: Qiu, Wen-Ze, Peng, Xing-Si, Xia, Hai-Qun, Huang, Pei-Yu, Guo, Xiang, Cao, Ka-Jia
Format: Article
Language:English
Subjects:
Adolescent
Cancer Research
Carcinoma - epidemiology
Carcinoma - pathology
Carcinoma - radiotherapy
Child
Children
Clinical outcomes
Disease-Free Survival
Female
Head & neck cancer
Hearing loss
Hematology
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Metastases
Nasopharyngeal Carcinoma
Nasopharyngeal Neoplasms - epidemiology
Nasopharyngeal Neoplasms - pathology
Nasopharyngeal Neoplasms - radiotherapy
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - radiotherapy
Neoplasm Staging
Oncology
Original Article – Clinical Oncology
Original – Clinical Oncology
Pediatrics
Radiation therapy
Radiotherapy, Intensity-Modulated
Retrospective Studies
Survival
Throat cancer
Toxicity
Treatment Outcome
Xerostomia
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Summary:Purpose To compare the clinical outcomes and toxicities of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) for the treatment of children and adolescent nasopharyngeal carcinoma (NPC). Methods A total of 176 children with non-metastatic NPC treated at Sun Yat-sen University Cancer Center between October 2003 and September 2013 were included in this study. Of the 176 patients, 74 received 2D-CRT and 102 were treated with IMRT. The clinical outcomes and acute and late toxicities were determined and compared. Results The IMRT group achieved significantly higher overall survival (OS) (90.4% vs. 76.1% at 5 year, P  = 0.007) and disease-free survival (DFS) (85.7% vs. 71.2%, P  = 0.029) mainly due to an improvement in locoregional relapse-free survival (LRRFS) (97.9 vs. 88.3%, P  = 0.049). After stratification by disease stage, IMRT provided significant benefits for patients with stage III–IV disease in terms of OS, LRRFS and DFS. Multivariate analyses indicated that the treatment group (2D-CRT vs. IMRT) was a prognostic factor for OS, LRRFS and DFS. A significant reduction in Grade 2–4 xerostomia (52.7 vs. 34.3%, P  = 0.015) and hearing loss (40.5 vs. 22.5%, P  = 0.010) was observed in patients treated by IMRT. Conclusion IMRT provides better locoregional relapse-free survival and overall survival, especially in late-stage children and adolescent NPC patients, and is associated with a lower incidence of Grade 2–4 xerostomia as well as hearing loss compared with 2D-CRT. Distant metastasis remains a challenge in the treatment of children and adolescent NPC.
ISSN:0171-5216
1432-1335
DOI:10.1007/s00432-017-2401-y