Effects of Surgery Combined with Chemoradiotherapy on Short- and Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma

Jing-Jin Weng; Jia-Zhang Wei; Min Li; Shao-Jie Zhang; Yun-Zhong Wei; Han-Wei Wang; Dan-Xue Qin; Jin-Long Lu; He Jiang; Shen-Hong Qu

doi:10.2147/CMAR.S262567

Effects of Surgery Combined with Chemoradiotherapy on Short- and Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma

Cancer Manag Res. 2020 Aug 25:12:7813-7826. doi: 10.2147/CMAR.S262567. eCollection 2020.

Authors

Affiliation

¹ Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, People's Republic of China.

^# Contributed equally.

Abstract

Objective: The efficacy of surgery as the primary treatment modality for nasopharyngeal carcinoma (NPC) is yet to be clarified. Therefore, we aimed to explore the short- and long-term efficacy of surgery for early-stage NPC.

Methods: We retrospectively evaluated 341 patients diagnosed with early-stage NPC between September 2010 and December 2015. Among them, 58 patients underwent endoscopic nasopharyngectomy combined with chemoradiotherapy, whereas 283 patients underwent conventional chemoradiotherapy. The patients who underwent concurrent chemoradiotherapy or radiotherapy alone were matched to patients who underwent surgery in a 1:2 ratio using propensity score matching to analyze the clinical efficacy of each therapeutic modality. The primary endpoint was survival, and the secondary endpoints were tumor regression rate and reduction in Epstein-Barr virus (EBV)-DNA levels.

Results: After matching, 156 patients were enrolled (58 patients in the surgery group; 98 patients in the non-surgery group). The baseline data of the matched patients had good inter-group comparability (All P>0.05). The surgery group had significantly higher 5-year overall survival (98.30% vs. 91.70%), disease-free survival (98.30% vs. 81.40%), and recurrence-free survival (100.00% vs. 90.10%) rates than did the non-surgery group (All P<0.05). In total, 0 and 14 patients in the surgery and non-surgery groups, respectively, had residual cancer at the end of treatment (P=0.001). All patients in the surgery group tested negative for EBV-DNA, whereas two patients in the non-surgery group tested positive. The incidence of hematologic toxicity during treatment was similar between the two groups (All P>0.05). Still, the incidence of severe oral mucositis was lower in the surgery group than in the non-surgery group (37.9% vs. 54.08%, P=0.051).

Conclusion: Surgery can improve the clearance rate of EB virus and reduce tumor residue. Surgery may be a safe and effective treatment for early NPC.

Keywords: endoscopic surgery; nasopharyngeal carcinoma; prognosis; radiotherapy.

Grants and funding

This work was supported by the National Natural Science Foundation of China (81602390, 81960493, 81960186, and 81460097), Guangxi Natural Science Foundation (2016GXNSFCB380003 and 2017GXNSFAA198013), Open Research Project of Key Laboratory of High-Incidence-Tumor Prevention & Treatment (Guangxi Medical University), Guangxi Key Research & Development Program (GuiKeAB1850010), Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (S2018039), Scientific Research Project of Guangxi Health and Family Planning Commission (No. Z2014629). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.