King Faisal Specialist Hospital and Research Centre Riyadh, Riyadh
M. Almahmoud, M. Aldehaim, F. Alsamari, K. Shehzad, M. S. Anwar, G. Mohamed, H. Ghebeh, and N. M. Alrajhi; King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Purpose/Objective(s): In Saudi Arabia, Nasopharyngeal carcinoma (NPC) is the most prevalent form of head and neck cancer. The optimal approach for managing newly diagnosed metastatic NPC is subject to debate, as a standardized treatment protocol has yet to be established. While recent studies have investigated the use of radical radiotherapy for the primary tumor in conjunction with palliative chemotherapy, the potential benefits of also applying radical radiotherapy to metastatic sites remain unclear. This study investigates whether a treatment strategy that employs both chemotherapy and radical radiotherapy to the primary and feasible metastatic sites can be considered curative for patients with de novo metastatic NPC. Materials/
Methods: This retrospective study encompasses de novo metastatic NPC patients who underwent treatment with curative intent at our facility between January 2010 and February 2023. Data collected included patient demographics, initial symptoms, metastasis location, metastatic lesion count, treatment approach, radiation dosage to primary and metastatic sites, and recurrence status. Categorical variables were evaluated using descriptive statistics, and survival outcomes, including overall survival (OS) and recurrence-free survival (RFS), were assessed using the Kaplan-Meier method. Results: A total of 54 patients were included; the median age was 44.5 years (12–70 years), 46 were males (85.2%). The median follow-up time was 42 months. The most common presenting symptoms were the presence of neck mass (47 patients, 87%) and nasal obstruction (27 patients, 50%). Eighteen patients (33%) had cranial nerve involvement, and 26 patients had intracranial extension of the primary disease (48%). The main sites of metastases were Bone (32 patients, 59%), Lung (13 patients, 24%), Parotid (8 patients, 15%), non-regional lymph nodes (7 patients, 13%) and Liver (3 patients, 6%). Most patients had less than 5 metastatic lesions (45 patients, 83%). Thirty-two patients (59%) were treated with induction chemotherapy followed by concurrent chemoradiotherapy (CCRT), while 21 (39%) patients were treated with induction chemotherapy followed by radiotherapy alone. Dose to the primary site was either 66 or 70 Gy. Metastatic lesions were treated with radiotherapy in 31 patients (57%), with a dose ranging between 45 to 66 Gy. The 3-year and 5-year OS were 77.5% and 62%, respectively. The 3-year and 5-year RFS were 35% and 32%, respectively. Conclusion: Curative treatment comprising chemotherapy alongside radical radiotherapy for both primary and accessible metastatic sites in newly identified metastatic NPC patients may enhance overall survival. However, to substantiate these findings, further prospective and randomized studies are warranted.
