Nasopharyngeal carcinoma is an aggressive malignant head and neck cancer that is highly prevalent in the southern and southwestern provinces of China. Although the incidence of the cancer is less than 1 per 100,000 in Europe, the United States, and the Pacific,1 data from the International Agency for Research on Cancer tell more of the story. In 2020, there were about 133,354 new cases of nasopharyngeal carcinoma in the world, with the highest incidence occurring in China; about 60,000 newly diagnosed cases were reported (accounting for 46.8% of the world), making the cancer a major public health problem in China.2
Although treatment of nasopharyngeal carcinoma typically includes concurrent chemoradiation, which can cause serious side effects (such as hearing loss and severe weight loss), a randomized phase III clinical trial conducted in China found that radiation therapy alone provided comparable survival or disease control and less toxicity than concurrent chemoradiation therapy in patients with low-risk nasopharyngeal cancer.3 This study, conducted by Rui Guo, MD, of Sun Yat-sen University Cancer Center, Guangzhou, China, and colleagues, was presented at the 2024 ASCO Breakthrough meeting in Yokohama, Japan.
Rui Guo, MD
Study Methodology
This multicenter, open-label, randomized, phase III, noninferiority clinical trial (ClinicalTrials.gov identifier NCT02633202) was conducted at five Chinese hospitals. It included 341 adults with low-risk nasopharyngeal cancer, enrolled between 2015 and 2020. In this study, low-risk disease was defined as stage II disease or T3N0—cancer that has limited spread to the lymph nodes and low Epstein-Barr virus (EBV) DNA without adverse features (all nodes < 3 cm, no level IV or Vb nodes; no extranodal extension; EBV DNA < 4,000 copies/mL).
Key Results
The patients were assigned to be treated with intensity-modulated radiotherapy (IMRT) alone (n = 172) or concurrent chemoradiotherapy (IMRT with cisplatin, n = 169). The researchers found that with a median follow-up of 70.1 months, the IMRT-alone group had similar 5-year overall survival (95.2% vs 98.2%, hazard ratio = 2.27 [95% confidence interval [CI] = 0.70–7.40]; P = .16) and failure-free survival (86.2% vs 88.4%, hazard ratio = 1.16 [95% CI = 0.64–2.07]; P = .63).
Hearing impairment data, assessed by the Hearing Handicap Inventory for Adults, were collected from 86 patients in the IMRT-alone group and 81 patients in the concurrent chemoradiotherapy group. The researchers found that among these patients, 45 (26.9%) developed hearing impairment (IMRT alone vs concurrent chemoradiotherapy: 20 [23.3%] vs 25 [30.9%]), among which 36 (21.6%) had mild hearing impairment (IMRT alone vs concurrent chemoradiotherapy: 15 [17.4%] vs 21 [25.9%]).
“Radiotherapy alone provides comparable survival or disease control and less toxicity compared [with concurrent chemoradiotherapy] in low-risk nasopharyngeal carcinoma,” concluded the study authors.
Clinical Significance
“In this era of IMRT for low-risk nasopharyngeal cancer, IMRT alone is effective and safe,” said lead author Dr. Guo in a statement. “Patients in the IMRT-alone group had a significantly lower incidence of reported grade 3 or 4 adverse events compared to those who received concurrent chemoradiation. Additionally, patients in the IMRT-alone group reported significantly better quality-of-life scores during treatment.”
DISCLOSURE: Dr. Guo reported no conflicts of interest. For full disclosures of her coauthors, visit meetings.asco.org/2024-asco-breakthrough/16006?presentation=239473.
REFERENCES
1. Sung H, Ferlay J, Siegel RL, et al: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209-249, 2021.
2. Zhang R, He Y, Wei B, et al: Nasopharyngeal carcinoma burden and its attributable risk factors in China: Estimates and forecasts from 1990 to 2050. Int J Environ Res Public Health 20:2926, 2023.
3. Guo R, Zhang Y, Zhang N, et al: Radiotherapy alone vs radiotherapy with concurrent chemoradiotherapy in patients with low-risk nasopharyngeal carcinoma: Updated results from a multicenter, open-label, non-inferiority, randomized phase III trial. 2024 ASCO Breakthrough. Abstract 142. Presented August 8, 2024.
