The Comparison Of Radiotherapy Alone Verse Combined Chemoradiotherapy In Patients With Stage Ⅱ Nasopharyngeal Carcinoma In The Intensity-modulated Radiotherapy Era

Background: The use of chemotherapy (CT) in the treatment of stage II nasopharyngeal carcinoma (NPC) is controversial. And the reports especially about intensity-modulated radiotherapy (IMRT) have been limited. The purpose of this study is to evaluate the long-term survival outcomes for stage II NPC treated with radiotherapy alone verse combined chemoradiotherapyin the era of IMRT.Methods:We reviewed records between January 2002 and December 2013 and identified 182 patients who were histologically diagnosed as stage II NPC received RT with or without CT in Shandong Tumor Hospital. Among these patients,52 were restaged T2N0M0 and the other 130 were restaged T1-2N1M0. One hundred and fifty-nine (38 in T2N0M0 and 121 in T1-2N1M0) received RT with CT (RT/CT) and 23 (14 in T2N0M0 and 9 in T1-2N1M0) underwent RT alone. The overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFF), and disease metastasis-free survival (DMF) were calculated with Kaplan-Meier method.Results: With a median follow-up of 63.6 months (range 9.4 to 145.7), the 3-year, 5-year and 10-year OS of all stage II patients were 93.2%,87.5% and 65.4%. No significant difference in OS, PFS, LRFF and DMF were observed between RT/CT group and RT alone group (p= 0.217,0.768,0.340 and 0.415, respectively). All locoregional recurrence occurred in the first 3 years and all distant metastases were developed in patients staged T1-2N1M0, referring more aggressive therapy such as chemotherapy may be indicated for these patients.Conclusions: This is the largest cohort of patients with stage Ⅱ NPC in the era of IMRT with long follow-up. Chemotherapy showed no additional benefit for patients with stage Ⅱ NPC. For those staged T1-2N1M0 who had a higher risk for distant metastasis, additional chemotherapy may be perferred.