Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Nov 15;39(1):75.
doi: 10.1186/s40880-019-0415-3.

Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma

You-Ping Liu  1   2 , Xing Lv  1   2 , Xiong Zou  1   2 , Yi-Jun Hua  1   2 , Rui You  1   2 , Qi Yang  1   2 , Le Xia  1   2 , Shao-Yan Guo  1   2 , Wen Hu  1   2 , Meng-Xia Zhang  1   2 , Si-Yuan Chen  1   2 , Mei Lin  1   2 , Yu-Long Xie  1   2 , Li-Zhi Liu  2   3 , Rui Sun  1   2 , Pei-Yu Huang  1   2 , Wei Fan  2   4 , Xiang Guo  1   2 , Ming-Huang Hong  2   5 , Ming-Yuan Chen  6   7
Affiliations
Comparative Study

Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma

You-Ping Liu et al. Cancer Commun (Lond). .

Abstract

Background: The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients. Endoscopic nasopharyngectomy (ENPG) was successfully applied in recurrent NPC with radiation free and relatively low medical costs. In this study, we examined whether ENPG could be an effective treatment for localized stage I NPC.

Methods: Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. Simultaneously, the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort. The survival outcomes, quality of life (QOL), and medical costs between two groups were compared.

Results: After a median follow-up of 59.0 months (95% CI 53.4-64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 patients treated with ENPG. The 5-year overall survival, local relapse-free survival, regional relapse-free survival, and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P > 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs ($ 4090.42 ± 1502.65 vs. $ 12620.88 ± 4242.65, P < 0.001) and improved QOL scores including dry mouth (3.3 ± 10.5 vs. 34.4 ± 25.8, P < 0.001) and sticky saliva (3.3 ± 10.5 vs. 32.6 ± 23.3, P < 0.001).

Conclusions: ENPG alone was associated with promising long-term survival outcomes, low medical costs, and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy. However, the application of ENPG should be prudent, and prospective clinical trials were needed to further verify the results.

Keywords: Early stage; Endoscopic nasopharyngectomy; Intensity-modulated radiotherapy; Localized; Medical cost; Nasopharyngeal carcinoma; Quality of life; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Work flow diagram. NPC nasopharyngeal carcinoma, 2DRT two-dimensional radiotherapy, 3DRT three-dimensional radiotherapy, RPLN retropharyngeal lymph node, CLN cervical lymph node, PET/CT 18F-fluorodeoxyglucose positron emission tomography and computed tomography, ENPG endoscopic nasopharyngectomy, IMRT intensity-modulated radiotherapy
Fig. 2
Fig. 2
Magenetic resonance and endoscopic images contrast before and after surgery. a–c shown the tumor invasion regions (red line) and surgical margin (yellow line) in preoperative T1-weighted MR images in horizontal, coronal and sagittal view, respectively. The tumor invasion regions were located in the right superior wall of the nasopharynx and the planed surgical margin which was made by our NPC experts team before surgery covered most of the superior wall and part of the posterior wall of the nasopharynx. d was the preoperative endoscopic nasopharyngeal image and shown that nodular masses were found in the right superior wall of the nasopharynx, not involving the bilateral pharyngeal recesses and eustachian tubes. e–g shown the resection regions in T1-weighted MR images in horizontal, coronal and sagittal view, respectively, at 3 days after surgery. The surgical defect was highly similar to the planned surgical margin (yellow line). h shown the endoscopic nasopharynx images during operation, which was marking the resection boundary according to the planed surgical margin delinerated before surgery. i–k shown no abnormal neoplasm was observed in nasopharynx in T1-weighted MR images in horizontal, coronal and sagittal view, respectively, at 10 years after surgery. l shown the synchronous endoscopic nasopharyngeal image and shown the nasopharyngeal defect was re-epithelized and no abnormal neoplasm was observed
Fig. 3
Fig. 3
Kaplan–Meier curves of overall survival (a), local relapse-free survival (b), regional relapse-free survival (c) and distant metastasis-free survival (d) for stage I NPC patients with ENPG and IMRT. ENPG endoscopic nasopharyngectomy, IMRT intensity modulated radiation therapy
See this image and copyright information in PMC

Comment in

References

    1. Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma. Semin Cancer Biol. 2002;12(6):421–429. doi: 10.1016/S1044579X02000858. - DOI - PubMed
    1. Wei KR, Zheng RS, Zhang SW, Liang ZH, Li ZM, Chen WQ. Nasopharyngeal carcinoma incidence and mortality in China, 2013. Chin J Cancer. 2017;36(1):90. doi: 10.1186/s40880-017-0257-9. - DOI - PMC - PubMed
    1. Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond). 2019;39(1):22. doi: 10.1186/s40880-019-0368-6. - DOI - PMC - PubMed
    1. Zhang MX, Li J, Shen GP, Zou X, Xu JJ, Jiang R, et al. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: a 10-year experience with a large cohort and long follow-up. Eur J Cancer. 2015;51(17):2587–2595. doi: 10.1016/j.ejca.2015.08.006. - DOI - PubMed
    1. Su SF, Han F, Zhao C, Chen CY, Xiao WW, Li JX, et al. Long-term outcomes of early-stage nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy alone. Int J Radiat Oncol Biol Phys. 2012;82(1):327–333. doi: 10.1016/j.ijrobp.2010.09.011. - DOI - PubMed

Publication types

MeSH terms