Overall survival in patients with resectable, locally recurrent nasopharyngeal cancer (NPC) was found to be improved with the use of salvage endoscopic surgery compared with intensity-modulated radiotherapy (IMRT), according to the results of a phase-3 study published in Lancet Oncology.
“On the basis of our findings, we recommend endoscopic surgery as primary treatment for patients with resectable locally recurrent nasopharyngeal carcinoma,” the study researchers wrote, noting that long-term follow-up is needed for this strategy.
The study included 200 patients who were randomly assigned to either endoscopic nasopharyngectomy or IMRT. The primary endpoint was overall survival.
With a median follow-up of 56.0 months, 29% of patients assigned to undergo endoscopic nasopharyngectomy and 45% of patients assigned to IMRT had died.
Overall survival was found to be significantly better for the surgical group (hazard ratio. 0.47; 95% CI, 0.29-0.76; P =.0015). The 3-year overall survival was 85.8% for endoscopic nasopharyngectomy compared with 68.0% for IMRT.
Patients assigned to undergo endoscopic nasopharyngectomy also had improved 3-year disease-free survival and locoregional recurrence-free survival compared with those receiving IMRT; however, there was no difference in 3-year distant metastasis-free survival between the 2 study arms.
The most common grade 3 adverse event was pharyngeal mucositis, which occurred in 5% of patients assigned to undergo endoscopic nasopharyngectomy and 26% of patients receiving IMRT. The incidence of late adverse events of grade 3 or worse related to radiotherapy were also worse in the IMRT group compared with the surgical group (37% vs 13%).
The researchers wrote that these data should be considered “when making decisions about which treatment to choose for patients with resectable locally recurrent NPC.”
Liu Y-P, Tang J, Wei Y, et al. Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomized, controlled phase 3 trial. Lancet Oncol. 2021;22:381-390. doi:10.1016/S1470-2045(20)30673-2