Metastasis-directed therapy in addition to definitive locoregional radiotherapy for De novo metastatic nasopharyngeal carcinoma: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background De novo metastatic nasopharyngeal carcinoma (mNPC) carries a poor prognosis with systemic therapy alone. Locoregional radiotherapy (LRRT) improves survival in chemotherapy-responsive patients, but the incremental role of metastasis-directed therapy (MDT) remains undefined. Methods This retrospective cohort included 54 patients with de novo mNPC treated between 2013 and 2024 at a tertiary cancer centre. All received platinum-based induction chemotherapy followed by definitive LRRT; selected patients underwent MDT to metastatic sites. Overall survival (OS), recurrence-free survival (RFS) and distant recurrence-free survival (DRFS) were estimated by Kaplan–Meier methods, with Cox regression for univariable and multivariable analysis. Results At a median follow-up of 27 months, 2-year OS, RFS and DRFS were 67.5%, 45.4% and 52.7%. MDT was associated with improved 2-year OS (92.3% vs 55.2%; p = 0.0069), RFS (81.9% vs 28.2%; p < 0.001) and DRFS (93.8% vs 35.0%; p < 0.001). On multivariable analysis MDT remained associated with improved RFS (HR 0.27, 95% CI 0.08–0.98; p = 0.047), with consistent estimates in a 2-month landmark analysis (HR 0.26, 95% CI 0.075–0.90) and with MDT modelled as a time-varying covariate (HR 0.17, 95% CI 0.040–0.76); the association with OS was not statistically significant (HR 0.25, 95% CI 0.06–1.13; p = 0.072). Oligometastatic disease was more frequent among patients receiving MDT (88% vs 41%). The association was most evident in the oligometastatic subgroup. In exploratory analyses, detectable post-treatment plasma EBV DNA and elevated post-LRRT PET SUV were associated with inferior survival. Conclusion In chemotherapy-responsive de novo mNPC treated with definitive LRRT, consolidative MDT was associated with improved disease control in multivariable, landmark and time-varying analyses, with a directionally consistent but non-significant association with OS. As residual confounding cannot be excluded, these findings support prospective evaluation in selected patients.
Authors: Sarbani Ghosh Laskar, Anuj Kumar, Rahat Malhotra, Shwetabh Sinha, Samarpita Mohanty, Kumar Prabhash, Amit Joshi, Nandini Menon, Omshree Shetty, Anuradha Chougule, Ashwini Budrukkar, Monali Swain, Vanita Noronha, Minit Shah, Aditya Dhanawat, Gouri Pantvaidya, Deepa Nair, Shivakumar Thiagarajan, Chandrashekhar Dravid, Vidisha Tuljapurkar, Anuja Deshmukh, Rishi Mittal, Richa Vaish, Rukmini Prabhu, Arjun Singh, Sudhir Nair, Poonam Joshi, Rathan Shetty, Pankaj Chaturvedi
Institutions: Homi Bhabha National Institute, Tata Memorial Hospital
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,430
OpenAlex ID: W7224158335