Efficacy of radiotherapy to local recurrence and distant metastasis nasopharyngeal carcinoma: long-term retrospective multicenter study

Purpose The patients with locoregional recurrence and distant failure after initial treatment was a unique group of nasopharyngeal carcinoma(NPC). This patients population presented unique challenges in management: when and in what sequence to add radiotherapy(RT) to address locoregional and distant disease. Methods This retrospective multicenter investigation enrolled local recurrence and distant metastasis (rmNPC) from five hospitals. Kaplan-Meier and log-rank tests were utilized for survival assessment of patients with distinct profiles of recurrence and metastasis, as well as diverse treatment modalities. Additionally, we employed the Cox regression model to investigate the stand-alone risk factors influencing the survival of patients with local recurrence and distant metastasis (rmNPC). Results 52 patients were enrolled in the study, the median follow up time was 68.3 months (range: 7-240 months). The median overall survival (OS) time was 23.4 months (range: 11.1–35.6 months), with 1, 2, 3, 4 and 5 years OS rates of 61.3%, 46.5%, 31.0%, 27.9%, 10.5% respectively. OS had no statistical difference in treatment modalities( p  = 0.071), the median OS was 10.8 months (95% CI, 7.7 to 13.9) for chemotherapy alone, 24.2 months (95% CI, 8.9 to 39.4) for chemotherapy combined with PD-1 inhibitors, and 47.1 months (95% CI, 10.2 to 84.0) for chemotherapy combined with radiotherapy. Among patients with oligometastasis, those who received radiotherapy exhibited a prolonged OS (50.1 vs. 24.1 months, p  = 0.021), whereas patients with polymetastasis who received radiotherapy failed to experience a substantial extension in OS (8.6 vs. 14.8 months, p  = 0.168). Similarly, among patients with one-organ metastasis, radiotherapy was intricately linked to extended OS(50.1 vs. 24.1 months, p  = 0.026), while patients with multiple organ metastases did not demonstrate a substantial OS benefit from radiotherapy (8.6 vs. 11.0 months, p  = 0.831). Conclusions The combines radiotherapy shows the promising efficacy for rmNPC patients with one-organ metastasis or oligometastasis.