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Nasopharyngeal cancers (NPC), rare outside endemic regions, are associated with excellent survival outcomes in the curative-intent setting. Despite introducing intensity modulated radiotherapy (IMRT), toxicity remains of concern.

Contemporary data detailing toxicity, including patient reported outcomes (PROs), following radical treatment for NPC is limited; we present the largest UK multicentre study of toxicity outcomes and late PROs following NPC reported to date.

Adult patients completing radical (chemo)radiotherapy for NPC between February 2016 and February 2020 at seven large UK cancer centres were identified on institutional databases. Patients were excluded if they had prior head and neck cancer, prior therapeutic head and neck surgery (other than neck dissection), current other active cancer(s), or were treated for a non-primary-NPC.

Demographic, treatment, acute toxicity and outcome data were collected retrospectively from patient records. Alive, disease-free patients completed patient reported outcome (PROs) questionnaires, including an M.D. Anderson Dysphagia Index (MDADI) and University of Washington (UoW) Quality of Life (QoL). 

A total of 180 patients fulfilled eligibility criteria; 68% were male, median age 54 years, 11% of patients were aged ≥ 70 years. EBV status was positive in 61% (unavailable in 12%). Patients had stage I (5%), II (22%), III (37%), and IV (36%) disease. 95% had a performance status between 0-1.

98% patients received either 70Gy in 33-35# or 65-66Gy in 33-35#. 66% received induction (chemo)radiotherapy (median 2, range 0-6 cycles), and 66% received concurrent chemotherapy (median 2 cycles, range 0-4).

At completion of treatment 9.5% had residual disease. At a median follow-up of 32.1 months (range 0-68), 6.1% of patients required persistent tube feeding, 79% patients were alive and 16% had died (of which 70% had known active disease). Locoregional and distant recurrence was noted in 5% and 12% respectively.

Patients lost an average of 7.1kg during therapy; 63% required enteral support. In those whose feeding tube was removed the median duration of use was 83 days. 18% experienced CTCAE grade 3 dermatitis, and 53% grade 3 mucositis. 82% received opioids and 40% were admitted during treatment.

90 patients completed the PROs (76% response rate) at a median of 37.8 months post treatment. Table 1 summarises the PRO results, demonstrating significant and persistent QoL issues. MDADI identified significant toxicity across all domains including 28% significant pain (24% require regular analgesia), and 59% significantly affecting daily activity.

This study demonstrates the significant acute and late toxicity following radical treatment of NPC, which can profoundly negatively impact patients’ quality of life. Excellent cancer survival outcomes, in line with published data, highlight the importance of toxicity reduction and support the evaluation of potential toxicity sparing technologies, such as proton beam radiotherapy.