296P - Nasopharyngeal carcinoma: A retrospective review of outcome in a single institution

Background

Nasopharyngeal carcinoma (NPC) is the 5^th commonest cancer in Malaysia. The distinctive ethnic and geographic distribution of NPC worldwide suggests both environmental and genetic factors contribute to its development. The Malaysian National Cancer Institute is a tertiary public hospital established 5 years ago. This study aims to analyze our institution’s experience in patients with localized NPC, responses to different treatment modalities and outcomes.

Methods

All newly diagnosed histologically confirmed (WHO classification) NPC patients of Stage I – IVB from Sept 2013 - April 2018 were identified from internal database. Demographic data e.g. age, gender, race and stage were extracted and entered into a pre-designed case report form. Staging was based on AJCC Staging 7th Edition. These patients received radiotherapy (RT) of 70Gy/35F/7weeks, either with IMRT or 3D conformal technique, with or without weekly concurrent chemotherapy (CRT). Some had induction chemotherapy prior to RT. Date of local recurrence and distant metastases were acquired. Data were analyzed using ‘R’ version 3.5.3.

Results

289 patients were identified. Median age at presentation was 53 with majority (66.1%) being males.The Chinese had highest prevalence (57%) followed by Malays (34.7%). Stage III & IV presentation accounted for 37% & 39% respectively. 277(95.8%) received IMRT and 12 had 3D conformal RT. WHO type 3 was the commonest histological subtype (87.2%). Median follow up was 31.7 months. The 3 year Overall Survival (OS) was 75.5% (95% CL 69.6;80.3)whereas 3 year progression free survival ( PFS) was 64.5% (95% CL 58.1;70.1). On follow up, 33 patients had distant metastasis & 15 had local recurrence; 9 patients had both local & distant failure. Stage 4 presentation had highest local – regional failure (53.3%) and distant failure (72.7%). 179 (46%) had neoadjuvant chemotherapy but it did not confer better OS and PFS, possibly due to high number of locally advanced patients in our cohort. Those received CRT had better 3 year – OS (77.8%)and PFS(66.7%).

Conclusions

Advanced T & N stage were adverse prognostic factors for PFS and OS. Distant metastasis was the commonest failure site. CRT improves PFS and OS. A longer follow up is required as median OS & PFS have not been reached in our cohort.

Clinical trial identification

Editorial acknowledgement

I would like to gratefully thanks Dr Wong Yoke Fui and Ms Ng Wei Ling in facilitating with Data Collection Secondly i would like to express my deepest gratitude to My Supervisor Dr Junie Khoo Yu Yen for her extraordinary supports and guidance in the whole process of preparing and writing up for the study. Last but not least i would like to my husband and family for the continuous support and encouragement.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.