Non-endemic nasopharyngeal cancer showed similar locoregional and distant failure rates

KEY POINTS

• The Young DEGRO MERLIN study retrospectively included 299 patients from nine German centers treated with definitive radiotherapy or chemoradiotherapy between 2004 and 2023. Median age was 57 years, 80% had stage III–IV disease, and 71% of tested tumors were EBV-positive.
• Treatment largely reflected curative multimodality practice: 92% received concurrent systemic therapy, 16% induction therapy and 5% adjuvant therapy. Median radiotherapy dose was 70 Gy; 91% received photons alone, 7% protons and 2% a photon–proton combination.
• At median follow-up of 62 months, five-year overall survival was 71% (95% CI 66–77%) and disease-free survival 61% (95% CI 55–67%). There were 93 deaths, 40 local failures, 19 regional failures and 41 distant failures.
• Five-year cumulative incidence was 18% for locoregional failure and 14% for distant failure, suggesting that locoregional and metastatic relapse remain similarly important in this non-endemic population rather than distant failure overwhelmingly dominating.
• Failure timing was highly concentrated early after treatment: 30/40 local, 15/19 regional and 38/41 distant failures occurred within three years. Bone was the most frequent first distant site (44%), followed by lung (39%), liver and distant lymph nodes (27% each).
• Local recurrence had a longer tail than metastatic relapse: approximately one quarter of local failures occurred beyond three years, supporting continued head-and-neck surveillance even after the period of highest overall recurrence risk.
• On multivariable analysis, stage IV disease independently predicted worse disease-free survival (HR 2.18, 95% CI 1.42–3.35) and overall survival (HR 2.14, 95% CI 1.31–3.50). KPS ≤80% and increasing age were also independently adverse, whereas EBV status did not retain independent significance.

CLINICAL TAKEAWAY

SOURCE

Strahlentherapie und Onkologie