Abstract：The treatment strategies and prognosis of previously untreated oligometastatic nasopharyngeal carcinoma (NPC) are extremely different due to the heterogeneity of this disease. More and more studies have found the survival advantages of oligometastatic NPC over NPC with multiple metastases. In addition to systemic chemotherapy, the primary tumor and metastatic lesions should be considered in the treatment of previously untreated oligometastatic NPC.Adding radical radiotherapy for primary tumor and aggressive managements for metastatic lesions to the systemic chemotherapy can substantially improve the survival of patients, even achieving a radical cure. Several molecular markers and prognostic models can screen out some patients who will benefit from aggressive treatment, but more studies are needed in the future.
Huang Shuang,Chen Xiaozhong. Progress in treatment of previously untreated oligometastatic nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2018, 27(1): 107-111.
[1] Melvin LK,Chua JT.Nasopharyngeal carcinoma[J].Lancet,2016,387:1012-1024.DOI:10.1016/S0140-6736(15)00055-0 [2] Lee AW,Ng WT,Chan LK,et al. The strength/weakness of the AJCC/UICC staging system (7th edition) for nasopharyngeal cancer and suggestions for future improvement[J].Oral Oncol,2012,48(10):1007-1013.DOI:10.1016/j.oraloncology.2012.03.022 [3] Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1):8-10 [4] Fong Y,Fortner J,Sun RL,et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer:analysis of 1001 consecutive cases[J].Ann Surg,1999,230(3):309-318,318-321 [5] Pastorino U,Buyse M,Friedel G,et al. Long-term results of lung metastasectomy:prognostic analyses based on 5206 cases[J].J Thorac Cardiovasc Surg,1997,113(1):37-49 [6] Pan C,Wu P,Yu J,et al. Comparative survival analysis in patients with pulmonary metastases from nasopharyngeal carcinoma treated with radiofrequency ablation[J].Euro J Radiol,2012,81(4):e473-e477 [7] 王春兰,苏胜发,欧阳伟炜,等.器官和病灶联合定义寡转移Ⅳ期NSCLC原发灶三维根治剂量放疗的意义——PPRA-RTOG 003再分析[J].中华放射肿瘤学杂志,2016,25(6):576-581.DOI:0.3760/cma.j.issn.1004.4221.2016.06.007.Wang CL,Su SF,Ouyang WW,et al. Significance of three-dimensional radical radiotherapy dose determined by organ-lesion combination for primary tumor of oligometastatic stage ⅠV NSCLC:a reanalysis of PPRA-RTOG 003[J].Chin J Radiat Oncol,2016,25(6):576-581.DOI:0.3760/cma.j.issn.1004.4221.2016.06.007 [8] Pan C,He N,Zhao M,et al. Subdividing the M1 stage of liver metastasis for nasopharyngeal carcinoma to better predict metastatic survival[J].Med Oncol,2011,28(4):1349-1355.DOI:10.1007/s12032-010-9643-8 [9] Lu X,Gu W,Zhang H,et al. Oligometastatic state predicts a favorable outcome for renal cell carcinoma patients with bone metastasis under the treatment of sunitinib[J].Oncotarget,2016,7(18):26879-26887.DOI:10.18632/oncotarget.8568 [10] Li W,Bai Y,Wu M,et al. Combined CT-guided radiofrequency ablation with systemic chemotherapy improves the survival for nasopharyngeal carcinoma with oligometastasis in liver:Propensity score matching analysis[J].Oncotarget, 2016 Jul 2;8(32):52132-52141.DOI:10.18632/oncotarget.10383 [11] Tosoian JJ,Gorin MA,Ross AE,et al. Oligometastatic prostate cancer:definitions,clinical outcomes,and treatment considerations[J].Nat Rev Urol, 2017 Jan;14(1):15-25.DOI:10.1038/nrurol.2016.175 [12] Tian YH,Zou WH,Xiao WW,et al. Oligometastases in AJCC stage IVc nasopharyngeal carcinoma:a subset with better overall survival[J].Head Neck,2016,38(8):1152-1157.DOI:10.1002/hed.24345 [13] 唐秋,胡巧英,朴永锋,等.不同方式治疗87例鼻咽癌放疗后肺寡转移患者的疗效分析[J].中华肿瘤杂志,2016,38(3):218-222.DOI:10.30.3760/cma.j.issn.0253-37662.016.03.011.Tang Q,Hu QK,Biao YF,et al. Analysis of the therapeutic effects of different treatmne t modalities no the outcomes of 87 patients with lung oligometastasis from nasopharyngeal carcinoma after radiotherapy[J].Cjin J Oncol,2016,38(3):218-222.DOI:10.30.3760/cma.j.issn.0253-37662.016.03.011 [14] 蓝玉宏,田允铭,白力,等.初治转移鼻咽癌疗后预后评分模型建立及分层治疗研究[J].中华放射肿瘤学杂志,2015(4):421-426.DOI:10.3760/cma.j.issn.1004-4221.2015.04.017.Lan YH,Tian YM,Bai L,et al. Post-treatment prognostic score model establishment and stratified therapy for newly diagnosed metastatic nasopharyngeal carcinoma[J].Chin J Radit Oncol,2015(4):421-426.DOI:10.3760/cma.j.issn.1004-4221.2015.04.017 [15] 郭晔.转移性鼻咽癌的系统性治疗[J].中国癌症杂志,2011,12(12):927-931.DOI:10 3969/j.issn.1007-3969.2011.12. 005.Guo Y. Systemic treatment in metastatic nasopharyngeaI carcinoma[J].Cancer Oncol,2011,12(12):927-931. DOI:10 3969/j.issn.1007-3969.2011.12.005 [16] Sun Y,Li W,Chen N,et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomised controlled trial[J].Lancet Oncol,2016,17(11):1509-1520.DOI:10.1016/S1470-2045(16)30410-7 [17] Zhang L,Huang Y,Hong S,et al. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre, randomised, open-label, phase3trial[J].Lancet,2016,388(10054):1883-1892.DOI:10.1016/S0140-6736(16)31388-5 [18] Hui EP,Ma BB,Leung SF,et al. Randomized phase Ⅱ trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma[J].J Clin Oncol,2009,27(2):242-249.DOI:10.1200/JCO.2008.18.1545 [19] 田允铭,韩非,曾雷,等.寡转移状态下初治鼻咽癌的预后及治疗模式探讨[J].中华放射肿瘤学杂志,2016,25(11):1156-1160.DOI:10.3760/cma.j.issn.1004.4221.2016.11.003.Tian YM,Han F,Zeng L,et al. Prognosis and treatment of newly diagnosed nasopharyngeal carcinoma with oligometastases[J].Chin J Radiat Oncol,2016,25(11):1156-1160. DOI:10.3760/cma.j.issn.1004.4221.2016.11.003 [20] Lin S,Tham IW,Pan J,et al. Combined high-dose radiation therapy and systemic chemotherapy improves survival in patients with newly diagnosed metastatic nasopharyngeal cancer[J].Am J Clin Oncol,2012,35(5):474.DOI:10.1097/COC.0b013e31821a9452[21] Yeh SA.Treatment outcomes of patients with AJCC stage ⅠVc nsopharyngeal carcinoma:benefits of primary radiotherapy[J].Japanese J Clin Oncol,2006,36(3):132-136.DOI:10.1093/jjco/hyi245 [22] Chen M,Jiang R,Guo L,et al. Locoregional radiotherapy in patients with distant metastases of nasopharyngeal carcinoma at diagnosis[J].Chin J Cancer,2013,32(11):604-613.DOI:10.5732/cjc.013.10148 [23] Nanji S,Cleary S,Ryan P,et al. Up-front hepatic resection for metastatic colorectal cancer results in favorable long-term survival[J].Ann Surg Oncol,2013,20(1):295-304.DOI:10.1245/s10434-012-2424-1 [24] Pan C,Wu P,Yu J,et al. CT-guided radiofrequency ablation prolonged metastatic survival in patients with liver metastases from nasopharyngeal carcinoma[J].Int J Hyperthermia,2011,27(6):549-554.DOI:10.3109/02656736.2011.593019 [25] Amalia P,Sonia G.Oligometastatic disease,the curative challenge in radiation oncology[J].World J Clin Oncol,2015(4):30-34.DOI:10.5306/wjco.v6.i4.30 [26] Lu T,Guo Q,Cui X,et al. Prognostic Evaluation of Nasopharyngeal Carcinoma with Bone-Only Metastasis after Therapy[J].Yonsei Med J,2016,57(4):840-845.DOI:10.3349/ymj.2016.57.4.840[27] Jin Y,Cai Y,Cao Y,et al. Radiofrequency ablation combined with systemic chemotherapy in nasopharyngeal carcinoma liver metastases improves response to treatment and survival outcomes[J].J Surg Oncol,2012,106(3):322-326.DOI:10.1002/jso.23034 [28] Lussier YA,Khodarev NN,Regan K,et al. Oligo-and polymetastatic progression in lung metastasis (es) patients is associated with specific microRNAs[J/OL].PLoS One,2012,7(12):e50141.DOI:10.1371/journal.pone.0050141 [29] Lussier YA,Xing HR,Salama JK,et al. MicroRNA expression characterizes oligometastasis (es)[J/OL].PLoS One,2011,6(12):e28650.DOI:10.1371/journal.pone.0028650 [30] Gardiner E,Beveridge NJ,Wu JQ,et al. Imprinted DLK1-DIO3 region of 14q32 defines a schizophrenia-associated miRNA signature in peripheral blood mononuclear cells[J].Mol Psychiatry,2012,17(8):827-840.DOI:10.1038/mp.2011.78 [31] Khodarev NN,Pitroda SP,Weichselbaum RR.microRNAs and oligometastasis[J].Aging (AlbanyNY),2015,7(3):146-147.DOI:10.18632/aging.100731 [32] Lin J,Wang W,Chen KY,et al. Quantification of Plasma Epstein-Barr Virus DNA in patients with advanced nasopharyngeal carcinoma[J].2004,350(24):2461-2470.DOI:10.1056/NEJMoa032260[33] An X,Wang F,Ding P,et al. Plasma Epstein-Barr virus DNA level strongly predicts survival in metastatic/recurrent nasopharyngeal carcinoma treated with palliative chemotherapy[J].Cancer,2011,117(16):3750-3757.DOI:10.1002/cncr.25932 [34] Wang WY,Twu CW,Chen HH,et al. Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma[J].Clin Cancer Res,2010,16(3):1016-1024.DOI:10.1158/1078-0432.CCR-09-2796[35] Hsu CL.Plasma epstein-barr virus DNA concentration and clearance rate as novel prognostic factors for metastatic nasopharyngeal carcinoma[J].Head Neck,2012(34):1064-1070.DOI:10.1002/hed.21890 [36] He S,Wang Y,Peng H,et al. Pretreatment alkaline phosphatase and Epstein-Barr virus DNA predict poor prognosis and response to salvage radiotherapy in patients with nasopharyngeal carcinoma and metachronous Bone-Only metastasis[J].J Cancer,2017,8(3):417-424.DOI:10.7150/jca.17310 [37] Chan SH,Cheung FM,Ng WT,et al. Can the analysis of ERCC1 expression contribute to individualized therapy in nasopharyngeal carcinoma?[J].2011,79(5),1414-1420.DOI:10.1016/j.ijrobp.2009.12.072 [38] Liaw CC,Wang CH,Huang JS,et al. Serum lactate dehydrogenase level in patients with nasopharyngeal carcinoma[J].Acta Oncologica,1997,36(2):159-164 [39] Jin Y,Cai XY,Cai YC,et al. To build a prognostic score model containing indispensible tumour markers for metastatic nasopharyngeal carcinoma in an epidemic area[J].2012,48(6),882-888.DOI:10.1016/j.ejca.2011.09.004
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