Main Session
Sep 29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care

3545 - Risk-Adapted Strategy for N3 Nasopharyngeal Carcinoma: Impact of Induction Chemotherapy Response and the Role of Upfront Neck Dissection for Poor Responders

03:45pm - 05:00pm ET
Poster Hall - Exhibit Hall A
Screen: 8
POSTER

Presenter(s)

Yi Chun Liu, MD - Taichung Veterans General Hospital, Taichung, Taiwan

Y. C. Liu1,2, K. L. Liang3,4, and J. C. Lin5,6; 1Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, 2Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, 3Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan, 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, 5Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taichung, Taiwan, 6Department of Radiation Oncology, Changhua Christian Hospital,, Changhua City, Taiwan

Purpose/Objective(s):

To evaluate the prognostic significance of induction chemotherapy (IC) response in patients with N3 nasopharyngeal carcinoma (NPC) and to investigate the efficacy of a risk-adapted strategy utilizing upfront neck dissection for poor responders.

Materials/Methods:

We retrospectively reviewed 213 patients with cT1-4N3M0 NPC treated with IC and subsequent curative radiotherapy (RT). Patients were stratified by nodal response: poor responders (<30% reduction in lymph node short-axis) and good responders (=30% reduction). For poor responders, a risk-adapted approach was employed, consisting of upfront neck dissection before definitive RT.

Results:

Among the 213 patients with cT1-4N3M0 NPC, the median follow-up time was 55.6 months. Patients with a good nodal response to IC demonstrated significantly superior 5-year relapse free survival (RFS) compared to poor responders (78.1% vs. 19.9%, p < 0.001). Significant differences were also observed in 5-year locoregional recurrence-free survival (LRRFS) (89.2% vs. 36.9%), 5-year distant metastasis-free survival (DMFS) (82.4% vs. 41.9%), and 5-year overall survival (OS) (82.6% vs. 42.3%) (all p < 0.001). Notably, in the risk-adapted subgroup where poor responders received upfront neck dissection (n=7), showed encouraging outcomes, with a 2-year RFS of 100% compared to 38.9% in those who did not receive surgery.

Conclusion:

Nodal response to IC is a potent predictor of relapse-free survival in N3 NPC. Our preliminary experience suggests that a risk-adapted strategy, incorporating upfront neck dissection for poor responders, may help narrow the survival gap between good and poor responders. While these findings are promising, further prospective studies with larger cohorts are warranted to define the definitive role of surgical intervention in this high-risk population.