Outcomes of Patients With Nasopharyngeal Carcinoma Treated With Chemoradio Therapy a Single - Institution Experience

Abstract

Background Nasopharyngeal carcinoma is the most prevalent head and neck malignancy in Kenya and contributes to significant morbidity and mortality. Most patients present with advanced disease because there is no effective screening method. The main treatment modalities include radiation and chemotherapy administered sequentially, concurrently, and adjuvantly. Re-irradiation and salvage surgery are used in cases of residual or recurrent disease. There are no studies performed in Kenya to evaluate outcomes for nasopharyngeal carcinoma. This study aimed to evaluate the outcomes and prognostic factors for patients with nasopharyngeal carcinoma managed at Kenyatta National Hospital and compare this to studies done in NPC endemic regions. Broad Objective: The purpose of this study was to determine the outcomes of nasopharyngeal carcinoma for patients managed with chemoradiotherapy at Kenyatta National Hospital. Methodology: This was a retrospective cross-sectional study which evaluated patients with stages II to IVA nasopharyngeal carcinoma managed at the KNH cancer treatment center between 1st January 2015 and 30th December 2019. From 318 total patients treated during this period, a total of 173 were selected using simple random sampling. 143 patients met the inclusion criteria, of which 91 were male and 50 were female. Details of patient demographics, nutritional status, disease histopathology, tumor stage, treatment details, and follow-up data were then entered into customized data abstraction charts. Data was analyzed using SPSS version 23 and a p-value of < 0.05 was considered significant. Results: The most commonly affected age group for NPC was between 30-39years, followed closely by 18-29 years with a median age of 47years. The majority of the patients presented with advanced disease, with stage III and IVA accounting for 48% and 35% of cases, respectively. The 2-year overall survival, LRFFS and DMFS were 36%, 84% and 86% respectively. 2D-EBRT was associated with more locoregional recurrences compared to 3D-CRT but there was no difference in the rate of distant metastasis between the two modalities. Age was the only significant prognostic factor for overall survival. Common treatment toxicities included odynophagia, mucositis and xerostomia. 11 Conclusion: The 2-year OS outcomes in this study were inferior to studies in endemic regions. This may be due to late disease presentation, delay in starting treatment, more use of 2D-EBRT, which limits the dose of radiation safely delivered, and fewer cycles of concurrent chemotherapy. Recommendations: There is need to formulate policies for cancer screening and early diagnosis. Patients should be managed with conformal radiotherapy techniques such as IMRT and measures should be taken to ensure the recommended doses and schedules of chemoradiotherapy are delivered