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Risk stratification and boost dose optimization for locoregionally advanced nasopharyngeal carcinoma with residual
Xinyi Hong1, Yi Li1,2, Chaoying Lin1
1Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
Background:
Residual locoregionally advanced nasopharyngeal carcinoma (LA-NPC) after definitive chemoradiation leads to poor outcomes, but current treatments lack standardized, evidence-based guidance for individualized dose escalation, causing varied practices.
Objective:
To develop a risk-stratification model to personalize boost doses for these patients.
Design:
A retrospective study.
Methods:
In this retrospective study, 364 LA-NPC patients with post-radiotherapy (post-RT) residual disease were enrolled. Patients were stratified into high-dose (≥600 cGy, n=201) and low-dose (<600 cGy, n=163) boost groups. Independent prognostic factors were identified via Cox regression. A risk stratification model was constructed using these factors, and its utility in guiding boost dose selection was evaluated.
Results:
Multivariate analysis confirmed that clinical stage (HR=2.012, 95% CI: 1.100-3.682, p=0.023) and detectable post-RT EBV DNA (HR=1.997, 95% CI: 1.129-3.535, p=0.018) were independent prognostic factors for LA-NPC patients with residual disease after definitive chemoradiotherapy. Based on these variables, a three-tiered risk model was established: low-risk (Stage III with undetectable post-RT EBV DNA), middle-risk (Stage III with detectable post-RT EBV DNA or Stage IVA with undetectable post-RT EBV DNA), and high-risk (Stage IVA with detectable post-RT EBV DNA). This model effectively stratified patients for overall survival (OS) (P<0.05). Crucially, a high-dose boost (≥600 cGy) was associated with improved OS in the high-risk group (HR=0.344, 95% CI: 0.122-0.967, P=0.043), whereas no survival advantage was identified in the low- or middle-risk groups. Among high-risk patients, no statistically significant differences in acute or late toxicities were observed between the high-dose and low-dose boost groups.
Conclusion:
We developed a clinically applicable risk stratification model integrating clinical stage and post-RT EBV DNA status. Our findings suggest that only high-risk patients may derive an OS benefit from a boost dose of ≥600 cGy, whereas low- and middle-risk patients do not appear to benefit from further dose escalation. This risk-adapted boost strategy provides a preliminary framework requiring prospective validation. Given the retrospective single-center design of this study, prospective multicenter studies are warranted before routine clinical implementation.