Metastasis-directed therapy in addition to definitive locoregional radiotherapy for De novo metastatic nasopharyngeal carcinoma: a retrospective cohort study.
4 affiliations
- 1Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
- 2Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
- 3Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
- 4Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Abstract
De novo metastatic nasopharyngeal carcinoma (mNPC) carries a poor prognosis with systemic therapy alone. Locoregional radiotherapy (LRRT) improves survival in chemotherapy-responsive patients, but the incremental role of metastasis-directed therapy (MDT) remains undefined. This retrospective cohort included 54 patients with de novo mNPC treated between 2013 and 2024 at a tertiary cancer centre. All received platinum-based induction chemotherapy followed by definitive LRRT; selected patients underwent MDT to metastatic sites. Overall survival (OS), recurrence-free survival (RFS) and distant recurrence-free survival (DRFS) were estimated by Kaplan-Meier methods, with Cox regression for univariable and multivariable analysis. At a median follow-up of 27 months, 2-year OS, RFS and DRFS were 67.5%, 45.4% and 52.7%. MDT was associated with improved 2-year OS (92.3% vs 55.2%; p = 0.0069), RFS (81.9% vs 28.2%; p < 0.001) and DRFS (93.8% vs 35.0%; p < 0.001). On multivariable analysis MDT remained associated with improved RFS (HR 0.27, 95% CI 0.08-0.98; p = 0.047), with consistent estimates in a 2-month landmark analysis (HR 0.26, 95% CI 0.075-0.90) and with MDT modelled as a time-varying covariate (HR 0.17, 95% CI 0.040-0.76); the association with OS was not statistically significant (HR 0.25, 95% CI 0.06-1.13; p = 0.072). Oligometastatic disease was more frequent among patients receiving MDT (88% vs 41%). The association was most evident in the oligometastatic subgroup. In exploratory analyses, detectable post-treatment plasma EBV DNA and elevated post-LRRT PET SUV were associated with inferior survival. In chemotherapy-responsive de novo mNPC treated with definitive LRRT, consolidative MDT was associated with improved disease control in multivariable, landmark and time-varying analyses, with a directionally consistent but non-significant association with OS. As residual confounding cannot be excluded, these findings support prospective evaluation in selected patients.
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BibTeX
@article{laskar2026metastasisdirected,
title = {{Metastasis-directed therapy in addition to definitive locoregional radiotherapy for De novo metastatic nasopharyngeal carcinoma: a retrospective cohort study.}},
author = {Sarbani Ghosh Laskar and Anuj Kumar and Rahat Malhotra and Shwetabh Sinha and Samarpita Mohanty and Kumar Prabhash and Amit Joshi and Nandini Menon and Omshree Shetty and Anuradha Chougule and Ashwini Budrukkar and Monali Swain and Vanita Noronha and Minit Shah and Aditya Dhanawat and Gouri Pantvaidya and Deepa Nair and Shivakumar Thiagarajan and Chandrashekhar Dravid and Vidisha Tuljapurkar and Anuja Deshmukh and Rishi Mittal and Richa Vaish and Rukmini Prabhu and Arjun Singh and Sudhir Nair and Poonam Joshi and Rathan Shetty and Pankaj Chaturvedi},
journal = {Clinical and translational radiation oncology},
year = {2026},
month = oct,
doi = {10.1016/j.ctro.2026.101338},
url = {https://europepmc.org/article/MED/42999892},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Metastasis-directed therapy in addition to definitive locoregional radiotherapy for De novo metastatic nasopharyngeal carcinoma: a retrospective cohort study.
AU - Sarbani Ghosh Laskar
AU - Anuj Kumar
AU - Rahat Malhotra
AU - Shwetabh Sinha
AU - Samarpita Mohanty
AU - Kumar Prabhash
AU - Amit Joshi
AU - Nandini Menon
AU - Omshree Shetty
AU - Anuradha Chougule
AU - Ashwini Budrukkar
AU - Monali Swain
AU - Vanita Noronha
AU - Minit Shah
AU - Aditya Dhanawat
AU - Gouri Pantvaidya
AU - Deepa Nair
AU - Shivakumar Thiagarajan
AU - Chandrashekhar Dravid
AU - Vidisha Tuljapurkar
AU - Anuja Deshmukh
AU - Rishi Mittal
AU - Richa Vaish
AU - Rukmini Prabhu
AU - Arjun Singh
AU - Sudhir Nair
AU - Poonam Joshi
AU - Rathan Shetty
AU - Pankaj Chaturvedi
PY - 2026
DA - 2026/10/29
JO - Clinical and translational radiation oncology
DO - 10.1016/j.ctro.2026.101338
UR - https://europepmc.org/article/MED/42999892
AB - De novo metastatic nasopharyngeal carcinoma (mNPC) carries a poor prognosis with systemic therapy alone. Locoregional radiotherapy (LRRT) improves survival in chemotherapy-responsive patients, but the incremental role of metastasis-directed therapy (MDT) remains undefined. This retrospective cohort included 54 patients with de novo mNPC treated between 2013 and 2024 at a tertiary cancer centre. All received platinum-based induction chemotherapy followed by definitive LRRT; selected patients underwent MDT to metastatic sites. Overall survival (OS), recurrence-free survival (RFS) and distant recurrence-free survival (DRFS) were estimated by Kaplan-Meier methods, with Cox regression for univariable and multivariable analysis. At a median follow-up of 27 months, 2-year OS, RFS and DRFS were 67.5%, 45.4% and 52.7%. MDT was associated with improved 2-year OS (92.3% vs 55.2%; p = 0.0069), RFS (81.9% vs 28.2%; p < 0.001) and DRFS (93.8% vs 35.0%; p < 0.001). On multivariable analysis MDT remained associated with improved RFS (HR 0.27, 95% CI 0.08-0.98; p = 0.047), with consistent estimates in a 2-month landmark analysis (HR 0.26, 95% CI 0.075-0.90) and with MDT modelled as a time-varying covariate (HR 0.17, 95% CI 0.040-0.76); the association with OS was not statistically significant (HR 0.25, 95% CI 0.06-1.13; p = 0.072). Oligometastatic disease was more frequent among patients receiving MDT (88% vs 41%). The association was most evident in the oligometastatic subgroup. In exploratory analyses, detectable post-treatment plasma EBV DNA and elevated post-LRRT PET SUV were associated with inferior survival. In chemotherapy-responsive de novo mNPC treated with definitive LRRT, consolidative MDT was associated with improved disease control in multivariable, landmark and time-varying analyses, with a directionally consistent but non-significant association with OS. As residual confounding cannot be excluded, these findings support prospective evaluation in selected patients.
SN - 2405-6308
ER -