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Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion



To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion.


A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan–Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated.


IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group.


IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.

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Fig. 1
Fig. 2



Two-dimensional conventional radiation therapy


Intensity-modulated radiation therapy


Nasopharyngeal carcinoma


Overall survival


Disease-free survival


Locoregional relapse-free survival


Distant metastasis-free survival


Radiation therapy


Planning target volume


Gross tumor volume of the primary


Nodal gross tumor volume


Induction chemotherapy


Concurrent chemoradiotherapy


Adjuvant chemotherapy


Hazard ratios


Response evaluation criteria in solid tumors


Complete remission


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This work was supported by the National Natural Science Foundation of China (Nos. 81560443, 81760546) and the Scientific Research and Technology Development Program of Guilin (No. 20170109-22), the Key Program of the Guangxi Natural Science Foundation of China (No. 2018JJD140054), the General Program of Guangxi Natural Science Foundation of China (No. 2018GXNSFAA138100).

Author information

Study concept and design: SFL and WJ. Data acquisition and analysis: SFL, YX, YF, YYZ and WJ. Data interpretation: all authors. Drafting the manuscript: SFL and WJ. Critical revision of the manuscript for important intellectual content: all authors. Supervision: WJ. All authors read and approved the final manuscript.

Correspondence to Wei Jiang.

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The study was approved by the Medical Ethics Committee of affiliated Hospital of Guilin Medical University, Wuzhou Red Cross Hospital, and Nanxishan Hospital of Guangxi Zhuang Autonomous Region.

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Informed consent was obtained from all individual participants included in the study.

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Liao, S., Xie, Y., Feng, Y. et al. Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion. J Cancer Res Clin Oncol 146, 429–439 (2020). https://doi.org/10.1007/s00432-019-03067-y

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  • Skull-base invasion
  • Intensity-modulated radiation therapy
  • Nasopharyngeal carcinoma