Efficacy of immediate radiotherapy versus salvage radiotherapy in patients with de novo metastatic nasopharyngeal carcinoma responsive to chemoimmunotherapy
In brief
Delayed radiation showed no worse 2-year survival in 439 responders
Among patients with metastatic nasopharyngeal cancer who responded to chemoimmunotherapy, 2-year survival was 97% with radiation deferred until local progression and 90% with immediate radiation; the adjusted analysis found no survival disadvantage with deferral. Delayed treatment was linked to poorer control at the original site but fewer radiation-related side effects, and this retrospective study cannot establish which timing is best.
- Journal
- ESMO open (Q1)
- Published
- 30 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Q-T Zhang, J-R He, H-B Guo, Y-N Sun, J Chen, H Cheng, et al.
- PMID
- 42962562
- DOI
- 10.1016/j.esmoop.2026.108608
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 3 November 2026): Salvage radiotherapy non‑inferior to immediate in dmNPC
Abstract
BACKGROUND: Chemoimmunotherapy has become the standard first-line treatment for de novo metastatic nasopharyngeal carcinoma (dmNPC). However, the role and optimal timing of locoregional radiotherapy in dmNPC in the chemoimmunotherapy era remain unclear. This study aims to evaluate whether salvage locoregional radiotherapy (SLRRT), deferred until locoregional progression in patients with well-controlled distant metastases, compromises survival compared with immediate locoregional radiotherapy (ILRRT) in responders to first-line chemoimmunotherapy. PATIENTS AND METHODS: This retrospective cohort study included consecutive patients with dmNPC who achieved a complete or partial response after first-line platinum-based chemotherapy combined with anti-programmed cell death protein 1 therapy. The primary endpoint was overall survival (OS). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline characteristics. Survival outcomes were assessed using Kaplan-Meier analyses and a multivariate Cox regression model. RESULTS: A total of 439 patients were included, with a median follow-up of 35.0 months (interquartile range, 24.0-45.2). Of these, 331 patients were assigned to the ILRRT cohort and 108 to the SLRRT cohort. After IPTW adjustment, SLRRT was not associated with inferior OS compared with ILRRT [2-year OS, 97.4% versus 90.1%; hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.54-1.59, P = 0.78]. SLRRT was associated with worse locoregional control (HR 4.78, 95% CI 2.98-7.66, P < 0.001) but better distant control (HR 0.62, 95% CI 0.41-0.95, P = 0.03). Radiotherapy-related adverse effects were substantially more frequent in the ILRRT cohort. CONCLUSIONS: Deferring SLRRT until locoregional progression did not compromise survival among responders to first-line chemoimmunotherapy. These findings support a response-adapted, de-escalated treatment strategy that may reduce treatment-related toxicities and improve quality of life without adversely affecting survival.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.