Journal of Clinical Oncology & Advanced Therapy

Abstract

This study aimed to evaluate the patterns of failure, disease recurrence, and survival outcomes in EBV positive nasopharyngeal carcinoma (NPC) patients treated at Pakistan’s largest tertiary cancer center, given the high incidence of this malignancy in endemic regions like Pakistan. We retrospectively analyzed 265 adult patients with biopsy-confirmed, locally advanced, non-metastatic NPC treated with definitive chemoradiation between January 2018 and December 2023. All patients received induction chemotherapy with Cisplatin and Gemcitabine, followed by intensity modulated radiotherapy (IMRT) combined with concurrent Cisplatin, with a median follow-up of 64 months. The cohort's median age was approximately 45 years, predominantly male, with most presenting with advanced T3/T4 (52.8%) and N2/N3 (76.6%) disease, and undifferentiated histology was common. Results showed that 69.1% of patients remained disease-free, while 30.9% experienced recurrence, mainly distant metastases involving bones, viscera, and multiple sites. Local control was satisfactory across the cohort, but distant metastasis, especially in osseous and visceral sites, was the main pattern of failure. The median overall survival was approximately 65 months, with 5-year OS of 60.9%. The five-year recurrence-free survival was 55%, and distant metastasis free survival was 65.7%. These findings highlight that while IMRT-based treatment provides excellent locoregional control, distant metastasis remains the primary challenge to long-term survival, emphasizing the need for more effective systemic therapies and biomarker-driven strategies to reduce distant relapse in endemic NPC populations.