{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:18:26Z","timestamp":1747196306734,"version":"3.40.5"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jiangsu Medical Innovation Team","award":["CXDT-37"],"award-info":[{"award-number":["CXDT-37"]}]},{"name":"Suzhou Science and Technology Development Program","award":["SZS201509"],"award-info":[{"award-number":["SZS201509"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Radiotherapy (RT) combined with chemotherapy is the standard treatment for T<jats:sub>1-2<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> nasopharyngeal carcinoma (NPC) based on conventional radiotherapy. However, intensity-modulated radiotherapy (IMRT) has narrowed the treatment gap between RT and chemoradiotherapy. Thus, this retrospective study aimed to compare the efficacy of RT and chemoradiotherapy (RT-chemo) in treating T<jats:sub>1-2<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> NPC in the IMRT era.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>From January 2008 to December 2016, 343 consecutive patients with T<jats:sub>1-2<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> NPC in two cancer centers were included. All patients received RT or RT-chemo, chemotherapy including induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT), CCRT, or CCRT + adjuvant chemotherapy (AC). The number of patients who received RT, CCRT, IC + CCRT, and CCRT + AC was 114, 101, 89, and 39. The survival rates were analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariable analysis was performed to identify valuable prognostic factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The median follow-up time for survivors was 93 (range: 55\u2013144) months. The 5-year overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) for the RT-chemo and RT groups were 93.7%, 88.5%, 93.8%, 93.8% and 93.0%, 87.7%, 91.9%, 91.2%, respectively (P&gt;0.05 for all outcomes). No significant survival differences were found between the two groups. The T<jats:sub>1<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> or T<jats:sub>2<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> subgroup analysis showed that treatment outcomes had no significant differences between the RT and RT-chemo groups. After adjusting for various factors, treatment mode was not identified as an independent prognostic factor for all survival rates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this study, outcomes of T<jats:sub>1-2<\/jats:sub>N<jats:sub>1<\/jats:sub>M<jats:sub>0<\/jats:sub> NPC patients treated by IMRT alone were comparable to chemoradiotherapy, supporting the omission or postponement of chemotherapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0279252","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T18:40:31Z","timestamp":1677782431000},"page":"e0279252","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["T1-2N1M0 nasopharyngeal carcinoma chemotherapy or not: A retrospective study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6576-1383","authenticated-orcid":true,"given":"Pei-Jing","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5295-2263","authenticated-orcid":true,"given":"Ye","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"pone.0279252.ref001","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J Clin."},{"key":"pone.0279252.ref002","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1007\/s11682-018-9931-z","article-title":"Radiation-induced hippocampal atrophy in patients with nasopharyngeal carcinoma early after radiotherapy: a longitudinal MR-based hippocampal subfield analysis","volume":"13","author":"X Lv","year":"2019","journal-title":"Brain Imaging Behav"},{"key":"pone.0279252.ref003","article-title":"NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. 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diagnosed from 1990 to 2012: A large-scale retrospective cohort study","volume":"51","author":"XS Sun","year":"2019","journal-title":"Cancer Res Treat"},{"key":"pone.0279252.ref020","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/cncr.11485","article-title":"Treatment outcome after radiotherapy alone for patients with Stage I-II nasopharyngeal carcinoma","volume":"98","author":"DTT Chua","year":"2003","journal-title":"Cancer"},{"key":"pone.0279252.ref021","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1002\/1097-0142(19880315)61:6<1117::AID-CNCR2820610611>3.0.CO;2-J","article-title":"Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation","volume":"61","author":"DX Qin","year":"1988","journal-title":"Cancer"},{"key":"pone.0279252.ref022","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1002\/cncr.11496","article-title":"Pretherapy quantitative measurement of circulating Epstein\u2014Barr virus DNA is predictive of posttherapy 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