{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:35:10Z","timestamp":1769538910950,"version":"3.49.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nasopharyngeal carcinoma (NPC) is rare in non-endemic regions but poses unique clinical challenges, especially among ethnically diverse populations. This study aimed to evaluate the characteristics, treatment outcomes, and toxicity profiles of NPC patients treated with definitive intensity-modulated radio-chemotherapy (IMRT-CRT) in a non-endemic European center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 82 consecutive patients with histologically confirmed NPC treated at Institut Jules Bordet between 2012 and 2024. Patient, tumor, treatment characteristics, survival outcomes, and treatment-related toxicity were evaluated. Survival endpoints were calculated using the Kaplan-Meier method and multivariate Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median follow-up was 35 months. Most patients were male (77%), of North African descent (66%), and had non-keratinizing carcinoma (96%). Advanced disease (stage III\/IV) was present in 72%, and 78% of tested tumors were EBV-positive. Induction chemotherapy (ICT) and concurrent chemotherapy (CCT) were administered in 32% of patients. At 5 years, actuarial estimates for overall survival (OS), progression-free survival (PFS), locoregional disease-free survival (LRDFS), recurrence-free survival (RFS), and distant disease-free survival (DFS) were 73%, 79%, 86%, 87%, and 87%, respectively. Higher T stage, treatment-related weight loss, positive nodal findings on 3-month FDG-PET-CT, and disease recurrence were associated with worse OS. Acute and late toxicities were generally manageable; however, xerostomia, hypothyroidism, ototoxicity, and weight loss were prevalent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite being conducted in a non-endemic region, this study revealed NPC characteristics and outcomes resembling those in endemic populations, likely due to patient demographics. Early metabolic response and nutritional status emerged as critical prognostic factors, highlighting the need for individualized treatment and supportive care strategies in NPC management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1724193","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T05:25:22Z","timestamp":1769491522000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes and patient profiles following intensity-modulated radio-chemotherapy for nasopharyngeal cancer in a nonendemic region"],"prefix":"10.3389","volume":"16","author":[{"given":"Tatiana","family":"Dragan","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Chiairi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]},{"name":"Department of Radiation Oncolgy, AZORG Hospital, affiliated with KU Leuven","place":["Aalst, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurine","family":"Salmon","sequence":"additional","affiliation":[{"name":"Data Centre, Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yassine","family":"Lalami","sequence":"additional","affiliation":[{"name":"Medical Oncology Clinic, Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Digonnet","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Lipski","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institut Jules Bordet, Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Van Gestel","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Libre de Bruxelles","place":["Brussels, Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","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":"Sung","year":"2021","journal-title":"CA. Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s12105-017-0787-0","article-title":"Update from the 4th edition of the world health organization classification of head and neck tumours: nasopharynx nasopharyngeal carcinoma","volume":"11","author":"Stelow","year":"2017","journal-title":"Head Neck Pathol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0140-6736(19)30956-0\/ASSET\/1DDF8BA2-4E38-40D6-95AF-7E8D5550B2F7\/MAIN.ASSETS\/GR2.JPG","article-title":"Nasopharyngeal carcinoma.","volume":"394","author":"Chen","year":"2019","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00055-0","article-title":"Nasopharyngeal carcinoma","volume":"387","author":"Chua","year":"2016","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.11.246","article-title":"Nonendemic HPV-positive nasopharyngeal carcinoma: Association with poor prognosis","volume":"88","author":"Stenmark","year":"2014","journal-title":"Int J Radiat. Oncol Biol Phys"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-13-298","article-title":"Secular trends of salted fish consumption and nasopharyngeal carcinoma: a multi-jurisdiction ecological study in 8 regions from 3 continents","volume":"13","author":"Lau","year":"2013","journal-title":"BMC Cancer"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-20-1702\/671059\/AM\/THE-EVOLVING-EPIDEMIOLOGY-OF-NASOPHARYNGEAL","article-title":"The evolving epidemiology of nasopharyngeal carcinoma","volume":"30","author":"Chang","year":"2021","journal-title":"Cancer Epidemiol. Biomarkers Prev"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70096-8","article-title":"A review of human carcinogens\u2014Part B: biological agents","volume":"10","author":"Bouvard","year":"2009","journal-title":"Lancet Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30488-7","article-title":"Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis","volume":"8","author":"de Martel","year":"2020","journal-title":"Lancet Glob Heal"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199509143331103;JOURNAL:JOURNAL:NEJMS","article-title":"Clonal proliferations of cells infected with epstein\u2013barr virus in preinvasive lesions related to nasopharyngeal carcinoma","volume":"333","author":"Pathmanathan","year":"1995","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0067488","article-title":"Radiation-induced temporal lobe injury for nasopharyngeal carcinoma: A comparison of intensity-modulated radiotherapy and conventional two-dimensional radiotherapy","volume":"8","author":"Zhou","year":"2013","journal-title":"PloS One"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/HED.23977","article-title":"Evidence on effectiveness of intensity-modulated radiotherapy versus 2-dimensional radiotherapy in the treatment of nasopharyngeal carcinoma: Meta-analysis and a systematic review of the literature","volume":"38","author":"Co","year":"2016","journal-title":"Head Neck"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/J.EJCA.2010.10.026","article-title":"Factors contributing to the efficacy of concurrent\u2013adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials","volume":"47","author":"Lee","year":"2011","journal-title":"Eur J Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)70126-9","article-title":"Chemotherapy and radiotherapy in nasopharyngeal carcinoma: An update of the MAC-NPC meta-analysis","volume":"16","author":"Blanchard","year":"2015","journal-title":"Lancet Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/CNCR.30850;PAGEGROUP:STRING:PUBLICATION","article-title":"A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity","volume":"123","author":"Lee","year":"2017","journal-title":"Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/JNCI\/DJI084","article-title":"Overall survival after concurrent cisplatin\u2013radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma","volume":"97","author":"Chan","year":"2005","journal-title":"JNCI J Natl Cancer Inst"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/J.RADONC.2011.12.022","article-title":"Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma","volume":"104","author":"Loong","year":"2012","journal-title":"Radiother. Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA1905287","article-title":"Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma","volume":"381","author":"Zhang","year":"2019","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/ONCO.13520","article-title":"Meta-analysis on induction chemotherapy in locally advanced nasopharyngeal carcinoma","volume":"26","author":"Man\u00e9","year":"2021","journal-title":"Oncologist"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70320-5","article-title":"Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: A phase 3 multicentre randomised controlled trial","volume":"13","author":"Chen","year":"2012","journal-title":"Lancet Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01123-5","article-title":"Metronomic capecitabine as adjuvant therapy in locoregionally advanced nasopharyngeal carcinoma: a multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial","volume":"398","author":"Chen","year":"2021","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/JAMAONCOL.2022.4656","article-title":"Adjuvant capecitabine following concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: A randomized clinical trial","volume":"8","author":"Miao","year":"2022","journal-title":"JAMA Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2024.100837","article-title":"Enhanced head and neck radiotherapy target definition through multidisciplinary delineation and peer review: A prospective single-center study","volume":"48","author":"Dragan","year":"2024","journal-title":"Clin Transl Radiat. Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.19.9109","article-title":"Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225","volume":"27","author":"Lee","year":"2009","journal-title":"J Clin Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.radonc.2017.10.032","article-title":"International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma","volume":"126","author":"Lee","year":"2018","journal-title":"Radiother. Oncol"},{"key":"B26","unstructured":"\u201cICRU report 83, prescribing, recording, and reporting intensity-modulated photon-beam therapy (IMRT) \u2013 ICRU"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514493","article-title":"PET-CT surveillance versus neck dissection in advanced head and neck cancer","volume":"374","author":"Mehanna","year":"2016","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.oraloncology.2015.11.015","article-title":"Long-term patterns of relapse and survival following definitive intensity-modulated radiotherapy for non-endemic nasopharyngeal carcinoma","volume":"53","author":"Setton","year":"2016","journal-title":"Oral Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2019.11.009","article-title":"A multicentre UK study of outcomes of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy \u00b1 Chemotherapy","volume":"32","author":"Slevin","year":"2020","journal-title":"Clin Oncol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/J.EJCA.2021.09.005","article-title":"Nasopharyngeal cancer in non-endemic areas: Impact of treatment intensity within a large retrospective multicentre cohort","volume":"159","author":"Bossi","year":"2021","journal-title":"Eur J Cancer"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/J.ORALONCOLOGY.2021.105182","article-title":"Treatment and outcomes of nasopharyngeal carcinoma in a unique non-endemic population","volume":"114","author":"Howlett","year":"2021","journal-title":"Oral Oncol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e251895","DOI":"10.1001\/JAMANETWORKOPEN.2025.1895","article-title":"Patient characteristics and treatment outcomes of nasopharyngeal carcinoma in nonendemic regions","volume":"8","author":"Alsavaf","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1259\/BJR.20180045","article-title":"Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma","volume":"92","author":"Jeong","year":"2019","journal-title":"Br J Radiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"33884","DOI":"10.18632\/ONCOTARGET.13934","article-title":"Prognostic value of 18F-FDG-PET\/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis","volume":"8","author":"Lin","year":"2016","journal-title":"Oncotarget"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.06.040","article-title":"Role of minor salivary glands in developing patient-rated xerostomia and sticky saliva during day and night","author":"Beetz","year":"2013","journal-title":"Radiother. Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/IJC.34861","article-title":"Long-term health-related quality of life in head and neck cancer survivors: A large multinational study","volume":"154","author":"Taylor","year":"2024","journal-title":"Int J Cancer"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70290-4","article-title":"Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial","volume":"12","author":"Nutting","year":"2011","journal-title":"Lancet Oncol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.radonc.2017.04.025","article-title":"Risk of hypothyroidism among patients with nasopharyngeal carcinoma treated with radiation therapy: A Population-Based Cohort Study","volume":"123","author":"Fan","year":"2017","journal-title":"Radiother. Oncol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00710","article-title":"Cisplatin-induced ototoxicity: A concise review of the burden, prevention, and interception strategies","volume":"19","author":"Chattaraj","year":"2023","journal-title":"JCO Oncol Pract"},{"key":"B40","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/S13014-018-1015-0","article-title":"Identifying risk factors for L\u2019Hermitte\u2019s sign after IMRT for head and neck cancer","volume":"13","author":"Laidley","year":"2018","journal-title":"Radiat. Oncol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/S00066-011-0010-2","article-title":"Lhermitte sign and myelopathy after irradiation of the cervical spinal cord in radiotherapy treatment of head and neck cancer","volume":"188","author":"Mul","year":"2012","journal-title":"Strahlentherapie und Onkol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2010\/907960","article-title":"Lhermitte\u2019s sign developing after IMRT for head and neck cancer","volume":"2010","author":"Lim","year":"2010","journal-title":"Int J Otolaryngol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"102960","DOI":"10.1016\/J.EJON.2025.102960","article-title":"Prevalence and risk factors for critical weight loss among patients with head and neck cancer undergoing radiotherapy: A systematic review and meta-analysis","volume":"78","author":"Zhang","year":"2025","journal-title":"Eur J Oncol Nurs"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.12.007","article-title":"Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up y behalf of the ESMO Guidelines Committee","volume":"32","author":"Bossi","year":"2021","journal-title":"Ann Oncol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(25)00326-2","article-title":"Primary target volume delineation for radiotherapy in nasopharyngeal carcinoma: CSTRO, CACA, CSCO, HNCIG, ESTRO, and ASTRO guidelines and contouring atlas","volume":"26","author":"Tang","year":"2025","journal-title":"Lancet Oncol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20190691\/220402","article-title":"Clinical value of a plasma Epstein\u2013Barr virus DNA assay in the diagnosis of recurrent or metastatic nasopharyngeal carcinoma: A meta-analysis","volume":"39","author":"Peng","year":"2019","journal-title":"Biosci Rep"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1724193\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T05:25:24Z","timestamp":1769491524000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1724193\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":46,"alternative-id":["10.3389\/fonc.2026.1724193"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1724193","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]},"article-number":"1724193"}}