To analyze the 10-year survival outcome and failure patterns for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT), aiming to provide reference for optimized treatment for NPC.

Clinical data of 866 patients with NPC receiving IMRT from January 2001 to December 2008 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier estimator. Univariate analysis was carried out by log-rank test and multivariate analysis was performed using Cox proportional hazards model.

The median follow-up time was 132 months. The 10-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and disease specific survival (DSS) were 92.0%, 83.4%, 75.7% and 78.6%, respectively. A total of 210 patients died including 124 patients (59.0%) from distant metastasis, which was the primary cause of death, and 47(22.3%) from local regional recurrence. Independent negative factors of DSS included age>50 years (P=0.00), LDH≥245 IU/L (P=0.00), Hb<120 g/L (P=0.01), T₂-T₄ staging (P=0.00), N₁-N₃ staging (P=0.00) and GTV-nx>20 cm³(P=0.00). The 10-year LRFS, DMFS and DSS of stage Ⅱ NPC patients did not significantly differ after IMRT alone and chemoradiotherapy (P=0.83, 0.22, 0.23). For patients with stage Ⅲ NPC, the 10-year LRFS and DSS in the chemoradiotherapy arm were significantly higher than those in the IMRT alone (P=0.01, 0.01), whereas no statistical significance was observed in the DMFS between two groups (P=0.14). The overall survival of stage Ⅳ_a+ Ⅳ_b NPC patients is relatively poor.

IMRT can improve the long-term survival of NPC patients. Distant metastasis is the primary failure pattern. Patients with stage Ⅰ-Ⅱ NPC can obtain satisfactory survival outcomes after IMRT alone. The addition of chemotherapy can further enhance the LRFS and DSS of stage Ⅲ NPC patients. However, the optimal therapeutic strategy remains to be urgently investigated for stage Ⅳ_a+ Ⅳ_b NPC patients.

Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Failure pattern; Prognosis