THE RELATIONSHIP BETWEEN CLINICAL STAGE AND THERAPEUTIC RESPONSE AFTER COMPLETE RADIOCHEMOTHERAPY IN NASOPHARYNGEAL CARCINOMA WHO TYPE III IN NGOERAH HOSPITAL DENPASAR

Abstract

Background: Nasopharyngeal cancer (NPC) is the fourth most common cancer in Indonesia, with WHO type III being the most aggressive yet highly responsive to radiochemotherapy. Various factors can impact treatment outcomes. Objective: To determine the relationship between clinical stage and therapeutic response after complete radiochemotherapy in patients with WHO type III NPC. Methods: This retrospective cohort study evaluated 148 WHO type III NPC patients who completed radiochemotherapy at Ngoerah Hospital (2020–2023). Patients were classified into early-stage (stage I-II, n=74) and advanced-stage (stage III-IVB, n=74) groups. Three months post-treatment, therapeutic response was assessed using RECIST 1.1 criteria (CR, PR, PD, SD) following re-staging procedures (imaging and diagnostics). A comparative analysis examined CR rates between the two groups and the relationship between clinical stage and treatment response. Results: The overall therapeutic response in this study was 27.7% CR, 22.3% PR, 25.0% SD, and 25.0% SD. Pre-radiochemotherapy clinical stage was significantly associated with the therapeutic response after complete radiochemotherapy. WHO type III NPC patients with advanced stage had a 37 times higher risk of non-CR than patients with early stage after adjustment for age, gender, and main symptoms (adjusted RR = 37.404; IK95% 8.308-168.393; p<0.001). Conclusion: Clinicians should prioritize early detection in high-risk patients with WHO type III NPC, as advanced-stage cases have poorer therapeutic responses. Patient education is crucial to ensure understanding of the disease progression and therapy prognosis, especially for advanced stages.