Effectiveness and Toxicities of Intensity-Modulated Radiotherapy for Patients with Locally Recurrent Nasopharyngeal Carcinoma

Abstract

PurposeTo analyze the effectiveness and toxicities in the re-irradiation of locally recurrent nasopharyngeal carcinoma (NPC) using intensity-modulated radiotherapy (IMRT).MethodsThis is a retrospective analysis of 54 NPC patients with local recurrence re-irradiated with IMRT. The re-staging for rT1, rT2, rT3, rT4 were 3 (5.6%), 8 (14.8%), 9 (16.7%), 34 (63%) respectively. The average dose to GTV was 69.95 Gy (49.8-76.58 Gy), the average BED3Gy was 116.8 Gy (83.5-127.9 Gy). V95 was 96%, and D95 was 65.75Gy. 33.3% of them received concurrent chemoradiotherapy.ResultsMedian overall survival (OS) was 21 months (1-93 mon). The 1-, 2-year local progression free survival (LPFS) rate was 84.5%, 64% and OS rate was 71.7%, 44.3%. Severe late adverse events (SLAE) occurred in 48.1% of patients, including 31.5% with ulcer or necrosis of the nasopharyngeal mucosa, 20.4% with difficulty in feeding, 18.5% with temporal lobe necrosis, 11.1% with massive hemorrhage. 15.4% died of local regional progression, 5.8% died of distant metastasis, 25% died of SLAE, 9.6% died of both local regional progression and SLAE that could not be differentiated, 5.8% died of other medical complications. Concurrent chemoradiotherapy was the independent negative prognostic factors for LPFS; PTV>100 ml was a predictive factor of poor OS; patients with invasion of post-styloid space were at higher risk of SLAE.ConclusionsThe present study demonstrated that IMRT with 70Gy was efficient for local tumor control. However, we observed a high frequency of serious late complications. More optimized combination treatment and patient selection are required to achieve excellent local control without significant late morbidities in locally recurrent NPC.

Reirradiation with intensity‐modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma

“…Although the rates of late toxicity in our cohort were comparable with other reirradiation series, one must understand the complication rates in all similar studies could be underestimated as many late toxicities can take years to develop but a significant proportion of patients died relatively early after reirradiation. The 8% treatment mortality rate in our series was, however, relatively low compared with the 9% to 35% reported in many other IMRT series . Because all our mortality was vascular in nature, there is a paramount need to study the vascular and mucosal tolerance, their complication detection, and to develop ways to tackle or prevent such tragic events.…”

Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in Saudi Arabia

“…rT4 (especially with intracranial extension via the foramen lacerum and foramen ovale) was the predominant manifestation of locoregional recurrence, which is also in agreement with international data 15. Recurrence with intracranial extension was found to have poor DFS and OS rates even after IMRT as also seen in our study 16. Most of the locoregional recurrences in our study were observed in patients with male sex, advanced-stage disease, positive Epstein–Barr virus status, and in patients without chemotherapy, where efforts were done to lessen the doses to spare critical neurologic structures (optic nerve/chiasm or temporal lobe).…”

Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma – A case-matched comparison

“…Although many studies have shown good results for salvage ENPG in rNPC with limited recurrent lesions, about 20% (18.5-26.5%) of rNPC patients with early stage recurrent lesions still underwent salvage IMRT [5,6,13,[17][18][19][20]. This fact prompted us to find which one was the better choice for those rNPC with limited recurrent lesions between IMRT and ENPG.…”