International Recommendations on Reirradiation by Intensity Modulated Radiation Therapy for Locally Recurrent Nasopharyngeal Carcinoma

Ng, Wai Tong; Soong, Yoke Lim; Ahn, Yong Chan; AlHussain, Hussain; Choi, H.C.W.; Corry, June; Grégoire, Vincent; Harrington, Kevin; Hu, Chao; Jensen, Kenneth; Kwong, Dora Lai-Wan; Langendijk, Johannes A.; Le, Quynh Thu; Lee, Nancy Y.; Jia, Lin; Lu, Tai Xiang; Mendenhall, William M.; O’Sullivan, Brian; Özyar, Enis; Pan, Jiadong; Peters, Lester J.; Poh, Sharon Shuxian; Rosenthal, David I.; Sanguineti, Giuseppe; Tao, Yungan; Wee, Joseph; Yom, Sue S.; Chua, Melvin L.K.; Lee, Anne W.M.

doi:10.1016/j.ijrobp.2021.01.041

Cited by 61 publications

(50 citation statements)

References 72 publications

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“…Especially in rT3–4 recurrent NPC, the bone and soft tissue at the skull base are easily invaded, and the ICA is adjacent to or even encircled by the lesion ( 2 , 21 – 23 ). For patients whose skull base structures are affected by the tumor, the design of the target area and dose control are difficult if they receive secondary radiotherapy, and the probability of fatal complications is higher ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Salvage Endoscopic Skull Base Surgery: Another Treatment Option After Immunotherapy for Recurrent Nasopharyngeal Carcinoma

et al. 2022

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BackgroundAdvanced recurrent nasopharyngeal carcinoma (NPC) is a relatively common nasopharyngeal skull base disease for which there is no uniform treatment modality. Not all patients are satisfied with the efficacy of immunotherapy with or without chemotherapy.MethodsThis study included patients who underwent salvage endoscopic skull base nasopharyngectomy after immunotherapy between February 2017 and June 2021. Patient survival information was analyzed. Relevant publications were retrieved from five databases from December 1, 2011 to December 1, 2021. The outcomes of patients with advanced recurrent NPC who received programmed death 1 (PD-1) immunotherapy were collected and analyzed.ResultsNine patients who underwent skull base surgery, all of whom had previously undergone PD-1 immunotherapy, were included in this study. The 2-year overall survival (OS) and progression-free survival (PFS) rates of these patients were 25% and 29.2%, respectively. Eight publications involving 688 patients with advanced recurrent NPC were also included in this study. The combined complete response (CR), partial response (PR), and stable disease (SD) values were 2%, 23%, and 29%, respectively. The combined DCR included the three disease conditions, CR, PR, and SD, with a value of 53%. PD-1 monotherapy was more effective than PD-1 combination chemotherapy.ConclusionsPD-1 immunotherapy may improve the remission rate in patients with recurrent NPC. Salvage endoscopic skull base nasopharyngectomy may be another option for patients with poor immunotherapeutic outcomes. For patients with advanced recurrent NPC, better evidence-based medical data are needed to determine whether they should receive immunotherapy before or after surgery.

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Section: Discussionmentioning

confidence: 99%

Salvage Endoscopic Skull Base Surgery: Another Treatment Option After Immunotherapy for Recurrent Nasopharyngeal Carcinoma

et al. 2022

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“…Currently, there is no prospective clinical evidence to prove whether the addition of chemotherapy to re-RT is beneficial for recurrent NPC. Clinically, when chemotherapy is considered, clinicians prefer the sequence of induction with or without concurrent chemotherapy, based on the positive results from trials showing a survival benefit for locoregionally advanced primary NPC [ 27 ]. Absence of clinical studies, prior exposure to chemotherapy, and latency of recurrence and previous chemotherapy-related toxicity from the initial course should be considered in deciding the chemotherapy regimen.…”

Section: Discussionmentioning

confidence: 99%

Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma

Zong

Liang

et al. 2021

BMC Cancer

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Background The present study compared the effectiveness and toxicity of two treatment modalities, namely radiotherapy combined with nimotuzumab (N) and chemoradiotherapy (CRT) in patients with locally recurrent nasopharyngeal carcinoma (LR-NPC). Methods Patients with LR-NPC who were treated with radiotherapy were retrospectively enrolled from January 2015 to December 2018. The treatment included radiotherapy combined with N or platinum-based induction chemotherapy and/or concurrent chemotherapy. The comparison of survival and toxicity between the two treatment modalities was evaluated using the log-rank and chi-squared tests. Overall survival (OS) was the primary endpoint. Results A total of 87 patients were included, of whom 32 and 55 were divided into the N group and the CRT group, respectively. No significant differences were noted in the survival rate between the N and the CRT groups (4-year OS rates, 37.1% vs. 40.7%, respectively; P = 0.735). Mild to moderate acute complications were common during the radiation period and mainly included mucositis and xerostomia. The majority of the acute toxic reactions were tolerated well. A total of 48 patients (55.2%) demonstrated late radiation injuries of grade ≥ 3, including 12 patients (37.5%) in the N group and 36 patients (66.5%) in the CRT group. The CRT group exhibited significantly higher incidence of severe late radiation injuries compared with that of the N group (P = 0.011). Conclusion Radiotherapy combined with N did not appear to enhance treatment efficacy compared with CRT in patients with LR-NPC. However, radiotherapy combined with N may be superior to CRT due to its lower incidence of acute and late toxicities. Further studies are required to confirm the current findings.

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“…Approximately 10%-20% of NPC patients will develop locoregional recurrence after definitive radiotherapy. Both surgical resection and re-irradiation are potential treatment options; the former is the modality of choice if expertise is available and a clear surgical margin is achievable (69). However, the toxicity and complication rates with either approach are high, especially in elderly patients who have suboptimal premorbid conditions.…”

Section: Locoregional Recurrent Npcmentioning

confidence: 99%

“…There is yet no concrete evidence on the benefit of integrating systemic therapy to re-irradiation, but extrapolating from the studies on primary treatment, majority of centres would recommend combined modality for locoregionally advanced recurrent NPC (69). Patient tolerance to chemotherapy is typically poor in the re-irradiation setting, with a high rate of discontinuation and treatment-related toxicities even in young individuals (82).…”

Section: Locoregional Recurrent Npcmentioning

confidence: 99%

Management of Nasopharyngeal Carcinoma in Elderly Patients

Chan

Chow

et al. 2022

Front. Oncol.

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Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%–15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients’ functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients’ preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.

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International Recommendations on Reirradiation by Intensity Modulated Radiation Therapy for Locally Recurrent Nasopharyngeal Carcinoma

Cited by 61 publications

References 72 publications

Salvage Endoscopic Skull Base Surgery: Another Treatment Option After Immunotherapy for Recurrent Nasopharyngeal Carcinoma

Salvage Endoscopic Skull Base Surgery: Another Treatment Option After Immunotherapy for Recurrent Nasopharyngeal Carcinoma

Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma

Management of Nasopharyngeal Carcinoma in Elderly Patients

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