Salvage radiation therapy for locally recurrent nasopharyngeal carcinoma

Leung, TW; Tung, Stewart Y.; Sze, W.M.; Wong, Victy Y. W.; Wong, Chi Kuen; Saiki, Osamu

doi:10.1016/s0360-3016(00)00776-8

Cited by 129 publications

(103 citation statements)

References 24 publications

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“…The optimal dose for re-irradiation in rnpc has still not been established, and based on retrospective evidence, a total dose of 60 Gy or more (2 Gy per fraction) is widely accepted by most radiation oncologists 6,8,34,55 . Leung et al 56 showed that a total equivalent dose of 60 Gy or more resulted in better local control, and total equivalent dose remained a significant prognostic factor in multivariate analyses. Lee et al 3 studied the relationship between late complications and the biologically effective dose (bed).…”

Section: What Is the Optimal Dose And Fractionation When Delivering Rmentioning

confidence: 99%

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Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

et al. 2013

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Recurrent nasopharyngeal carcinoma, which represents a small proportion of head-and-neck cancers, has a unique set of patho-clinical characteristics. The management of recurrent nasopharyngeal carcinoma remains a challenging clinical problem. Traditional treatments offer limited local control and survival benefits; more seriously, they frequently induce severe late complications. Recently, novel treatment techniques and strategies—including precision radiotherapy, endoscopic surgery or transoral robotic resection, third-generation chemotherapy regimens, and targeted therapies and immunotherapy—have provided new hope for patients with recurrent nasopharyngeal carcinoma. Some of these patients can potentially be cured with modern treatments. However, a lack of adequate evidence makes it difficult for clinicians to apply these powerful techniques and strategies. Individualized management guidelines, full evaluation of quality of life in these patients, and a further understanding of the mechanisms underlying recurrence are future directions for research into recurrent nasopharyngeal carcinoma.

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Section: What Is the Optimal Dose And Fractionation When Delivering Rmentioning

confidence: 99%

“…Temporal lobe necrosis, cranial neuropathy, and bone necrosis were very common. Leung et al 56 found that a high risk of central nervous system complications was closely associated with advanced rT stage.…”

Section: Late Toxicities and Qolmentioning

confidence: 99%

Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

et al. 2013

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“…However, advances in radiation oncology have improved the locoregional control, and treatment failure is now due mainly to distant metastasis. To date, the outcome of salvage treatment for relapse is still very poor, with the 5-year survival rates after local recurrence and distant metastasis being 9.4% to 30% and <5%, respectively (1)(2)(3)(4)(5)(6). Because most metastatic/recurrent patients will succumb rapidly to the disease, the development of a quick and precise marker to predict treatment response is urgently needed.…”

mentioning

confidence: 99%

Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma

Wang

Twu

Chen

et al. 2010

Clinical Cancer Research

152

111

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Purpose: To investigate the prognostic effect of the concentrations and clearance rates of plasma EBV DNA in metastatic/recurrent nasopharyngeal carcinoma (NPC).Experimental Design: Thirty relapsed and four previously nontreated metastatic NPC patients were treated according to the consensus guidelines of the head and neck cancer team in our hospital (i.v. chemotherapy first, followed by local irradiation boost and oral maintenance chemotherapy where applicable). Multiple plasma samples were collected during the first month of chemotherapy. Circulating EBV DNA concentrations were measured by a real-time quantitative PCR. The half-life values (t 1/2 ) of plasma EBV DNA clearance were calculated. The associations between clinical outcome and plasma EBV DNA assays were analyzed.Results: Tumor response evaluated after 12 weeks of treatment showed 14 complete responses (41.2%), 12 partial responses (35.3%), 7 stable diseases (20.6%), and 1 progression disease (2.9%). The plasma EBV DNA concentrations have no significant effects on outcome prediction. The t 1/2 of plasma EBV DNA clearance ranged from 1.85 to 28.29 days (median, 3.99). Patients with a short t 1/2 of plasma EBV DNA clearance have significantly higher complete response rate and overall survival than those with long t 1/2 . Multivariate analysis revealed a significant effect of the t 1/2 of plasma EBV DNA clearance on survival.Conclusions: The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival. Early change of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate. Clin Cancer Res; 16(3); 1016-24. ©2010 AACR.Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck by its epidemiology, histopathology, clinical characteristics, methods of treatment, and patterns of failure. Because of the inherent anatomic constraints and a high degree of radiosensitivity, radiotherapy has been the primary treatment for NPC patients without distant metastasis. Treatment failure in the past was due to a high rate of local recurrence and/or distant metastasis. However, advances in radiation oncology have improved the locoregional control, and treatment failure is now due mainly to distant metastasis. To date, the outcome of salvage treatment for relapse is still very poor, with the 5-year survival rates after local recurrence and distant metastasis being 9.4% to 30% and <5%, respectively (1-6). Because most metastatic/recurrent patients will succumb rapidly to the disease, the development of a quick and precise marker to predict treatment response is urgently needed.NPC has been proven as an EBV-associated cancer. EBV genome is present in the cells from almost every primary and metastatic NPC, regardless of the degree of tumor differentiation or the geographic origin of the patients. Recently, the quantification of plasma EBV DNA by the real-time quantitative PCR has been shown as a useful marker in the detection, monitoring, and prognos...

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“…29 When salvage surgery is not feasible, chemotherapy alone with or without biological therapy, and conventional EBRT reirradiation with or without 31 Therefore, while conventional EBRT using 3D conformal reirradiation approaches may be acceptable for properly selected patients with limited salvage therapy options, they are associated with substantial acute and late morbidities. 22,44,50,57 Applications of SBRT in HNC Linear accelerator gantry-based and Gamma Knife intracranial SRS use invasive head frames, which can often be uncomfortable and poorly tolerated. To date, LINAC and Gamma Knife SRS have limited application for extracranial locations including HNC, largely due to limitations in immobilization requirements and difficulty in tracking movement of potentially mobile organs, making it difficult to apply the concept of rigid immobilization to nonrigid structures.…”

Section: Salvage Options For Recurrent Hncmentioning

confidence: 99%

Emerging applications of stereotactic radiotherapy in head and neck cancer

Truong

Grillone²,

Tschoe

et al. 2009

FOC

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Advances in the management of locally advanced head and neck cancer (HNC) have been focused on treatment intensification, including concomitant chemoradiotherapy, biological agents, and combining surgery with chemoradiotherapy. Despite these improvements, locoregional recurrence still constitutes the main pattern of treatment failure. As improvements in radiotherapy delivery and image-guided therapy have come to fruition, the principles of stereotactic radiosurgery are now being applied to extracranial sites, leading to stereotactic body radiotherapy. This article focuses on the emerging evidence for the use of stereotactic body radiotherapy for treatment of HNC as a boost after conventional external-beam radiotherapy, and also as reirradiation in recurrent or second primary HNC.

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Salvage radiation therapy for locally recurrent nasopharyngeal carcinoma

Cited by 129 publications

References 24 publications

Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

Plasma EBV DNA Clearance Rate as a Novel Prognostic Marker for Metastatic/Recurrent Nasopharyngeal Carcinoma

Emerging applications of stereotactic radiotherapy in head and neck cancer

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