Treatment Outcome with Brachytherapy for Recurrent Nasopharyngeal Carcinoma

Abstract

Background: To evaluate the treatment outcome and major late complications of all patients with recurrent nasopharyngeal carcinoma (NPC) treated with intracavitary brachytherapy (ICBT) in Hospital Kuala Lumpur. Materials and Methods: This retrospective study was conducted at the Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Malaysia. All patients with histologically confirmed recurrent NPC in the absence of distant metastasis treated in the period 1997-2010 were included in this study. These patients were treated with ICBT alone or in combination with external beam radiotherapy (EBRT). Treatment outcomes measured were local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS). Results: Thirty three patients were eligible for this study. The median age at recurrence was 56 years with a median time to initial local recurrence of 27 months. Majority of patients were staged as rT1-2 (94%) or rN0 (82%). The proportion of patients categorised as stage III-IV at first local recurrence was only 9%. Twenty one patients received a combination of ICBT and external beam radiotherapy while 12 patients were treated with ICBT alone. Median interval of recurrence post re-irradiation was 32 months (range: 4-110 months). The median LRFS, DFS and OS were 30 months, 29 months and 36 months respectively. The 5 year LRFS, DFS and OS were 44.7%, 38.8% and 28.1% respectively. The N stage at recurrence was found to be a significant prognostic factor for LRFS and DFS after multivariate analysis. Major late complications occurred in 34.9% of our patients. Conclusions: Our study shows ICBT was associated with a reasonable long term outcome in salvaging recurrent NPC although major complications remained a significant problem. The N stage at recurrence was a significant prognostic factor for both LRFS and DFS.

Photodynamic therapy as salvage therapy for patients with nasopharyngeal carcinoma experiencing local failures following definitive radiotherapy

“…Brachytherapy is the most used modality for small local failures. Cheah et al [23] retrospectively reviewed the outcome of 33 patients treated with brachytherapy. The 5-year local disease free interval was 45% and overall survival was 28%.…”

“…Besides, the cumulative dose toxicity makes side effects the limiting factor, i.e. brain necrosis, cranial nerve palsy and endocrine dysfunction [23]. Brachytherapy is the most used modality for small local failures.…”

Brachytherapy in Reirradiation of Locally Recurrent Nasopharyngeal Cancer: Case Report

“…In the literature, EBRT remains a main treatment method to be used. Many authors combined external RT with a localized boost (using brachytherapy or SRS/FSRT) to achieve high tumor dose with better sparing of adjacent organs at risk [8,9]. Qiu et al [8] in a retrospective study reported the result of different reirradiation techniques for local recurrence NPC, 168 patients were treated with four different irradiation modalities (3D-CRT, IMRT, BT, and BT with external radiotherapy), and 43% have received brachytherapy.…”

“…Age, histology, recurrence T-classification, and interval to recurrence were factors for overall survival [1,8,13]. Several publications reported the lymph node spread and reirradiation dose are one of the most important factors for local-regional progression after the salvage treatment [9,4,15]; the general consensus is that reirradiation dose above 60 Gray (Gy) is needed for effective salvage [2]. Brachytherapy is an option for treating located small tumors.…”

“…Patients, who develop local recurrence, salvage treatment remains a very difficult challenge due to the proximity to critical structures. Management of recurrences includes external radiotherapy or external radiation with a boost delivered by brachytherapy, chemotherapy, surgery, radiosurgery, or combinations of these methods [3][4][5][6][7][8][9][10][11]. No randomized trials have been performed to evaluate the therapeutic ratio of different treatment methods.…”