With or without reirradiation in advanced local recurrent nasopharyngeal carcinoma: a case–control study

Abstract

BackgroundThe study aimed to evaluate the long-term outcome in patients with advanced local recurrent nasopharyngeal carcinoma (NPC) treated with or without reirradiation.MethodsA total of 44 patients treated without reirradiation (non-RT + chemotherapy) were matched with 44 patients treated with reirradiation (re-RT+/-chemtherapy) by age, sex, Karnosky performance score (KPS), rT stage, rN stage, and time interval between initial radiation and recurrence (TI). Overall survival (OS) rate and time to progression (TTP) rate were assessed using Kaplan–Meier method, log-rank test, and Cox regression analysis.ResultsFrom March 2008 to December 2013, a total of 88 well-balanced rT3–4 N0-1 NPC patients were retrospectively analyzed. After a median follow-up of 27 months (range: 6–85), the 5-year OS rate and TTP rate was 23.4 %, 39.0 % in the non-RT + chemotherapy group and 27.5 %, 49.8 % in the re-RT+/-chemtherapy group, respectively. Multivariate analysis showed that significant toxic effect was the only significant prognosticator correlated with OS (HR: 2.15, 95 % CI = 1.02–4.53, p = 0.044). No statistically significant survival differences were observed between the two treatment groups in either univariate or multivariate analyses.ConclusionCompared with reiradiation, treating advanced local recurrent NPC with chemotherapy alone warrants further validation in the view of its similar survival and more acceptable toxicities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2803-2) contains supplementary material, which is available to authorized users.

Re-irradiation for recurrent NPC—is the treatment merited at all?

“…Although surgery or re-RT is the only chance to cure, the survival outcomes of palliative chemotherapy may not be worse than 'curative' treatment. A case-matched, retrospective study showed equivalent OS for patients received re-RT and chemotherapy alone (13). As expected, more RT-induced mortalities were observed in the re-RT group and more deaths due to local recurrence were observed in the chemotherapy alone group.…”

Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

“…Among the patient groups with recurrent stage III and IVA/IVB disease, 52.1% and 41.2% were treated with re-RT, respectively. However, in a case-matched retrospective study, similar survival outcomes were observed for patients who received re-RT vs chemotherapy alone, 22 and the latter was inevitably associated with fewer RT-related toxicities. However, despite a numerical 10% survival advantage, our data showed that re-RT was only marginally better than chemotherapy alone (5-year OS 21.8% vs 11.6%; P = .06), and it was likely attributed to the high rates of life-threatening late toxicities (grade 4:22.9%; grade 5:17.7%).…”

“…[10][11][12] Our analysis suggests that age and rGTV volume were the most important parameters for OS. However, in a case-matched retrospective study, similar survival outcomes were observed for patients who received re-RT vs chemotherapy alone, 22 and the latter was inevitably associated with fewer RT-related toxicities. We believe that chemotherapy alone might be regarded as a reasonable alternative for patients with adverse prognostic factors, especially those with extensive local recurrence.…”

Establishment of an integrated model for predicting survival and guiding treatment in local recurrence nasopharyngeal carcinoma

“…Our group launched the rst case-control study to compare the survival of rT3-4 lrNPC patients treated with reirradiation or PCT alone and found that patients in these two groups achieved similar OS [26]. However, You et al established a new surgical system and veri ed that a combination of aggressive reirradiation could further enhance OS compared with PCT alone [27].…”