Reirradiation of locally recurrent nasopharynx cancer with external beam radiotherapy with or without brachytherapy Journal Article
| Authors: | Koutcher, L.; Lee, N.; Zelefsky, M.; Chan, K.; Cohen, G.; Pfister, D.; Kraus, D.; Wolden, S. |
| Article Title: | Reirradiation of locally recurrent nasopharynx cancer with external beam radiotherapy with or without brachytherapy |
| Abstract: | Purpose: To determine survival rates of patients with locally recurrent nasopharynx cancer (LRNPC) treated with modern therapeutic modalities. Methods and Materials: From July 1996 to March 2008, 29 patients were reirradiated for LRNPC. Thirteen patients received combined-modality treatment (CMT), consisting of external beam radiotherapy (EBRT) followed by intracavitary brachytherapy, whereas 16 received EBRT alone. The median age was 50 years, 59% were male, 38% were Asian, 69% had World Health Organization Class III histology, and 86% were treated for their first recurrence. Nine, 6, 8, and 6 patients had recurrent Stage I, II, III, and IV disease, respectively. Patients in the EBRT-alone group had more advanced disease. Median time to reirradiation was 3.9 years. In total, 93% underwent imaging with positron emission tomography and/or magnetic resonance imaging before reirradiation, 83% received intensity-modulated radiotherapy, and 93% received chemotherapy, which was platinum-based in 85% of cases. Results: The median follow-up for all patients was 45 months and for surviving patients was 54 months. Five-year actuarial local control, event-free survival, and overall survival rates were 52%, 44%, and 60%, respectively. No difference was observed between patients treated with EBRT or CMT. Overall survival was superior in patients who achieved local control (p = 0.0003). The incidence of late Grade ≥3 events in patients re-treated with EBRT alone was significantly increased compared with those receiving CMT (73% vs. 8%; p = 0.005). Conclusions: In this modern reirradiation series of patients with LRNPC, favorable overall survival compared with historical series was achieved. Patients treated with CMT experienced significantly fewer severe late effects compared with those treated with EBRT. © 2010 Elsevier Inc. All rights reserved. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; controlled study; aged; middle aged; survival rate; overall survival; intensity modulated radiation therapy; cisplatin; multimodality cancer therapy; antineoplastic agents; paclitaxel; cancer radiotherapy; radiation dose; combined modality therapy; chemotherapy; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; recurrent cancer; follow up; magnetic resonance imaging; neoplasm staging; neoplasm recurrence, local; radiotherapy dosage; radiotherapy; patient monitoring; radiation injury; oncology; cetuximab; time factors; late effects; syncope; intensity-modulated radiotherapy; radiotherapy, intensity-modulated; radiation injuries; brachytherapy; platinum; world health organization; platinum derivative; local control; external beam radiotherapy; nasopharynx cancer; fluorine containing polymers; nasopharyngeal neoplasms; brain hemorrhage; trismus; retreatment; radiation necrosis; cranial neuropathy; resonance; overall survival rates; asian; intracavitary brachytherapy; late complications; locally recurrent nasopharynx cancer; reirradiation; therapeutic modality |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 76 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-01-01 |
| Start Page: | 130 |
| End Page: | 137 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2009.01.055 |
| PUBMED: | 19467802 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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