Abstract
BackgroundTo evaluate the effectiveness and toxicities of intensity-modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC).MethodsOne hundred and eighty-four previously irradiated NPC patients with recurrent disease and re-irradiated by IMRT between February 2005 to May 2013 had been reviewed. The disease was re-staged I in 33, II in 27, III in 70 and IV in 54 patients. Seventy-five percent of the patients received cisplatin-based chemotherapy.ResultsThe median survival time was 33 months. The 3-year actuarial rates of local recurrence–free survival (LRFS), distant metastases–free survival (DMFS), and overall survival (OS) rates were 85.1, 91.1, and 46.0%, respectively. About 53% of the patients experienced Grade 3–4 late toxicities. Forty-four patients died of massive hemorrhage of the nasopharynx caused by radiation induced mucosal necrosis. Multivariate analysis indicated that chemotherapy and time interval between initial radiotherapy and re-irradiation were independent predictors for DMFS.ConclusionIMRT is an effective method for patients with locally recurrent NPC. Massive hemorrhage of the nasopharynx is the major sever late complication and also the leading cause of death. Early recurrence is negative factor for DMFS. Combination of chemotherapy can improve DMFS, but not for OS. Optimal salvage treatment strategies focusing on improvement of survival and minimization of late toxicities are warranted.
Highlights
To evaluate the effectiveness and toxicities of intensity-modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC)
Patients From February 2005 to May 2013, 184 patients with recurrent NPC treated by curative re-irradiation with IMRT in Fudan University Shanghai Cancer Center were enrolled in this study
Patients were previously treated with two-dimensional conventional radiotherapy (RT) or IMRT to a median dose of 70Gy
Summary
To evaluate the effectiveness and toxicities of intensity-modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). Recurrent nasopharyngeal carcinoma (NPC) occurred in 20–40% for patients treated with traditional radiotherapy [1,2,3]. With the development of modern radiation technique, the local control has been definitely improved. Recurrence inevitably happens in some patients, especially those with local-regionally advanced disease [4]. Salvage treatment for locally recurrent NPC remains a challenge for clinical oncologists. Various strategies, including surgery, brachytherapy, and stereotactic radiosurgery have. Intensity-modulated radiotherapy (IMRT) is an ideal radiation modality for NPC, due to its favorable balance between target coverage and the sparing of adjacent organs [13]. Published reports have shown that the use
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