Reirradiation for locally recurrent nasopharyngeal carcinoma: Treatment results and prognostic factors

Abstract

Purpose To analyze the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. Methods and materials Forty-one patients with locally recurrent nasopharyngeal carcinoma, who were reirradiated between 1979 and 2000, were retrospectively analyzed. There were 32 men and 9 women with median age of 46 years. Histologically, 9 tumors (22%) were World Health Organization (WHO) I, 17 (41.5%) WHO II, and 15 (36.5%) WHO III. According to the 1998 TNM staging system of the American Joint Committee on Cancer, the recurrent disease was Stage I in 5 (12.2%), Stage II in 11 (26.8%), Stage III in 6 (14.6%), and Stage IV in 19 (46.4%) patients. Treatment was delivered with 4–6 MV X-rays or Co-60 γ rays. The median reirradiation dose was 50 Gy. Treatment was delivered at 1.8–2 Gy/fraction daily, 5 days a week. Chemotherapy was used in 41.5% of the patients. Results Median follow-up was 23 months (range, 3–143 months). The 2-year and 5-year local progression-free and overall survival rates were 39%, 23%, 48%, and 28%, respectively. On univariate analysis, age ( p = 0.04), total reirradiation dose ( p = 0.0008) were significant prognostic factors for local progression-free rate. For overall survival age, total reirradiation dose, stage, T stage were significant. On multivariate analysis only total dose ( p = 0.005) remained significant for local progression-free rate and total reirradiation dose ( p = 0.02), interval to recurrence ( p = 0.03), stage ( p = 0.018) were significant for overall survival. Conclusions Early diagnosis of local recurrence and high-dose reirradiation (60 Gy) are crucial for improving the local control and survival.