Reirradiation with robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma.

Aysen Dizman,Gonca Altinisik-Inan,Yildiz Guney,Mehmet Faik Cetindag,Gokce Kaan Olcay,Mehtap Coskun-Breuneval

doi:10.7314/apjcp.2014.15.8.3561

Abstract

Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT). Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife® FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6). The median follow-up for all patients was 19.5 months (IQR: 12.2. -29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection. The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.

Highlights

Recurrent nasopharyngeal carcinoma (NPC) in a previously irradiated volume remains a challenging problem
Despite the developments in head and neck cancer treatments, locoregionally recurrent tumors in previously irradiated areas remain as a challenging problem with a morbidity rate as high as 50-60% (DeConti and Schoenfeld, 1981; Hong et al, 1985; Fontanesi et al, 1989; Hao et al, 2008; Huang et al, 2012)
Tumor and patient characteristics are important in decision making of the physician

Summary

Introduction

Recurrent nasopharyngeal carcinoma (NPC) in a previously irradiated volume remains a challenging problem. The localisation of the nasopharynx and high doses of radiotherapy (RT) and chemotherapy given for primary therapy make retreatment difficult (DeConti and Schoenfeld, 1981; Hong et al, 1985; Fontanesi et al, 1989). Options for the treatment of recurrent NPC include external irradiation, brachytherapy, chemotherapy, nasopharyngectomy and various combinations of these modalities. Recurrent NPC reirradiation causes several concerns due to limited tissue tolerances and the high radiation doses used previously. Brachytherapy (BT) has been used in salvage treatment of recurrent NPC for several decades but can be applicable only to a small volume within the nasopharynx (Law et al, 2002). There is not enough data in the literature about the effectiveness and toxicity of SRS/FSRT in recurrent NPC treatment.

Materials and Methods

Results

Discussion