No abstract

Background This study evaluates the contemporary care for patients with locally recurrent nasopharyngeal carcinoma after failure of the primary course of intensity modulated radiotherapy. Methods Eligible patients were identified through the Hong Kong Cancer Registry database. Patterns of care and treatment outcomes were analyzed. Results Two hundred seventy‐two patients with locally recurrent tumors were identified. Of them, 30.9% received surgery, whereas 35.7% received re‐irradiation (re‐RT). The 5‐year overall survival (OS) for the whole group was 30.2%. Old age and advanced rT classification were adverse prognostic factors, whereas surgery (mainly in resectable recurrence) was associated with favorable survival outcome. The 5‐year OS rates for patients who received surgery and re‐RT were 56.3% and 21.8%, respectively. Conclusions Early detection of resectable recurrence is of paramount importance as surgery for resectable tumors offers the potential to achieve excellent outcomes. Re‐RT could be considered in selected patients with unresectable disease and favorable prognostic features.

Radioactive phosphorus effected substantial palliation of intractable bone pain in 17 of 33 (51.5%) women with metastatic carcinoma of the breast and in 14 of 15 (93.3%) men with metastatic carcinoma of the prostate. No significant difference in the overall response rate was found between androgen and parathormone priming prior to radiophosphorus therapy. The degree of response was not dependent on total dose of 32P within the range of 9--18 mCi (333--666 MBq). Myelosuppression was a transient complication in 9 of 33 patients with metastatic breast carcinoma and in 7 of 15 patients with metastatic prostate carcinoma. Symptomatic hypercalcemia was an infrequent complication of radiophosphorus therapy irrespective of the priming regimen.

Background: This study analyzed the dose volume effects of re-irradiation for locally recurrent nasopharyngeal carcinoma (NPC) and attempts to determine the optimal dose for the best survival. Methods: Ninety-one patients were studied. The local control, fatal complication, and overall survival were analyzed against the dose (in Equivalent Dose at 2 Gy/fractions) and recurrent gross tumor volume (GTV). Results: The local control and fatal complication rate appear to increase with prescribed dose. The overall survival peaks at around 60 Gy 10 . Local control decreases significantly with increasing GTV (P < .001) while overall survival shows similar trend (P = .06). No correlation was observed between the fatal complication rate and GTV volume. The dose response of local control appears to be stronger for smaller tumors. Conclusion: GTV volume plays a significant role in local control. A 60 Gy 10 appears to be optimal for the best survival outcome; higher doses might be considered for small tumors.

55 (25%) patients in the DRT and control groups, respectively. A propensity score model incorporating age, gender, tumor subsite, performance score, histology subtype, staging method, clinical T and N stage, tumor size, and era of treatment was constructed using logistic regression. Treatment outcomes between groups were compared using 1:1 nearestneighbor matching. Results: In the DRT arm, 43 patients (74%) received chemoradiation therapy (CRT), and 52 patients (90%) were treated with intensity modulated radiation therapy, with a median dose of 72 Gray. The control group patients were treated with surgery alone (nZ29, 13%) or surgery followed by adjuvant radiation therapy (nZ98, 45%) or CRT (nZ92, 42%). Patients who received DRT were characterized by a significantly higher clinical T (P<.001), N (PZ.002), and disease stage (P<.001), larger tumor size (P<.001), poor performance score (PZ.001), and a higher prevalence of minor salivary gland origin (P<.001). In addition, DRT patients were more likely to receive advanced imaging modalities (P<.001) and be treated in more recent years (PZ.026). After propensity score matching, all the preexisting differences were balanced between groups (58 pairs). The median follow-up lengths for DRT and control arms were 47 and 50 months, respectively. The 5-year overall survival and disease-free survival rates for DRT and control groups were 65% versus 64% and 65% versus 48%, respectively (PZ.672 and PZ.348). No statistically significant differences were observed between DRT and control arms in 5-year locoregional control (69% vs 76%, PZ.591) and distant metastasis-free survival (80% vs 55%, PZ.227). Conclusion: DRT may be an alternative treatment for HGSGC without jeopardizing oncologic outcomes and survival.