CT-guided ¹²⁵I brachytherapy for locally recurrent nasopharyngeal carcinoma

Abstract

Purpose: The study evaluated the feasibility, clinical effectiveness, and quality of life of computed tomography (CT)-guided 125 I brachytherapy for locally recurrent nasopharyngeal carcinoma (NPC). Methods: We recruited 81 patients diagnosed with locally recurrent NPC after previous radiotherapy with or without chemotherapy. Thirty-nine patients received 125 I brachytherapy (group A) and 42 received re-irradiation (IMRT, group B). The evaluated outcomes were local control, complications, and quality of life. Cox proportional hazards regression analysis was used to compare local tumor progression-free survival (LTPFS) and overall survival (OS) in the two treatment groups. Results: The median follow-up was 30 months (range, 5-68 months), median LTPFS was 21 in group A and 17 months in group B. The 1-, 2-, and 3-year OS in group A were 84.6%, 51.3%, 30.7%, and 85.7%, 50.0%, and 32.6% in group B. In group A, 10/39 patients (25.6%) experienced at least one ≥grade III complication; no grade V complications occurred. In group B, 28/42 (66.7%) experienced at least one ≥grade III complication and 6/42 (14.3%) died of severe grade V complications. No significant between-group difference existed in the Quality of Life score on the EORTC QLQ-H&N35 questionnaire before treatment. In group A, quality of life was significantly improved after treatment; but did not improve, or even deteriorated in group B. Conclusions:125 I brachytherapy was a feasible, safe, and effective treatment for locally recurrent NPC.125 I brachytherapy significantly reduced complications caused by re-irradiation and improved patients' quality of life.

Reirradiation for Recurrent Nasopharyngeal Carcinomas: Experience From an Academic Tertiary Center in a Low- to Middle-Income Country

“…We used cutoffs for age and recurrent tumor volume used by prior studies, which reported these as significant prognosticators. 22 - 25 To determine patterns of failure after primary RT, we fused the primary and re-RT plans. This was done via rigid registration based on bony landmarks (top of the dens, C1 to C2 vertebrae, pterygoid plates, hard palate, and the clinoid processes).…”

Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic

“…Moreover, LC was superior in recurrences confined to the nasopharynx compared to those extending beyond the nasopharynx [110]. Severe late toxicity occurred in 26%, mostly in the form of nasopharyngeal necrosis, epistaxis, and headache, with no treatment-related deaths observed [112]. Intracavitary high-dose-rate BRT predominantly used to treat T2 recurrences resulted in 5-year LC and OS in 97% and 78%, respectively, with severe late toxicity occurring in 29%, predominantly as endocrine dysfunction and cranial nerve palsy [113] (Table 3).…”

“…Re-irradiation (overlap of the new radiation fields with the prior full-dose radiation volume) should be approached with caution in all cases, as there is a high risk of iatrogenic treatment-related morbidity and mortality [72]. Various techniques of re-irradiation have been proposed in this setting, including IMRT [17,19,20,37,[73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88], SRS [89][90][91], stereotactic body radiotherapy (SBRT) [91][92][93][94][95][96][97][98][99][100], proton beam therapy (PBT) [101][102][103], carbon ion radiation therapy (CIRT) [104][105][106][107][108][109], and intracavitary or interstitial brachytherapy (BRT) [110][111][112][113]…”

“…The inherent physical and dosimetric characteristics of BRT allow the delivery of a very high dose to the nasopharynx while minimizing the dose to the adjacent structures. Current treatment options include brachytherapy alone with either interstitial [110][111][112] or intracavitary [113] approach, or in combination with external beam radiation therapy (EBRT) [114], SRS [115] and SBRT [116].…”

“…When permanent radioactive 198 Au [110] or 125 I [111,112] interstitial implantation was used, the reported 2-and 3-year LCs were 26-41% and 5-23%, respectively, and the reported 1-, 2-, 3-, and 5-year OS were 84%, 30-51%, 6-30%, and 54%, respectively [110][111][112] (Table 3). Moreover, LC was superior in recurrences confined to the nasopharynx compared to those extending beyond the nasopharynx [110].…”