Brachytherapy in Reirradiation of Locally Recurrent Nasopharyngeal Cancer: Case Report

Abstract

Purpose: Nasopharyngeal carcinoma (NPC) is a most cancer of head and neck in North Africa and South East Asia. The risk of local recurrence after treatment is higher. Reirradiation can be difficult and limited by the constraints of doses to organs at risk already irradiated. The aim of this study was to determine the role of brachytherapy in safety reirradiation of recurrent NPC. Methods and Materials:From 2002 to 2011, five patients were reirradiated for local recurrence nasopharyx cancer with or without external beam radiotherapy (EBRT). Results:The median age was 49 years, all were male, four patients had World Health Organization Class III histology, and one with nasopharyx cancer type I. Two, 1 and 2 patients had recurrent Stage I, II, III, respectively. Median time to reirradiation was 49 months. Four patients received combined-modality treatment, consisting of external beam radiotherapy (EBRT) with chemotherapy followed by intracavitary brachytherapy High Dose Rate (HDR) boost, one patient received intracavitary brachytherapy alone for dosimetric constraints for organs at risk. The total radiation dose EQD2 was between 60 and 70Gy. All patients received concomitant chemotherapy and two neoadjuvant chemotherapy. The median follow-up for all patients was 40 months; one patient developed an immobility of the soft palate and another had grade II trismus. Conclusion:Brachytherapy alone or after EBRT may play an important role in reirradiation of locally recurrent NPC with acceptable toxicity.