External Beam Radiotherapy With Endocavitary Boost for Nasopharyngeal Cancer: Treatment Results and Late Toxicity After Extended Follow-Up

Schinagl, Dominic A.X.; Marres, H.A.M.; Kappelle, A.C.; Merkx, Matthias A.W.; Pop, L.A.M.; Verstappen, Suzanne M M; Kaanders, Johannes H.A.M.

doi:10.1016/j.ijrobp.2009.08.072

Cited by 17 publications

(22 citation statements)

References 22 publications

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“…Leung et al and Yeo et al both reported that brachytherapy boost supplementing radical EBRT improved local control in NPC patients with early T1-2B disease [37,38]. However, Schinagl et al reported that while EBRT with endocavitary brachytherapy produced excellent rates of local control for T1-2 tumors, the high incidence of late toxicity suggested overtreatment [39]. In this study, boost irradiation did not confer any survival benefit to patients with persistent PT at the end of RT.…”

Section: Discussionmentioning

confidence: 99%

Primary tumor regression speed after radiotherapy and its prognostic significance in nasopharyngeal carcinoma: a retrospective study

Zhang

Deng

et al. 2014

BMC Cancer

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BackgroundTo observe the primary tumor (PT) regression speed after radiotherapy (RT) in nasopharyngeal carcinoma (NPC) and evaluate its prognostic significance.MethodsOne hundred and eighty-eight consecutive newly diagnosed NPC patients were reviewed retrospectively. All patients underwent magnetic resonance imaging and fiberscope examination of the nasopharynx before RT, during RT when the accumulated dose was 46–50 Gy, at the end of RT, and 3–4 months after RT.ResultsOf 188 patients, 40.4% had complete response of PT (CRPT), 44.7% had partial response of PT (PRPT), and 14.9% had stable disease of PT (SDPT) at the end of RT. The 5-year overall survival (OS) rates for patients with CRPT, PRPT, and SDPT at the end of RT were 84.0%, 70.7%, and 44.3%, respectively (P < 0.001, hazard ratio [HR] = 2.177, 95% confidence interval [CI] = 1.480-3.202). The 5-year failure-free survival (FFS) and distant metastasis-free survival (DMFS) rates also differed significantly (87.8% vs. 74.3% vs. 52.7%, P = 0.001, HR = 2.148, 95% CI, 1.384-3.333; 91.7% vs. 84.7% vs. 66.1%, P = 0.004, HR = 2.252, 95% CI = 1.296-3.912). The 5-year local relapse–free survival (LRFS) rates were not significantly different (95.8% vs. 86.0% vs. 81.8%, P = 0.137, HR = 1.975, 95% CI, 0.976-3.995). By multivariate analyses, the PT regression speed at the end of RT was the only independent prognostic factor of OS, FFS, and DMFS (P < 0.001, P = 0.001, and P = 0.004, respectively). The 5-year FFS rates for patients with CRPT during RT and CRPT only at the end of RT were 80.2% and 97.1%, respectively (P = 0.033). For patients with persistent PT at the end of RT, the 5-year LRFS rates of patients without and with boost irradiation were 87.1% and 84.6%, respectively (P = 0.812).ConclusionsPT regression speed at the end of RT was an independent prognostic factor of OS, FFS, and DMFS in NPC patients. Immediate strengthening treatment may be provided to patients with poor tumor regression at the end of RT.

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Section: Discussionmentioning

confidence: 99%

Primary tumor regression speed after radiotherapy and its prognostic significance in nasopharyngeal carcinoma: a retrospective study

Zhang

Deng

et al. 2014

BMC Cancer

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“…For patients with persistent NPC, the local control rate is nearly 40% [3]. To date, intracavitary brachytherapy remains the most effective salvage therapy for locally superficial residual NPC (≤1 cm below the nasopharyngeal epithelium) [4], [5]. For patients with T1-2 persistent NPC, the local relapse-free survival (LRFS) rate is 91.0–95.8% after ICBT boost radiation, whereas was 60.0–85.2% in patients without given ICBT boost [6], [7], [8].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the overall survival (OS) rate can be elevated from 79.6% to 91.1% by adding the ICBT boost [9]. Importantly, ICBT had a limited dosage in paranasopharyngeal vital organs, and evidently reduced temporal lobe necrosis, cranial nerve palsy and endocrine dysfunction [4].…”

Section: Introductionmentioning

confidence: 99%

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Endoscope-Guided Interstitial Intensity-Modulated Brachytherapy and Intracavitary Brachytherapy as Boost Radiation for Primary Early T Stage Nasopharyngeal Carcinoma

et al. 2014

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BackgroundIntracavitary brachytherapy (ICBT) is usually applied as boost radiotherapy for superficial residual of nasopharyngeal carcinoma (NPC) after primary extern-beam radiptherapy (ERT). Here, we evaluated the outcome of endoscope-guided interstitial intensity-modulated brachytherapy (IMBT) boost radiation for deep-seated residual NPC.Methodology/Principal FindingsTwo hundred and thirteen patients with residual NPC who were salvaged with brachytherapy boost radiation during 2005–2009 were analyzed retrospectively. Among these patients, 171 patients had superficial residual NPC (≤1 cm below the nasopharyngeal epithelium) were treated with ICBT boost radiation, and interstitial IMBT boost radiation was delivered to 42 patients with deep-seated residual NPC (>1 cm below the nasopharyngeal epithelium). We found that IMBT boost subgroup had a higher ratio of T2b (81.0% VS 34.5%, P<0.001) and stage II (90.5% VS 61.4%, P = 0.001) than that of ICBT boost subgroup. The dosage of external-beam radiotherapy in the nasopharyngeal (63.0±3.8 VS 62.6±4.3 Gray (Gy), P = 0.67) and regional lymph nodes (55.8±5.0 VS 57.5±5.7 Gy, P = 0.11) was comparable in both groups. For brachytherapy, IMBT subgroup had a lower boost radiation dosage than ICBT subgroup (11.0±2.9 VS 14.8±3.2 Gy, P<0.01). Though the IMBT group had deeper residual tumors and received lower boost radiation dosages, both subgroups had the similar 5-year actuarial overall survival rate (IMBT VS ICBT group: 96.8% VS 93.6%, P = 0.87), progression-free survival rate (92.4% VS 86.5%, P = 0.41) and distant metastasis-free survival rate (94.9% VS 92.7%, P = 0.64). Moreover, IMBT boost radiation subgroup had a similar local (97.4% VS 94.4%, P = 0.57) and regional (95.0% VS 97.2%, P = 0.34) control to ICBT subgroup. The acute and late toxicities rates were comparable between the both subgroups.Conclusions/SignificanceIMBT boost radiation may be a promising therapeutic selection for deep-seated residual NPC.

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“…71,72 Brachytherapy can be used as the sole salvage treatment, in particular in the case of re-irradiation for local residual occurring within 6 months, or well circumscribed/non-bulky recurrent disease diagnosed after achievement of complete remission with radical radiotherapy. [73][74][75][76] Very selected nasopharyngeal recurrence from other skull base tumours may also be candidate to brachytherapy reirradiation. 77 Compared to conventional EBRT, the main advantages of temporary or permanent brachytherapy, bringing the radiation sources directly near and/or into the tumour include a higher localized dose around the target volume and a shorter overall treatment time.…”

Section: Brachytherapymentioning

confidence: 99%

Review of photon and proton radiotherapy for skull base tumours

Fossati

Vavassori²,

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tAn extremely large variety of benign and malignant tumours occur at skull base; these tumour lesions are in the proximity to structures deputed to relevant physiologic functions, limiting extensive surgical approaches to this body district. Most recent progresses of surgery and radiotherapy have allowed to improve local control with acceptable rates of side effects. Various photon radiotherapy techniques are employed, including 3-dimensional conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy (SRT) and brachytherapy that is manly limited to the treatment of primary or recurrent nasopharyngeal carcinoma. Proton beam radiotherapy is also extensively used thanks to its physical characteristics. Our review, focusing in particular on meningioma, chordoma, and chondrosarcoma, suggests that proton therapy plays a major role in the treatment of malignant tumours whereas photon therapy still plays a relevant role in the treatment of benign tumour lesions.

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External Beam Radiotherapy With Endocavitary Boost for Nasopharyngeal Cancer: Treatment Results and Late Toxicity After Extended Follow-Up

Cited by 17 publications

References 22 publications

Primary tumor regression speed after radiotherapy and its prognostic significance in nasopharyngeal carcinoma: a retrospective study

Primary tumor regression speed after radiotherapy and its prognostic significance in nasopharyngeal carcinoma: a retrospective study

Endoscope-Guided Interstitial Intensity-Modulated Brachytherapy and Intracavitary Brachytherapy as Boost Radiation for Primary Early T Stage Nasopharyngeal Carcinoma

Review of photon and proton radiotherapy for skull base tumours

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