Gamma Knife Radiosurgery Using Co-Registration with PET-CT and MRI for Recurrent Nasopharyngeal Carcinoma with Previous Radiotherapy : A Single Center 14-Year Experience

Abstract

Objective :We retrospectively evaluated the efficacy of Gamma Knife radiosurgery (GKS) for recurrent nasopharyngeal carcinoma (NPC) in patients who previously underwent radiotherapy, and analyzed the treatment outcomes over 14 years. Methods : Ten patients with recurrent NPC who had previously received radiotherapy underwent stereotactic radiosurgery using a Gamma Knife® (Elekta Inc, Atlanta, GA, USA) between 2005 and 2018. The median target volume was 8.2 cm 3 (range, 1.7-17.8), and the median radiation dose to the target was 18 Gy (range, 12-30). The median follow-up period was 18 months (range, 6-76 months). Overall and local failure-free survival rates were determined using the Kaplan-Meier method. Results : The NPCs recurred at the primary cancer site in seven patients (70%), as distant brain metastasis in two (20%), and as an extension into brain in one (10%). The recurrent tumors in seven of the 10 patients (70%) were found on the routine follow-up imaging studies. Two patients presented with headache and one with facial pain. Local failure after GKS occurred in five patients (50%) : two of whom died eight and 6 months after GKS, respectively. No adverse radiation effects were noted after GKS. The 1-and 3-year overall survival rates after GKS were 90% and 77%, respectively. The local failure-free survival rates at 6 months, 1 year, and 3 years after GKS were 80%, 48%, and 32%, respectively. The median interval from GKS to local failure was 8 months (range, 6-12). Univariate analysis revealed that using co-registration with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) was associated with a lower local failure rate of recurrent NPC (p=0.027). Conclusion : GKS is an acceptable salvage treatment option for patients with recurrent NPC who previously received radiation therapy. PET-CT and MRI co-registration for dose planning can help achieve local control of recurrent NPC. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Salvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta‐analysis

“…As such, based on the treatment strategy, 101 cohorts underwent data collection. Among these, 24 cohorts reported on IMRT, 26–49 17 on CRT, 34,49–64 11 on SRS, 34,57,65–73 9 on brachytherapy, 13,47,51,74–79 18 on open nasopharyngectomy, 41,80–95 and 22 on endoscopic nasopharyngectomy 39,40,48,49,62,92,96–112 …”

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

“…With the use of a single fraction of 12.5-18 Gy, satisfactory treatment outcomes were observed with reported 1-, 3-, and 5-year OS in 90-98%, 66-77%, and 47%, respectively [89][90][91] (Table 3). The time interval from previous RT, T classification of the recurrence, and tumor volume are all predictive factors of local control and survival.…”

“…Severe late toxicity reported in 0-33% of the patients after SRS for rNPC included brain necrosis, pituitary insufficiency, and cranial nerve palsy, in descending order, with no treatment-related deaths observed in the published studies [89][90][91]. 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]…”

“…Stereotactic radiosurgery is a highly accurate form of radiation therapy that delivers a single dose of precisely targeted radiation using focused gamma-ray beams that converge solely on the specific area where the tumor resides, minimizing the amount of radiation to healthy tissues. Limited evidence on the use of linac-based SRS [89] or Gamma Knife [90,91] as a single treatment modality in rNPC is available.…”