Long-term Outcomes and Prognostic Factors of Re-irradiation for Locally Recurrent Nasopharyngeal Carcinoma using Intensity-modulated Radiotherapy

Han, Fei; Zhao, Chong; Huang, Shao Min; Lu, Li Xia; Huang, Ying; Deng, Xiao Wu; Yuan, Wei; Teh, Bin S.; Butler, E. Brian; Lu, Tai Xiang

doi:10.1016/j.clon.2011.11.010

Cited by 131 publications

(196 citation statements)

References 28 publications

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“…Even the 5-year survival rate of patients with advanced NPC may increase if they are treated properly (18,19). Previous studies have revealed that IMRT is valuable in the clinical treatment of patients with NPC, in particular for locally advanced and recurrent NPC subsequent to radiotherapy (20,24). As revealed in the present study, IMRT improves the local control and survival rate and also reduces radiation side-effects experienced by patients.…”

Section: Discussionsupporting

confidence: 59%

“…When using 2D-CRT, the tumor target dose must be reduced due to the tolerance dose of the spinal cord (17). However, with IMRT the dose may be optimized based on the precision and degree of control over the radiation dose, which allows the tumor radiation dose to be increased significantly (3,(18)(19)(20). The maximum tolerance dose of the spinal cord in the IMRT group was 45 Gy, compared to 40 Gy in the 2D-CRT group.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the efficacy of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma with involvement of the cervical spine

et al. 2015

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Abstract. The aim of the present study was to retrospectively analyze the clinical efficacy and side-effects of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) in 53 NPC patients with cervical spine involvement, without distant metastases. In total, 53 patients were enrolled in the present study, with 24 being treated with IMRT and 29 being treated with 2D-CRT. All 53 patients received platinum-based concurrent chemotherapy and 4-6 cycles of adjuvant chemotherapy subsequent to radiation. The patients were clinically staged according to the seventh edition of the UICC and AJCC staging systems. Overall survival (OS), local progression-free survival (LPFS) and distant metastasis-free survival (DMFS) rates were calculated. The 3-and 5-year OS rates were 87.7% and 45.5% in the IMRT-treated group and 65.5% and 9.1% in the 2D-CRT-treated group (P=0.01). The 3-and 5-year LPES rates were 87.4% and 69.9% in the IMRT-treated group compared with 49.4% and 9.4% in the 2D-CRT-treated group, respectively (P=0.00). The 3-and 5-year DMFS rates were 94.4 and 40.8% in the IMRT-treated group and 79.8 and 30.4% in the 2D-CRT-treated group (P=0.13). N stage (P=0.00) and radiotherapy methods (P=0.01) were relevant to the OS and LPFS rates, it also revealed a significant difference when the DMFS rates were analyzed in N stage. The incidence of dry mouth in the IMRT group was significantly lower (P=0.01), but there was no statistically significant difference in acute oropharyngeal mucositis or myelosuppression. IMRT had significant advantages in local control and OS compared with conventional 2D-CRT, but IMRT failed to reduce the incidence of distant metastasis.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Analysis of the efficacy of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma with involvement of the cervical spine

et al. 2015

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“…However, re-irradiation using mainly EBRT techniques to more than 60Gy failed to achieve long term LC instead was associated with significant neurological complications (Teo et al, 1998). Re-irradiation doses between 50-60Gy were able to obtain 100% LC rate for recurrent T1-3 lesions using IMRT techniques (Han et al, 2012). Other studies show retreatment total dose between 50-60Gy was associated with improved LRFS or OS (Chang et al, 2000;Leung et al, 2000).…”

Section: Resultsmentioning

confidence: 88%

“…Six patients did not have nasopharyngoscopy as planned. to dose escalation (Han et al, 2012). Our median total dose was 56Gy but there was a wide range of doses from 13-74Gy.…”

Section: Resultsmentioning

confidence: 99%

Treatment Outcome with Brachytherapy for Recurrent Nasopharyngeal Carcinoma

Cheah¹,

Lau²,

Yusof³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: To evaluate the treatment outcome and major late complications of all patients with recurrent nasopharyngeal carcinoma (NPC) treated with intracavitary brachytherapy (ICBT) in Hospital Kuala Lumpur. Materials and Methods: This retrospective study was conducted at the Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Malaysia. All patients with histologically confirmed recurrent NPC in the absence of distant metastasis treated in the period 1997-2010 were included in this study. These patients were treated with ICBT alone or in combination with external beam radiotherapy (EBRT). Treatment outcomes measured were local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS). Results: Thirty three patients were eligible for this study. The median age at recurrence was 56 years with a median time to initial local recurrence of 27 months. Majority of patients were staged as rT1-2 (94%) or rN0 (82%). The proportion of patients categorised as stage III-IV at first local recurrence was only 9%. Twenty one patients received a combination of ICBT and external beam radiotherapy while 12 patients were treated with ICBT alone. Median interval of recurrence post re-irradiation was 32 months (range: 4-110 months). The median LRFS, DFS and OS were 30 months, 29 months and 36 months respectively. The 5 year LRFS, DFS and OS were 44.7%, 38.8% and 28.1% respectively. The N stage at recurrence was found to be a significant prognostic factor for LRFS and DFS after multivariate analysis. Major late complications occurred in 34.9% of our patients. Conclusions: Our study shows ICBT was associated with a reasonable long term outcome in salvaging recurrent NPC although major complications remained a significant problem. The N stage at recurrence was a significant prognostic factor for both LRFS and DFS.

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“…Its efficacy has been established in various studies, with documented long-term OS rates ranging from 45% to 65%. [48][49][50][51][52][53][54][55][56] Yet, most of the patients in those studies were treated with conventional 2D-RT in the pre-IMRT era. In a recent study conducted by Kong et al, 56 77 patients received salvage IMRT for rNPC after a definitive course of primary IMRT.…”

Section: Radiotherapymentioning

confidence: 99%

Beating 'Guangdong cancer': a review and update on nasopharyngeal cancer

2017

Hong Kong Med J

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Long-term Outcomes and Prognostic Factors of Re-irradiation for Locally Recurrent Nasopharyngeal Carcinoma using Intensity-modulated Radiotherapy

Cited by 131 publications

References 28 publications

Analysis of the efficacy of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma with involvement of the cervical spine

Analysis of the efficacy of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma with involvement of the cervical spine

Treatment Outcome with Brachytherapy for Recurrent Nasopharyngeal Carcinoma

Beating 'Guangdong cancer': a review and update on nasopharyngeal cancer

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