Stereotactic radiotherapy for locally recurrent nasopharyngeal carcinoma

Abstract

Objective: To determine the efficacy of stereotactic radiotherapy (SRT) in the treatment of recurrent nasopharyngeal carcinoma. Study Design: A retrospective review of the outcome of SRT for patients with recurrent nasopharyngeal carcinomas following definitive conventional radiation therapy. Methods: Five patients were treated with daily static multiportal irradiation. Two Gy was administered with eight isocentric portals in a single plane 5 days a week, and the plane was changed for every 20 to 30 Gy. Of these patients, three had poorly differentiated squamous cell carcinoma. Tumor sizes ranged from 1 to 15 cm3, with a median size 3.2 cm3. Median follow‐up time from SRT was 34 months (range, 4–61 mo). Results: Four of five recurrent tumors responded well and achieved complete regression. Three patients have survived without evidence of local recurrence with a median follow‐up time of 34 months. Marginal recurrence was observed at the posterosuperior wall in a patient with adenoid cystic carcinoma at 30 months after SRT. One patient who received SRT after the two complete courses of radiation therapy died 6 months after SRT as a result of rupture of a branch of the left carotid artery, but autopsy revealed no local residual tumor. Conclusions: Stereotactic radiotherapy with isocentric multiportals in one plane, which is changed at every 20 to 30 Gy, can provide local control with acceptable toxicity in patients with recurrent nasopharyngeal carcinoma, but increased clinical experience and longer follow‐up will be necessary to evaluate the overall role of this technique in nasopharyngeal carcinoma.

Comparison of single versus fractionated dose of stereotactic radiotherapy for salvaging local failures of nasopharyngeal carcinoma: a matched-cohort analysis

“…Based on radiobiology principle, fractionation will provide better therapeutic ratio and improve treatment outcome in retreatment of NPC, and SRM has subsequently been explored as a salvage treatment for NPC. Mitsuhashi et al treated 3 patients with rT1 NPC using SRM at a dose of 50–64 Gy, and all 3 patients achieved complete response and remained free of local disease at 4–61 months [ 23 ]. The report by Mitsuhashi et al also included another patient with mucoepidermoid carcinoma of the nasopharynx treated by SRM after previous two courses of external radiotherapy, but the treatment was complicated by rupture of the internal carotid artery resulting in patient death.…”

Stereotactic Radiosurgery as a Salvage Treatment for Recurrent Epipharyngeal Carcinoma

“…The epipharynx is surrounded by several important anatomic structures, such as the brainstem, the spinal cord, the pituitary gland, the optic pathways, the temporo-mandibular joint, the parotid, and so on. Today, in the management of EPC the use of new irradiation techniques has been much reported and discussed such as stereotactic radiosurgery [1][2][3][4][5][6][12][13][14] , stereotactic radiation therapy [15,16] , 3-dimensional conformal radiation therapy [17] , intensity-modulated radiation therapy [18] and brachytherapy, so these techniques will be used more and more. Recently, stereotactic radiosurgery was investigated as a salvage therapy [1][2][3][4][5][6] or as a boost treatment [7,8] after irradiation in advanced recurrent EPC, and there are several reports demonstrating the success of controlling skull base recurrence with this method ( table 3 ).…”

Two Cases of Stereotactic Radiosurgical Boost as an Initial Treatment for Young Nasopharyngeal Cancer Patients

“…The technology of STI has been applied not only to intracranial lesions but also to extracranial ones. Nasopharyngeal tumors are now commonly treated with STI, but most reports involve recurrent nasopharyngeal cancer (6)(7)(8)(9). Regarding the use of STI for recurrent nasopharyngeal cancer, we have so far treated five patients with hypofractionated SRT (30-36 Gy/5-6 fractions) alone.…”