Locally recurrent nasopharyngeal carcinoma
Introduction
Nasopharyngeal carcinoma (NPC) is a common malignancy in Taiwan [16]. Radiotherapy is the major treatment modality, and the overall 5-year survival approaches 50–70% [9], [18], [25], [30]. The causes of treatment failure area either local recurrence or distant metastasis. The extent of the primary tumor is closely related to the degree of achievable local tumor control [9], [20], [30]. Primary tumor control can be achieved in up to 80–90% of small tumors, but in only 50–60% of advanced tumors, despite total radiation doses are usually up to 70 Gy [25], [27], [29]. Recurrence of the primary tumor is one of the major causes of death from this disease, especially with locally advanced tumors. A major issue in discussions of the treatment of NPC is the management of these primary recurrent tumors.
Re-treatment for local recurrent NPC with additional course of radiotherapy will induce high complications for high radiation dose. How to increase re-treatment effect but did not elevate too much complication is a major consideration to treat the local recurrent NPC. There were a lot of new treatment modalities to approach the recurrent tumor. Conformal radiotherapy will reduce the radiation dose the normal tissue may reduce the complications. Radiosurgery has the benefit of a rapid fall-off in radiation dose, increasing the radiation therapeutic ratio. The use of radiosurgery for recurrent NPC appears to have significant potential [2], [7]. Surgery for recurrent NPC has also been attempted with some success but the definite role remained uncertain [13], [15], [33]. Chemotherapy has been used for recurrent NPC, producing partial and complete responses in the range 60–70% [4], [10], [12]; however, long-term tumor control is rarely achieved.
In this paper, we report our experience in treating recurrent NPC at Chang Gung Memorial Hospital, Linkou from 1982 to 1995. In particular, we tried to identify factors and the potential role of new treatment modalities for this disease.
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Patient characteristics
From 1982 to 1995, 205 NPC patients initially treated in the Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, had local failure in the nasopharynx and were re-treated with radiotherapy as the primary modality. We excluded the patients with combined relapse in neck and/or distant sites in this discussion. All patients had received >64.8 Gy in their initial course; details of the radiotherapy procedure have been described previously [3], [29]. Recurrence was documented by
Survival
The 1-, 2- and 3-year survival was 54.9, 30.2 and 22.1%, respectively. Four patients were lost to follow-up. One hundred and forty patients had died by the end of the study. Twenty patients subsequently developed distant metastasis. The usual sites of metastasis were lung (9), bone (8), liver (4), brain (1) and soft tissue (1). Three patients had metastasis in two different sites. Two patients died of unrelated causes: one in a car accident and the other of a cerebrovascular accident.
Death was
Discussion
Patients with recurrent nasopharyngeal carcinoma have a very poor prognosis if they are not treated. Yan et al. [34] reported only one 5-year survivor in a group of 276 patients with recurrent disease who received no further treatment. The 3- and 5-year survival in our subjects was 22.1 and 12.4%. Most of our patients presented with advanced recurrence; almost 60% had rT3 or rT4 lesions, despite regular follow-up after treatment of their primary disease. Our data show that stage at which
References (35)
- et al.
The role of brachytherapy in early stage nasopharyngeal carcinoma
Int. J. Radiat. Oncol. Biol. Phys.
(1996) - et al.
Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome
Int. J. Radiat. Oncol. Biol. Phys.
(1997) - et al.
Locally recurrent nasopharyngeal carcinoma: treatment results for patients with computed tomography assessment
J. Radiat. Oncol. Biol. Phys.
(1998) - et al.
Radiosurgery for skull base malignancies and nasopharyngeal carcinoma
Int. J. Radiat. Oncol. Biol. Phys.
(1997) - et al.
Effect of time, dose and fractionation on local control of nasopharyngeal carcinoma
Radiother Oncol
(1995) - et al.
Reirradiation for recurrent nasopharyngeal carcinoma: factors affecting the therapeutic ratio and ways for improvement
Int. J. Radiat. Oncol. Biol. Phys.
(1997) - et al.
Carcinoma of the nasopharynx: factors affecting prognosis
Int. J. Radiat. Oncol. Biol. Phys.
(1992) - et al.
Re-treatment of nasopharyngeal carcinoma in 53 patients
Int. J. Radiat. Oncol. Biol. Phys.
(1992) - et al.
Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control
Int. J. Radiat. Oncol. Biol. Phys.
(1997) - et al.
A clinical study of 407 cases of nasopharyngeal carcinoma in Hong Kong
Int. J. Radiat. Oncol. Biol. Phys.
(1989)
How successful is high-dose (>60 Gy) reirradiation using mainly external beams in salvaging local failures of nasopharyngeal carcinoma?
Int. J. Radiat. Oncol. Biol. Phys.
Re-irradiation of recurrent nasopharyngeal carcinoma – treatment techniques and results
Int. J. Radiat. Oncol. Biol. Phys.
Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099
J. Clin. Oncol.
Linac radiosurgery for locally recurrent nasopharyngeal carcinoma: rationale and technique
Head Neck
Chemotherapy for recurrent or metastatic carcinoma of the nasopharynx
A review of the Princess Margaret Hospital experience. Cancer
A comparison of staging system for nasopharyngeal carcinoma
Cancer
The relationship of nasopharyngeal carcinomas and second independent malignancies based on the radiation therapy oncology group experience
Cancer
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