Advantages of intensity modulated radiotherapy in recurrent T1-2 nasopharyngeal carcinoma: a retrospective study

BMC Cancer

Jianji Pan¹  Lingling Huang²  Yuanji Xu²  Chaobin Huang²  Shaojun Lin²  Luying Xu²  Wei Zheng²  Jun Lu¹  Sufang Qiu¹ 

[1]The Teaching Hospital of Fujian Health College, Fuzhou, Fujian, People’s Republic of China

[2]Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People’s Republic of China

关键词: Re-irradiation treatment;    Recurrent T1-2 nasopharyngeal carcinoma;    IMRT;   

Others  :  1120940
DOI  :  10.1186/1471-2407-14-797

 received in 2014-06-13, accepted in 2014-10-23,  发布年份 2014

【 摘 要 】

Background

Recurrent T1-2 Nasopharyngeal Carcinoma (rT1-2) may be salvaged by 3D – CRT (3D-Conformal Radiotherapy), IMRT (Intensity Modulated Radiotherapy), Brachytherapy (BT), BT with external radiotherapy. The purpose of this study is to address the efficacy and toxicity profile of aforementioned four modalities for rT1-2 NPC.

Methods

168 patients, median age 48 years (range 16–75 years) proven rT1-2 NPC were diagnosed and treated with four different irradiation modalities (3D-CRT, IMRT, BT, BT with external radiotherapy). Median time to recurrence was 30 months (range 1–180 months). The median follow-up time was 28 months (range, 4–135 months).

Results

161 patients completed a median dose of 6445 cGy (ranging 30 to 87 Gy). Seven patients prematurely terminated their treatment due to acute side-effects and received 30–49 Gy. The 1- and 3-year local regional recurrent free survival (LRRFS), distant free survival (DFS), and overall survival (OS) rates were 82.03% vs. 82.03% vs. 82.58%, 51.33% vs. 51.33% vs. 53.41, respectively. Gender and recurrence T-classification were the two significant adverse prognostic factors for LRRFS, DFS, and OS rates. Grade 3 or 4 toxicities were tolerable.

Conclusion

3D-CRT, IMRT, BT, BT with external radiotherapy are feasible and efficacious for rT1-2 NPC. In toxicity 3D-CRT/IMRT group is lower than BT group. IMRT is superior for rT1-2 NPC.

【 授权许可】

   
2014 Qiu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Lee AW, Lin JC, Ng WT: Current management of nasopharyngeal cancer. Semin Radiat Oncol 2012, 22:233-244.
• [2]Zhang L, Chen QY, Liu H, Tang LQ, Mai HQ: Emerging treatment options fornasopharyngeal carcinoma. Drug Des Devel Ther 2013, 7:37-52.
• [3]Xu T, Tang J, Gu M, Liu L, Wei W, Yang H: Recurrent nasopharyngeal carcinoma: a clinical dilemma and challenge. Curr Oncol 2013, 20(5):e406-e419. doi:10.3747/co.20.1456.
• [4]Ho AS, Kaplan MJ, Fee WE Jr, Yao M, Sunwoo JB, Hwang PH: Targeted endoscopic salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma. Int Forum Allergy Rhinol 2012, 2:166-173.
• [5]Cheah SK, Lau FN, Yusof MM, Phua VC: Treatment outcome with brachytherapy for recurrent nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2013, 14:6513-6518.
• [6]Ozyigit G, Cengiz M, Yazici G, Yildiz F, Gurkaynak M, Zorlu F, Yildiz D, Hosal S, Gullu I, Akyol F: A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2011, 81:22.
• [7]Chen C, Fee W, Chen J, Chan C, Khong B, Hara W, Goffinet D, Li D, Le QT: Salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC). Am J Clin Oncol 2012, 27:27.
• [8]Succo G, Rosso S, Fadda G, Fantini M, Crosetti E: Salvage photodynamic therapy for recurrent nasopharyngeal carcinoma. Photodiagnosis Photodyn Ther 2014, 13:00006-00004.
• [9]Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW, Mai WY, Teh BS, Butler EB, Lu TX: Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol 2012, 24:569-576.
• [10]Chen D, Yu Y, Qi B, Liu J, Li M, Liang Y: Comparison of temporomandibular joint injuries after three-dimensional conformal and intensity-modulated radiotherapies for nasopharyngeal carcinoma. Nan Fang Yi Ke Da Xue Xue Bao 2012, 32:991-994.
• [11]Cox JD, Stetz J, Pajak TF: Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995, 31(5):1341-1346.
• [12]Chan JY, Chow VL, Tsang R, Wei WI: Nasopharyngectomy for locally advanced recurrent nasopharyngeal carcinoma: exploring the limits. Head Neck 2012, 34:923-928.
• [13]Law SC, Lam WK, Ng MF, Au SK, Mak WT, Lau WH: Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy: an effective means of local salvage. Int J Radiat Oncol Biol Phys 2002, 54:1095-1113.
• [14]Leung TW, Tung SY, Sze WK, Sze WM, Wong VY, Wong CS, SK O: Salvage radiation therapy for locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000, 48:1331-1338.
• [15]Wu SX, Chua DT, Deng ML, Zhao C, Li FY, Sham JS, Wang HY, Bao Y, Gao YH, Zeng ZF: Outcome of fractionated stereotactic radiotherapy for 90 patients with locally persistent and recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2007, 69:761-769.
• [16]Chua DT, Sham JS, Kwong PW, Hung KN, Leung LH: Linear accelerator-based stereotactic radiosurgery for limited, locally persistent, and recurrent nasopharyngeal carcinoma: efficacy and complications. Int J Radiat Oncol Biol Phys 2003, 56:177-183.
• [17]Taheri-Kadkhoda Z, Pettersson N, Bjork-Eriksson T, Johansson KA: Superiority of intensity-modulated radiotherapy over three-dimensional conformal radiotherapy combined with brachytherapy in nasopharyngeal carcinoma: a planning study. Br J Radiol 2008, 81:397-405.
• [18]Kam MK, Teo PM, Chau RM, Cheung KY, Choi PH, Kwan WH, Leung SF, Zee B, Chan AT: Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2004, 60:1440-1450.
• [19]Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Weinberg V, Fu KK: Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002, 53:12-22.
• [20]Lin S, Pan J, Han L, Zhang X, Liao X, Lu JJ: Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys 2009, 75:1071-1078.
• [21]Kristensen CA, Kjaer-Kristoffersen F, Sapru W, Berthelsen AK, Loft A, Specht L: Nasopharyngeal carcinoma. Treatment planning with IMRT and 3D conformal radiotherapy. Acta Oncol 2007, 46:214-220.
• [22]Lu TX, Mai WY, Teh BS, Zhao C, Han F, Huang Y, Deng XW, Lu LX, Huang SM, Zeng ZF, Lin CG, Lu HH, Chiu JK, Carpenter LS, Grant WH III, Woo SY, Cui NJ, Butler EB: Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2004, 58:682-687.
• [23]Chua DT, Sham JS, Leung LH, Au GK: Re-irradiation of nasopharyngeal carcinoma with intensity-modulated radiotherapy. Radiother Oncol 2005, 77:290-294.
• [24]Qiu S, Lin S, Tham IW, Pan J, Lu J, Lu JJ: Intensity-modulated radiation therapy in the salvage of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2012, 83:676-683.
• [25]Oksuz DC, Meral G, Uzel O, Cagatay P, Turkan S: Reirradiation for locally recurrent nasopharyngeal carcinoma: treatment results and prognostic factors. Int J Radiat Oncol Biol Phys 2004, 60:388-394.
• [26]Tian YM, Tian YH, Zeng L, Liu S, Guan Y, Lu TX, Han F: Prognostic model for survival of local recurrent nasopharyngeal carcinoma with intensity-modulated radiotherapy. Br J Cancer 2014, 110:297-303.
• [27]Hua YJ, Han F, Lu LX, Mai HQ, Guo X, Lu TX, Zhao C: Long-term treatment outcome of recurrent nasopharyngeal carcinoma treated with salvage intensity modulated radiotherapy. Eur J Cancer 2012, 48:3422-3428.
• [28]Chen HY, Ma XM, Ye M, Hou YL, Xie HY, Bai YR: Effectiveness and toxicities of intensity-modulated radiotherapy for patients with locally recurrent nasopharyngeal carcinoma. PLoS One 2013, 8(9):e73918.