Published in:
01-12-2013 | Original article
Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma
Treatment results and locoregional recurrence
Authors:
J.L.-Y. Chen, M.D., Y.-S. Huang, M.D., S-H. Kuo, M.D. Ph.D., Y.-F. Chen, M.D., R.-L. Hong, MD. Ph.D., J.-Y. Ko, M.D. Ph.D., P.-J. Lou, M.D. Ph.D., C.-L. Tsai, M.D., W.-Y. Chen, M.D., C.-W. Wang, M.D.
Published in:
Strahlentherapie und Onkologie
|
Issue 12/2013
Login to get access
Abstract
Purpose
The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).
Methods and materials
Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33–35 fractions. In addition, 97 % of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.
Results
The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1 %, respectively. A total of 27 patients had locoregional recurrence: 85.2 % in-field failures, 11.1 % marginal failures, and 3.7 % out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9 %) compared to those receiving conservative treatment (32.0 %, p = 0.051). In patients treated with 1 course of radiotherapy, grade ≥ 3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6 % of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.
Conclusion
IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.