title: Stereotactic radiosurgical boost following radiotherapy in primary nasopharyngeal carcinoma: impact on local control.
abstract: OBJECTIVE
  Treatment of patients with nasopharyngeal carcinoma using external beam radiation therapy (EBRT) alone results in significant local recurrence. Although intracavitary brachytherapy can be used as a component of management, it may be inadequate if there is extension of disease to the skull base. To improve local control, stereotactic radiosurgery was used to boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma.
  
  
  METHODS
  Twenty-three consecutive patients were treated with radiosurgery following radiotherapy for nasopharyngeal carcinoma from 10/92 to 5/98. All patients had biopsy confirmation of disease prior to radiation therapy; Stage III disease (1 patient), Stage IV disease (22 patients). Fifteen patients received cisplatinum-based chemotherapy in addition to radiotherapy. Radiosurgery was delivered using a frame-based LINAC as a boost (range 7 to 15 Gy, median 12 Gy) following fractionated radiation therapy (range 64.8 to 70 Gy, median 66 Gy).
  
  
  RESULTS
  All 23 patients (100%) receiving radiosurgery as a boost following fractionated radiation therapy are locally controlled at a mean follow-up of 21 months (range 2 to 64 months). There have been no complications of treatment caused by radiosurgery. However, eight patients (35%) have subsequently developed regional or distant metastases.
  
  
  CONCLUSIONS
  Stereotactic radiosurgical boost following fractionated EBRT provides excellent local control in advanced stage nasopharynx cancer and should be considered for all patients with this disease. The treatment is safe and effective and may be combined with cisplatinum-based chemotherapy.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, CA 94305, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Tate
authors.forename: J R
authors.initials: JR
authors.lastname: Adler
authors.forename: S D
authors.initials: SD
authors.lastname: Chang
authors.forename: S
authors.initials: S
authors.lastname: Marquez
authors.forename: S M
authors.initials: SM
authors.lastname: Eulau
authors.forename: W E
authors.initials: WE
authors.lastname: Fee
authors.forename: H
authors.initials: H
authors.lastname: Pinto
authors.forename: D R
authors.initials: DR
authors.lastname: Goffinet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009333:Neck; D009367:Neoplasm Staging; D016634:Radiosurgery; D011879:Radiotherapy Dosage