title: Brachytherapy for primary and recurrent nasopharyngeal carcinoma: 20 years' experience at Long Beach Memorial.
abstract: OBJECTIVE
  We evaluated treatment outcomes of patients with mostly locally advanced primary and recurrent cancer of the nasopharynx managed with interstitial and intraluminal brachytherapy.
  
  
  METHODS
  This is a retrospective analysis of 56 patients with cancer arising from the nasopharynx treated with interstitial and intracavitary afterloading brachytherapy from 1978 to 1997. Patients were divided into three treatment groups: 15 patients with primary cancer (Group 1), 34 patients with recurrent or persistent disease (Group 2), and 7 patients with cancer in the nasopharynx who had history of previous definitive radiation therapy to the nasopharynx for head and neck cancer (Group 3). Fifty-three percent of patients in Group 1 had 1992 AJCC Stage IV disease, and 49% of patients in Groups 2 and 3 had extensive disease (defined as T3, T4, or parapharyngeal extension). Group 1 received megavoltage radiation to 50-60 Gy followed by a boost to the primary site and neck (in cases of persistent neck disease) with a combination of interstitial and intracavitary brachytherapy (mean dose 33-37 Gy). Five patients received chemotherapy, and 6 patients received hyperthermia. Groups 2 and 3 patients were treated with brachytherapy implants (mean dose 50-58 Gy) without external beam radiation. Twenty-five patients received chemotherapy either before or during radiation, and 21 patients received hyperthermia.
  
  
  RESULTS
  The overall survival at 2, 5, and 10 years for patients in Group 1 was 79%, 61%, and 61%, respectively, and for patients in Groups 2 and 3 combined was 48%, 30%, and 20%, respectively. Cause-specific survival at 2, 5, and 10 years was 87%, 74%, and 74%, respectively, for patients in Group 1; and 82%, 60%, and 60%, respectively, for patients in Groups 2 and 3. Local control at 2, 5, and 10 years was 93%, 93%, and 77%, respectively, for patients in Group 1; and 81%, 59%, and 49%, respectively, for patients in Groups 2 and 3. Control in the neck at 2, 5, and 10 years was achieved in 93%, 93%, and 93% of patients, respectively, in Group 1; and 88%, 81%, and 81%, respectively, for patients in Groups 2 and 3. Disease-free survival was 87%, 74%, and 62%, respectively, for patients in Group 1, and 56%, 41%, and 34%, respectively, for patients in Groups 2 and 3. There were 4 peri-operative deaths. One death (2%) was attributable to the development of late complications. Forty-five percent of patients experienced some form of late complications.
  
  
  CONCLUSIONS
  Interstitial afterloading brachytherapy can provide effective treatment for nasopharyngeal cancers, especially for locally persistent/recurrent and locally extensive lesions.
authors.affiliation: Department of Radiation Oncology, Long Beach Memorial Medical Center, CA 90806, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Syed
authors.forename: A A
authors.initials: AA
authors.lastname: Puthawala
authors.forename: S J
authors.initials: SJ
authors.lastname: Damore
authors.forename: J M
authors.initials: JM
authors.lastname: Cherlow
authors.forename: P A
authors.initials: PA
authors.lastname: Austin
authors.forename: R
authors.initials: R
authors.lastname: Sposto
authors.forename: N S
authors.initials: NS
authors.lastname: Ramsinghani
mesh_terms: D000704:Analysis of Variance; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000532:radiotherapy*; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011379:Prognosis; D011832:Radiation Injuries / Q000150:complications; D012044:Regression Analysis; D012189:Retrospective Studies; D013280:Stomatitis / Q000209:etiology