Reirradiation for locally recurrent nasopharyngeal carcinoma: treatment results and prognostic factors.
OBJECTIVE
To analyze the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma.


METHODS
Forty-one patients with locally recurrent nasopharyngeal carcinoma, who were reirradiated between 1979 and 2000, were retrospectively analyzed. There were 32 men and 9 women with median age of 46 years. Histologically, 9 tumors (22%) were World Health Organization (WHO) I, 17 (41.5%) WHO II, and 15 (36.5%) WHO III. According to the 1998 TNM staging system of the American Joint Committee on Cancer, the recurrent disease was Stage I in 5 (12.2%), Stage II in 11 (26.8%), Stage III in 6 (14.6%), and Stage IV in 19 (46.4%) patients. Treatment was delivered with 4-6 MV X-rays or Co-60 gamma rays. The median reirradiation dose was 50 Gy. Treatment was delivered at 1.8-2 Gy/fraction daily, 5 days a week. Chemotherapy was used in 41.5% of the patients.


RESULTS
Median follow-up was 23 months (range, 3-143 months). The 2-year and 5-year local progression-free and overall survival rates were 39%, 23%, 48%, and 28%, respectively. On univariate analysis, age (p = 0.04), total reirradiation dose (p = 0.0008) were significant prognostic factors for local progression-free rate. For overall survival age, total reirradiation dose, stage, T stage were significant. On multivariate analysis only total dose (p = 0.005) remained significant for local progression-free rate and total reirradiation dose (p = 0.02), interval to recurrence (p = 0.03), stage (p = 0.018) were significant for overall survival.


CONCLUSIONS
Early diagnosis of local recurrence and high-dose reirradiation (60 Gy) are crucial for improving the local control and survival.
Oksüz
Didem Colpan
DC
Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. didemoksuz@superonline.com
Meral
Gülşen
G
Uzel
Omer
O
Cağatay
Pembe
P
Turkan
Sedat
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies