Effectiveness of brachytherapy and fractionated stereotactic radiotherapy boost for persistent nasopharyngeal carcinoma.
BACKGROUND
Nasopharyngeal carcinoma (NPC) with local persistence after primary radiotherapy carries a high risk of treatment failure. We compared the effectiveness of brachytherapy and a fractionated stereotactic radiotherapy (SRT) boost in improving tumor control.


METHODS
We retrospectively reviewed the records of 755 patients with NPC treated from 1994 to 2001. Fifty-two patients (7%) had persistent local disease, but seven of them were unsuitable for radiotherapy boost. Overall, 24 patients received brachytherapy boost at a median dose of 20 Gy, and 21 patients received an SRT boost at a median dose of 15 Gy.


RESULTS
Despite the radiotherapy boost, the overall 3-year local failure-free control rate was still significantly lower for patients with persistent disease than for the rest (71% vs 86%, p < .01). Only the SRT subgroup achieved a local failure-free control rate close to that of the complete responders (82% vs 86%, p = .71).


CONCLUSIONS
SRT boost is more effective in reverting the poor prognostic influence of local persistent disease.
Yau
Tsz-Kok
TK
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong. tkyau@i-cable.com
Sze
Wai-Man
WM
Lee
Wing-Mui
WM
Yeung
Mei-Wan
MW
Leung
Kim-Cheung
KC
Hung
Wai-Man
WM
Chan
Wing-Ip
WI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome