Customized conformal high-dose-rate brachytherapy boost for limited-volume nasopharyngeal cancer.
OBJECTIVE
To determine the feasibility of and patient outcomes using customized high-dose-rate (HDR) brachytherapy to boost the nasopharynx after external beam radiation therapy (EBRT) in patients with carcinoma of the nasopharynx.


METHODS
Patients with nonmetastatic squamous cell carcinoma of the nasopharynx were treated using EBRT followed by a HDR brachytherapy boost delivered via customized catheters in a noninvasive, accurate, and reproducible method under direct fiber-optic visualization. Local control (LC), disease-free survival (DFS), and overall survival (OS) were analyzed. We also measured the change in maximum oral aperture as an indication of temporomandibular joint dysfunction.


RESULTS
Between March 1996 and July 2003, we treated 38 patients with this customized brachytherapy method. The procedure was well tolerated without any incidents of soft-tissue or bone necrosis and with minimal decrease of oral aperture. Median follow-up time was 47 months (range, 2-84 months); 35 patients had at least 1 year of follow-up. The 5-year actuarial rate of LC, DFS, and OS were 96.0%, 81.4%, and 92.7%, respectively.


CONCLUSIONS
The treatment has been well tolerated by all patients. The combination of conformal EBRT with our customized HDR brachytherapy boost has resulted in excellent local control to date, while minimizing temporomandibular joint dysfunction.
Ng
Tracy
T
Department of Radiation Oncology, St. Vincent's Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011, USA.
Richards
Gregory M
GM
Emery
Richard S
RS
Ho
Garman
G
Yung
Raymond
R
Cheng
Andrew
A
Berson
Anthony M
AM
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000295:instrumentation / Q000379:methods*; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis