title: Outcome of fractionated stereotactic radiotherapy for 90 patients with locally persistent and recurrent nasopharyngeal carcinoma.
abstract: OBJECTIVE
  Local recurrence remains one of the major causes of failure in nasopharyngeal carcinoma (NPC). Stereotactic radiosurgery and fractionated stereotactic radiation therapy (FSRT) have recently evolved as a salvage option of NPC. This study was conducted to review the treatment outcome after FSRT for NPC.
  
  
  METHODS
  Between September 1999 and December 2005, 90 patients with persistent (Group 1: n = 34, relapse within 6 months of RT) or recurrent (Group 2: n = 56, relapse beyond 6 months) NPC received FSRT using multiple noncoplanar arcs of 8-MV photon to the target. Median FSRT dose was 18 Gy in three fractions (Group 1) or 48 Gy in six fractions (Group 2). Median follow-up was 20.3 months.
  
  
  RESULTS
  Complete response rate after FSRT was 66% for Group 1 and 63% for Group 2. One-, 2-, and 3-year disease-specific survival (DSS) and progression-free survival (PFS) rates for all patients were 82.6%, 74.8%, 57.5%, and 72.9%, 60.4%, 54.5%, respectively. Three-year local failure-free survival, DSS, and PFS rates were 89.4%, 80.7%, and 72.3% for Group 1, and 75.1%, 45.9%, and 42.9% for Group 2, respectively. Multivariate analysis showed that recurrent disease and large tumor volume were independent factors that predicted poorer DSS and PFS. Seventeen patients developed late complications, including 2 with fatal hemorrhage.
  
  
  CONCLUSIONS
  Our results indicate that FSRT is effective for patients with persistent and recurrent NPC. Compared with reported results of radiosurgery, FSRT provides satisfactory tumor control and survival with a lower risk of complications and it may be a better treatment for local failures of NPC.
authors.affiliation: Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, China. wushaox@mail.sysu.edu.cn
authors.forename: Shao-Xiong
authors.initials: SX
authors.lastname: Wu
authors.forename: Daniel T T
authors.initials: DT
authors.lastname: Chua
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Deng
authors.forename: Chong
authors.initials: C
authors.lastname: Zhao
authors.forename: Feng-Yan
authors.initials: FY
authors.lastname: Li
authors.forename: Jonathan S T
authors.initials: JS
authors.lastname: Sham
authors.forename: Han-Yu
authors.initials: HY
authors.lastname: Wang
authors.forename: Yong
authors.initials: Y
authors.lastname: Bao
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Gao
authors.forename: Zhi-Fan
authors.initials: ZF
authors.lastname: Zeng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome