title: Fractionated stereotactic radiotherapy in residual or recurrent nasopharyngeal carcinoma.
abstract: The aim of this study was to evaluate results of fractionated stereotactic radiotherapy (FSRT) in patients with residual or recurrent nasopharyngeal carcinoma (NPC) in terms of local progression-free (LPFS) and overall survival (OS) rate and complications after treatment. There were 32 residual or recurrent NPC patients treated with FSRT using linac-based radiosurgery system. Time from the previous radiotherapy to FSRT was 1-165 months (median, 15). Two patients were treated for the second and one for the third recurrence. Thirteen patients (40.6%) also received chemotherapy with FSRT. Tumor volume ranged from 6.2-215 cc (median, 44.4). Average FSRT dose was 17-59.4 Gy (median, 34.6) in 4-25 fractions (median,6) in 1-5.5 weeks (median, 3). Median follow-up time was 25.5(3-67) months. LPFS rate at 1 and 3 years after FSRT was 67.8% and 37.9%. OS rate at 1 and 3 years was 89.7% and 71.2%. If all patients who had tumor progression with no further follow-up were assumed dead, the OS rate at 1 and 3 years would be 75.0% and 37.9%. Univariate analysis showed better local tumor control in patients with tumor volume </=100 cc (p=0.04) or in those without chemotherapy (p=0.0005). Only chemotherapy retained significance in multivariate analysis (hazard ratio 5.47, 95%CI 1.86-16.04). Eight patients (25%) had complications after FSRT, all grade 2-3 except 1 grade 4 with complete recovery.
authors.affiliation: Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. ramdn@mahidol.ac.th
authors.forename: Mantana
authors.initials: M
authors.lastname: Dhanachai
authors.forename: Puangtong
authors.initials: P
authors.lastname: Kraiphibul
authors.forename: Somjai
authors.initials: S
authors.lastname: Dangprasert
authors.forename: Putipun
authors.initials: P
authors.lastname: Puataweepong
authors.forename: Ladawan
authors.initials: L
authors.lastname: Narkwong
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Laothamatas
authors.forename: Boonchu
authors.initials: B
authors.lastname: Kulapraditharom
authors.forename: Ekaphop
authors.initials: E
authors.lastname: Sirachainan
authors.forename: Pornpan
authors.initials: P
authors.lastname: Yongvithisatid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome