title: Stereotactic radiosurgery versus gold grain implantation in salvaging local failures of nasopharyngeal carcinoma.
abstract: BACKGROUND
  Limited local failure of nasopharyngeal carcinoma (NPC) can often be salvaged by reirradiation using different techniques. Both gold grain implantation (GGI) and stereotactic radiosurgery (SRS) have been used as salvage treatment of NPC but the relative efficacy of these two treatments is not known.
  
  
  METHODS
  A total of 74 patients with local NPC failure were included in this retrospective analysis. Of these patients, 37 underwent SRS (median dose, 12.5 Gy) and 37 split-palatal GGI at a dose of 60 Gy. The two groups were individually matched for prognostic factors, except for tumor volume. The median follow-up was 42 months.
  
  
  RESULTS
  Local control was better in the GGI group. The 3-year local failure-free rate was 77.9% for the GGI group compared with 68.3% for the SRS group. However, the difference was not statistically significant (p = 0.098). In the subgroup with a tumor volume of <or=5 cm3, the 3-year local failure-free rates were similar, with 79.3% in the GGI group and 72.4% in the SRS group. Neuroendocrine complications were more common in the SRS group, and headache and fistula were more common in the GGI group.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery and GGI are both effective salvage treatment for NPC. In patients with limited local failure, both yielded comparable high tumor control rates.
authors.affiliation: Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China. dttchua@hkucc.hku.hk
authors.forename: Daniel T T
authors.initials: DT
authors.lastname: Chua
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
authors.forename: Jonathan S T
authors.initials: JS
authors.lastname: Sham
authors.forename: Kwan Ngai
authors.initials: KN
authors.lastname: Hung
authors.forename: Gordon K H
authors.initials: GK
authors.lastname: Au
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006050:Gold Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D047368:Tumor Burden
chemical_list: D006050:Gold Radioisotopes