title: Excellent local control with stereotactic radiotherapy boost after external beam radiotherapy in patients with nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To determine long-term outcomes in patients receiving stereotactic radiotherapy (SRT) as a boost after external beam radiotherapy (EBRT) for locally advanced nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Eight-two patients received an SRT boost after EBRT between September 1992 and July 2006. Nine patients had T1, 30 had T2, 12 had T3, and 31 had T4 tumors. Sixteen patients had Stage II, 19 had Stage III, and 47 had Stage IV disease. Patients received 66 Gy of EBRT followed by a single-fraction SRT boost of 7-15 Gy, delivered 2-6 weeks after EBRT. Seventy patients also received cisplatin-based chemotherapy delivered concurrently with and adjuvant to radiotherapy.
  
  
  RESULTS
  At a median follow-up of 40.7 months (range, 6.5-144.2 months) for living patients, there was only 1 local failure in a patient with a T4 tumor. At 5 years, the freedom from local relapse rate was 98%, freedom from nodal relapse 83%, freedom from distant metastasis 68%, freedom from any relapse 67%, and overall survival 69%. Late toxicity included radiation-related retinopathy in 3, carotid aneurysm in 1, and radiographic temporal lobe necrosis in 10 patients, of whom 2 patients were symptomatic with seizures. Of 10 patients with temporal lobe necrosis, 9 had T4 tumors.
  
  
  CONCLUSIONS
  Stereotactic radiotherapy boost after EBRT provides excellent local control for patients with NPC. Improved target delineation and dose homogeneity of radiation delivery for both EBRT and SRT is important to avoid long-term complications. Better systemic therapies for distant control are needed.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Hara
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
authors.forename: Don R
authors.initials: DR
authors.lastname: Goffinet
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.forename: John R
authors.initials: JR
authors.lastname: Adler
authors.forename: Harlan A
authors.initials: HA
authors.lastname: Pinto
authors.forename: Willard E
authors.initials: WE
authors.lastname: Fee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011832:Radiation Injuries / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects; D011879:Radiotherapy Dosage; D013702:Temporal Lobe / Q000528:radiation effects; D016896:Treatment Outcome