title: Recurrent nasopharyngeal carcinoma: current management approaches.
abstract: OBJECTIVE
  Providing the primary recurrence is localized, salvage treatment is possible for nasopharyngeal carcinoma (NPC). This is a review of the experience of retreatment of this malignancy highlighting the roles of surgery and repeat radiotherapy.
  
  
  METHODS
  The Tumor Registry of the Prince of Wales Cancer Centre was audited for patients with an initial diagnosis of squamous/nonsquamous cell NPC who had primary treatment with radiotherapy, and now presented for retreatment. Features relating to patient, disease and treatment factors were evaluated. The primary end point was subsequent local control, and secondary endpoints were overall and cancer-specific survival.
  
  
  RESULTS
  Over a 30-year period 39 patients were eligible, with 25 receiving both primary and retreatment at Prince of Wales Hospital. There were 25 males and 14 females with a median age of 50 years. Thirty-six patients had radiotherapy, 4 had stereotactic radiosurgery, 5 had brachytherapy, and the remainder had external treatment. Surgery was performed in 10 patients, of whom 3 had this as the only retreatment modality. Radiotherapy doses for retreatment ranged from 15 Gy (stereotactic radiosurgery) to 71.28 Gy (mean fractionated dose). Local control was achieved in 16 patients giving an overall rate of 41.0%, and the 5-year overall survival rate was 33.3%. Treatment modality was a significant prognostic factor for local control (P < 0.001) and cancer-specific survival (P < 0.05).
  
  
  CONCLUSIONS
  The presence of local recurrence after definitive treatment of NPC may still be salvageable. The best outcomes with reirradiation occur in the context of limited volume recurrence and a disease-free interval greater than 18 months.
authors.affiliation: Departments of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia. robert.smee@sesiahs.health.nsw.gov.au
authors.forename: Robert I
authors.initials: RI
authors.lastname: Smee
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Meagher
authors.forename: Kathryn
authors.initials: K
authors.lastname: Broadley
authors.forename: Timothy
authors.initials: T
authors.lastname: Ho
authors.forename: Janet R
authors.initials: JR
authors.lastname: Williams
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Bridger
mesh_terms: D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis