External beam radiotherapy with endocavitary boost for nasopharyngeal cancer: treatment results and late toxicity after extended follow-up.
OBJECTIVE
To evaluate the long-term outcome after treatment of nasopharyngeal carcinoma and assess late toxicity in a multidisciplinary clinic.


METHODS
A retrospective analysis of 117 patients treated for nasopharyngeal cancer in a single institute between 1985 and 2002 was performed. Fifty-one long-term survivors were evaluated for late toxicity by a multidisciplinary team comprising a radiation oncologist, otolaryngologist, neurologist, and oral and maxillofacial surgeon.


RESULTS
The 5-year local control rate for T1 to T2 and T3 to T4 tumors was 97% and 76%, respectively. Five-year disease-free survival and overall survival were 82% and 88% for Stage I to IIb disease and 46% and 52% for Stage III to IVb, respectively. Late morbidity evaluation revealed Radiation Therapy Oncology Group (RTOG) Grade III to IV toxicity in 71% of patients. A high incidence of cranial nerve palsies (47%) and mandibular osteolysis (82%) was found, although these complications had limited clinical impact.


CONCLUSIONS
The multidisciplinary late morbidity clinic revealed an unexpected high incidence of cranial nerve palsies and mandibular osteolysis and overall an RTOG Grade III to IV toxicity in 71% of patients treated for nasopharyngeal cancer. External beam radiotherapy with endocavitary brachytherapy produces excellent rates of local control for T1 to T2 tumors, but the high incidence of late toxicity suggests an overtreatment.
Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. d.schinagl@rther.umcn.nl
Dominic A X
DA
Schinagl
Henri A M
HA
Marres
Arnoud C
AC
Kappelle
Matthias A W
MA
Merkx
Lucas A M
LA
Pop
Suzan M M
SM
Verstappen
Johannes H A M
JH
Kaanders
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002648:Child; D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008336:Mandibular Diseases / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D010014:Osteolysis / Q000453:epidemiology / Q000209:etiology*; D010348:Patient Care Team / Q000458:organization & administration; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012189:Retrospective Studies; D017741:Survivors; D055815:Young Adult