title: Fractionated stereotactic radiotherapy with vagina carotica protection technique for local residual nasopharyngeal carcinoma after primary radiotherapy.
abstract: BACKGROUND
  Local failure of nasopharyngeal carcinoma (NPC) after radiotherapy (RT) remains one of the major treatment failures. This study aimed to evaluate the clinical efficacy and complications of fractionated stereotactic radiotherapy (FSRT) with vagina carotica protection technique for local residual of NPC patients after the primary RT.
  
  
  METHODS
  From August 2006 to August 2010, FSRT with vagina carotica protection technique was applied to 36 patients in our department, the patients aged between 13 and 76 years with a median of 41.3 years, 25 of them were male and 11 were female. According to 2002 Union for International Cancer Control (UICC) Staging System, the stages before primary radiotherapy were: IIa 2, IIb 5, III 18, IVa 7, IVb 4. In the first course of radiotherapy, 9 patients received conventional RT, 27 patients received intensity modulated radiotherapy (IMRT) and 20 out of the 36 patients received concurrent chemoradiotherapy. The total dose in the first course of RT was 69.96 - 76.90 Gy (median, 72.58 Gy). The intervals between the primary RT and FSRT ranged from 12 to 147 days (median, 39.8 days). Target volumes ranged from 1.46 to 32.98 cm(3) (median, 14.94 cm(3)). The total FSRT doses were 10.0 - 24.0 Gy (median, 16.5 Gy) with 2.0 - 5.0 Gy per fraction. The most common regimen was 15 Gy in 5 fractions of 3 Gy, the irradiation dose to vagina carotica was less than 2 Gy per fraction.
  
  
  RESULTS
  The median follow-up time was 34 months (range, 12 - 59 months). The 3-year local control rate was 100%; the 3-year overall survival rate was 94.4%; the 3-year disease-free survival rate was 77.8%. In this study, we had one case of cranial nerve injury, two cases of temporal lobe necrosis, and no nasopharyngeal massive hemorrhage was observed.
  
  
  CONCLUSIONS
  FSRT with vagina carotica protection technique is an effective and safe RT regimen for local residual of NPC with reduction of radiation-related neurovascular lesions.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Xiao
authors.forename: Ying-Jie
authors.initials: YJ
authors.lastname: Xu
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.forename: Guo-Zhen
authors.initials: GZ
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.forename: Jun-Lin
authors.initials: JL
authors.lastname: Yi
authors.forename: Jing-Wei
authors.initials: JW
authors.lastname: Luo
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Huang
authors.forename: Fu-Kui
authors.initials: FK
authors.lastname: Huan
authors.forename: Hao
authors.initials: H
authors.lastname: Fang
authors.forename: Bao
authors.initials: B
authors.lastname: Wan
authors.forename: Ye-Xiong
authors.initials: YX
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D055815:Young Adult