title: Effectiveness and toxicities of intensity-modulated radiotherapy for patients with locally recurrent nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To analyze the effectiveness and toxicities in the re-irradiation of locally recurrent nasopharyngeal carcinoma (NPC) using intensity-modulated radiotherapy (IMRT).
  
  
  METHODS
  This is a retrospective analysis of 54 NPC patients with local recurrence re-irradiated with IMRT. The re-staging for rT1, rT2, rT3, rT4 were 3 (5.6%), 8 (14.8%), 9 (16.7%), 34 (63%) respectively. The average dose to GTV was 69.95 Gy (49.8-76.58 Gy), the average BED(3Gy) was 116.8 Gy (83.5-127.9 Gy). V₉₅ was 96%, and D₉₅ was 65.75 Gy. 33.3% of them received concurrent chemoradiotherapy.
  
  
  RESULTS
  Median overall survival (OS) was 21 months (1-93 mon). The 1-, 2-year local progression free survival (LPFS) rate was 84.5%, 64% and OS rate was 71.7%, 44.3%. Severe late adverse events (SLAE) occurred in 48.1% of patients, including 31.5% with ulcer or necrosis of the nasopharyngeal mucosa, 20.4% with difficulty in feeding, 18.5% with temporal lobe necrosis, 11.1% with massive hemorrhage. 15.4% died of local regional progression, 5.8% died of distant metastasis, 25% died of SLAE, 9.6% died of both local regional progression and SLAE that could not be differentiated, 5.8% died of other medical complications. Concurrent chemoradiotherapy was the independent negative prognostic factors for LPFS; PTV>100 ml was a predictive factor of poor OS; patients with invasion of post-styloid space were at higher risk of SLAE.
  
  
  CONCLUSIONS
  The present study demonstrated that IMRT with 70Gy was efficient for local tumor control. However, we observed a high frequency of serious late complications. More optimized combination treatment and patient selection are required to achieve excellent local control without significant late morbidities in locally recurrent NPC.
authors.affiliation: Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hai-yan
authors.initials: HY
authors.lastname: Chen
authors.forename: Xiu-mei
authors.initials: XM
authors.lastname: Ma
authors.forename: Ming
authors.initials: M
authors.lastname: Ye
authors.forename: Yan-li
authors.initials: YL
authors.lastname: Hou
authors.forename: Hua-Ying
authors.initials: HY
authors.lastname: Xie
authors.forename: Yong-rui
authors.initials: YR
authors.lastname: Bai
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011859:Radiography; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
references.citation: Int J Radiat Oncol Biol Phys. 2000 Dec 1;48(5):1331-8
references.pmid: 11121630
references.citation: J Oral Maxillofac Surg. 1983 May;41(5):283-8
references.pmid: 6572704
references.citation: Int J Radiat Oncol Biol Phys. 1993 Aug 1;26(5):773-82
references.pmid: 8344845
references.citation: Int J Radiat Oncol Biol Phys. 1987 Jul;13(7):953-6
references.pmid: 3597157
references.citation: Int J Radiat Oncol Biol Phys. 1992;23(2):261-70
references.pmid: 1587745
references.citation: Eur Arch Otorhinolaryngol. 2010 Dec;267(12):1811-24
references.pmid: 20865269
references.citation: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Mar;47(3):185-90
references.pmid: 22805017
references.citation: Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):682-7
references.pmid: 14967420
references.citation: Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e263-8
references.pmid: 21514737
references.citation: Head Neck. 2009 Jun;31(6):807-12
references.pmid: 19340873
references.citation: Catheter Cardiovasc Interv. 2008 Oct 1;72(4):563-8
references.pmid: 18819153
references.citation: J Clin Oncol. 2005 Sep 20;23(27):6730-8
references.pmid: 16170180
references.citation: Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):676-83
references.pmid: 22024207
references.citation: Clin Oncol (R Coll Radiol). 2012 Oct;24(8):569-76
references.pmid: 22209574
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):63-71
references.pmid: 16226395
references.citation: Radiother Oncol. 2000 Feb;54(2):135-42
references.pmid: 10699476
references.citation: Radiother Oncol. 2005 Dec;77(3):290-4
references.pmid: 16289398
references.citation: Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):130-7
references.pmid: 19467802