title: Reirradiation with robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma.
abstract: BACKGROUND
  Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT).
  
  
  METHODS
  Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife® FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6).
  
  
  RESULTS
  The median follow-up for all patients was 19.5 months (IQR: 12.2. -29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection.
  
  
  CONCLUSIONS
  The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.
authors.affiliation: Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey E-mail : coskunmehtap@gmail.com.
authors.forename: Aysen
authors.initials: A
authors.lastname: Dizman
authors.forename: Mehtap
authors.initials: M
authors.lastname: Coskun-Breuneval
authors.forename: Gonca
authors.initials: G
authors.lastname: Altinisik-Inan
authors.forename: Gokce Kaan
authors.initials: GK
authors.lastname: Olcay
authors.forename: Mehmet Faik
authors.initials: MF
authors.lastname: Cetindag
authors.forename: Yildiz
authors.initials: Y
authors.lastname: Guney
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016879:Salvage Therapy; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D055815:Young Adult