Abstract
The prevailing use of intensity-modulated radiation therapy (IMRT) and the concurrent chemoradiotherapy strategy have significantly improved treatment outcomes of nonmetastatic nasopharyngeal cancer (NPC). However, approximately 10–15% of patients will fail locoregionally after treatment despite high-dose radiation or combined chemoradiotherapy. Salvage treatment for locally recurrent NPC (LR-NPC) after prior course(s) of radiation is challenging. Re-irradiation therapy with photon-based intensity-modulated radiation therapy (IMRT) technology is the most utilized modality for salvaging LR-NPC; however, it is associated with substantial and often fatal adverse effects. The use of particle beam radiation therapy (PBRT) such as proton therapy or carbon-ion radiotherapy has prevailed in the past decade for head and neck cancer patients who failed previous course(s) of radiation. However, available evidence of salvage PBRT for LR-NPC is limited. This chapter provides updated clinical evidence of salvage radiation therapy using IMRT and PBRT technologies and provides a practical guideline for clinicians who encounter LR-NPC cases.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lin JC. Adjuvant chemotherapy in advanced nasopharyngeal carcinoma based on plasma EBV load. J Radiat Oncol. 2012;1:117–27.
Kong L, Wang L, Shen C, et al. Salvage intensity-modulated radiation therapy (IMRT) for locally recurrent nasopharyngeal cancer after definitive IMRT: a novel scenario of the modern era. Sci Rep. 2016;6:32883.
Guan Y, Liu S, Wang HY, et al. Long-term outcomes of a phase II randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma. Chin J Cancer. 2016;35:20.
Nieder C, Milas L, Ang KK. Tissue tolerance to reirradiation. Semin Radiat Oncol. 2000;10(3):200–9.
Liu SW, Li JM, Chang JY, et al. A treatment planning comparison between proton beam therapy and intensity-modulated x-ray therapy for recurrent nasopharyngeal carcinoma. J Xray Sci Technol. 2010;18(4):443–50. https://doi.org/10.3233/XST-2010-0265.
Wang L, Hu J, Liu X, et al. Intensity-modulated carbon-ion radiation therapy versus intensity-modulated photon-based radiation therapy in locally recurrent nasopharyngeal carcinoma: a dosimetric comparison. Cancer Manag Res. 2019;11:7767–77.
Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavierion beams. J Clin Oncol. 2007;25:953–64.
Lin R, Slater JD, Yonemoto LT, et al. Nasopharyngeal carcinoma: repeat treatment with conformal proton therapy—dose-volume histogram analysis. Radiology. 1999;213(2):489–94.
Dionisi F, Croci S, Giacomelli I, et al. Clinical results of proton therapy reirradiation for recurrent nasopharyngeal carcinoma. Acta Oncol. 2019;58(9):1238–45.
Bao C, Sun Y, Dong Y, et al. The relative biological effectiveness of proton and carbon ion beams in photon-sensitive and resistant nasopharyngeal cancer cells. Trans Cancer Res. 2018;7:1.
Feehan PE, Castro JR, Phillips TL, et al. Recurrent locally advanced nasopharyngeal carcinoma treated with heavy charged particle irradiation. Int J Radiat Oncol Biol Phys. 1992;23(4):881–4.
Hu J, Bao C, Gao J, et al. Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: initial results. Cancer. 2018;124(11):2427–37.
Hu J, Huang Q, Gao J, et al. Clinical outcomes of carbon-ion radiation therapy for locoregionally recurrent nasopharyngeal carcinoma. Cancer. 2020;126:5173–83.
Kong L, Hu J, Guan X, et al. Phase I/II trial evaluating carbon ion radiotherapy for salvaging treatment of locally recurrent nasopharyngeal carcinoma. J Cancer. 2016;7(7):774–83.
Moyers MF, Toth T, Sadagopan R, et al. Physical uncertainties in the planning and delivery of light ion beam treatments. AAPM report no. 202 (American Association of Physicists in Medicine, 2019).
Tian YM, Huang WZ, Yuan X, et al. The challenge in treating locally recurrent T3-4 nasopharyngeal carcinoma: the survival benefit and severe late toxicities of re-irradiation with intensity-modulated radiotherapy. Oncotarget. 2017;8(26):43450–7.
Tian YM, Guan Y, Xiao WW, et al. Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma. Head Neck. 2016;38(2):225–31.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kong, L., Lu, J.J. (2021). Salvage Radiation Therapy for Locally Recurrent Nasopharyngeal Cancer. In: Ma, J., Lee, N.Y., Lu, J.J. (eds) Nasopharyngeal Cancer. Practical Guides in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-65037-7_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-65037-7_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-65036-0
Online ISBN: 978-3-030-65037-7
eBook Packages: MedicineMedicine (R0)