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Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma

Treatment results and locoregional recurrence

Intensitätsmodulierte Strahlentherapie für T4-Nasoparynxkarzinom

Behandlungsergebnisse und lokoregionäre Rezidive

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Abstract

Purpose

The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).

Methods and materials

Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33–35 fractions. In addition, 97 % of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.

Results

The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1 %, respectively. A total of 27 patients had locoregional recurrence: 85.2 % in-field failures, 11.1 % marginal failures, and 3.7 % out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9 %) compared to those receiving conservative treatment (32.0 %, p = 0.051). In patients treated with 1 course of radiotherapy, grade ≥ 3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6 % of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.

Conclusion

IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.

Zusammenfassung

Ziel

Untersuchung der Ergebnisse bei Patienten mit T4-Nasopharynxkarzinom (NPC), die mit intensitätsmodulierter Strahlentherapie (IMRT) behandelt wurden.

Material und Methoden

Zwischen 2007 und 2010 wurden 154 Patienten mit nichtmetastasierendem T4-NPC mittels IMRT in einer Gesamtdosis von 70 Gy in 33–35 Fraktionen behandelt. 97 % der Patienten erhielten gleichzeitig eine platinbasierte Chemotherapie. Die mittlere Nachlaufzeit betrug 52,8 Monate.

Ergebnisse

Der Grad der lokoregionären Rezidivfreiheit, die Überlebensrate ohne Fernmetastasen oder Progressionen und die Gesamtüberlebensrate (OS) lagen nach 5 Jahren bei 81,2, 72,2, 61,9 und 78,1 %. Bei 27 Patienten kam es zu lokoregionären Rezidiven: 85,2 % in der zuvor betroffenen Region, 11,1 % in der Nähe dieser Region, 3,7 % in einer entfernten Region. 14 Patienten mit lokoregionären Rezidiven erhielten aggressive Therapien, z. B. Nasopharyngektomie, „neck dissection“ oder eine erneute Bestrahlung. Hier war die OS nach 5 Jahren im Vergleich zu den Patienten, die konservativ behandelt wurden (32,0 %, p = 0,051), höher (61,9 %). Die Schädigungen bis Grad 3 in Form von Ototoxizität, Fibrose am Hals, Mundtrockenheit, Epistaxis sowie durch Bestrahlung verursachte Nekrose des Schläfenlappens lagen bei 18,2%, 9,8%, 6,3%, 2,1% und 5,6 %. Erhöhte Ototoxizität, Osteonekrose, schweres Nasenbluten und Nekrose des Schläfenlappens wurden bei Patienten, die durch Re-Bestrahlung behandelt wurden, beobachtet.

Schlussfolgerungen

IMRT bietet gute lokoregionäre Kontrollmöglichkeiten bei Patienten mit T4-NPC. Bei Patienten mit lokoregionären Rezidiven ist zur Verbesserung der Ergebnisse eine aggressive lokale Therapie in Betracht zu ziehen.

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Compliance with ethical guidelines

Conflict of interest. J.L.-Y. Chen, Y.-S. Huang, S.-H. Kuo, Y.-F. Chen, R.-L. Hong, J.-Y. Ko, P.-J. Lou, C.-L. Tsai, W.-Y. Chen, and C.-W. Wang state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, 100, Taipei, Taiwan

    J.L.-Y. Chen M.D., S-H. Kuo M.D. Ph.D., C.-L. Tsai M.D., W.-Y. Chen M.D. & C.-W. Wang M.D.

  2. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan

    Y.-S. Huang M.D. & Y.-F. Chen M.D.

  3. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    S-H. Kuo M.D. Ph.D.

  4. Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan

    R.-L. Hong MD. Ph.D.

  5. Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan

    J.-Y. Ko M.D. Ph.D. & P.-J. Lou M.D. Ph.D.

Authors
  1. J.L.-Y. Chen M.D.
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  2. Y.-S. Huang M.D.
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  3. S-H. Kuo M.D. Ph.D.
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  4. Y.-F. Chen M.D.
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  5. R.-L. Hong MD. Ph.D.
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  6. J.-Y. Ko M.D. Ph.D.
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  7. P.-J. Lou M.D. Ph.D.
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  8. C.-L. Tsai M.D.
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  9. W.-Y. Chen M.D.
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  10. C.-W. Wang M.D.
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Corresponding author

Correspondence to C.-W. Wang M.D..

Additional information

Presented in part at the 54th Annual Meeting of the American Society of Radiation Oncology (ASTRO), 28–31 October 2012, Boston, MA, USA.

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Chen, JY., Huang, YS., Kuo, SH. et al. Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma. Strahlenther Onkol 189, 1001–1008 (2013). https://doi.org/10.1007/s00066-013-0429-8

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  • DOI: https://doi.org/10.1007/s00066-013-0429-8

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