High dose 3-dimensional re-irradiation for locally recurrent nasopharyngeal cancer

This is to report the results of 3-dimensional (3D) high dose re-irradiation (re-RT) for patients with locally recurrent nasopharyngeal cancer. Between May 1995 and Dec. 2000, 21 patients with locally recurrent cancer of the nasopharynx received high dose 3D re-RT at Samsung Medical Center. The median 55 (45 - 70) Gy was applied by daily fractions of 2.5 Gy or 3.0 Gy. The median survival period, the rates of local control, overall survival and disease-free survival at 5 years, of all patients, were 21 months, 71.8%, 32.3%, and 21.2% respectively. The number of patients who experienced treatment failures at any site was 14 (67.0%): eight patients (38.1%) experienced distant hematogenous metastases; five patients (23.8%) experienced recurrences within the current re-RT treatment volume; and seven patients (33.0%) had recurrences outside this volume. Five patients (23.8%) experienced severe late radiation-induced complications of RTOG grade IV or V, and these were brainstem necrosis (2), temporal lobe necrosis (1), mucosal necrosis (1), and massive epistaxis (1). For locally recurrent nasopharyngeal cancer patients, high dose 3D re-RT could lead to improved results when compared with the historic data by conventional re-RT techniques. Further treatment refinements, that would be necessary, may include optimization in patient selection, improvement in target localization and patient immobilization, and the addition of systemic agents, either as a radiation sensitizer or a radiation protector.