Three-dimensional conformal radiotherapy versus intracavitary brachytherapy for salvage treatment of locally persistent nasopharyngeal carcinoma

被引:20
作者
Zheng, XK [1 ]
Chen, LH [1 ]
Chen, YQ [1 ]
Deng, XG [1 ]
机构
[1] First Mil Med Univ, Nanfang Hosp, Dept Radiat Oncol, Guangzhou 510515, Peoples R China
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2004年 / 60卷 / 01期
关键词
nasopharyngeal carcinoma; radiotherapy; persistent disease; 3D-CRT; brachytherapy;
D O I
10.1016/j.ijrobp.2004.02.059
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To compare the outcomes of three-dimensional conformal radiotherapy (3D-CRT) and intracavitary brachytherapy (ICBT) as salvage treatment for locally persistent nasopharyngeal carcinoma. Methods and Materials: Between March 1994 and November 2001, a total of 117 patients with locally persistent nasopharyngeal carcinoma received salvage treatment for 2-8 weeks (median, 4 weeks) after a full course of conventional external beam RT. Of the 117 patients, 54 were salvaged with 3D-CRT (3D group) and 63 with ICBT (BT group). No statistically significant differences were found in the patient characteristics between the two groups (p > 0.05). In the 3D group, the planning target volume for 3D-CRT was defined as the persistent disease plus a 5-mm margin; three to seven static conformal coplanar or noncoplanar portals were delivered for each fraction. The median salvage dose was 24 Gy (range, 18-38 Gy), with fraction size of 2.0 Gy/d. In the BT group, a median salvage dose of 20 Gy (range, 15-30 Gy) was delivered with a Ir-192 source, at 5 Gy/fraction, twice weekly. The brachytherapy dose was prescribed at a distance of 1 cm from the center of the surface as defined by the sources, irrespective of the extent of persistent disease. The actuarial rates of survival were estimated using the Kaplan-Meier method. Potential differences in the actuarial outcomes between groups were evaluated using the Mantel log-rank test. Multivariate analyses were performed with the Cox regression proportional hazards model. Results: The 5-year actuarial rates of overall survival, disease-specific survival, and local failure-free survival for the 3D group and BT group were 64.50% vs. 55.78% (p = 0.33), 70.03% vs. 59.56% (p = 0.11), and 88.93% vs. 76.28% (p = 0.07), respectively. Subgroup analysis showed that the 5-year actuarial local failure-free survival rate of patients with initially diagnosed T3-T4 disease for the 3D group and BT group was 84.01% vs. 60.50% (p = 0.03). The incidence of Grade 3-4 late complications was comparable between the two groups. Multivariate analyses performed in the whole group showed that T stage at initial diagnosis and the salvage technique (3D-CRT or ICBT) were the statistically significant, independent prognostic factors for local failure-free survival (p = 0.00 and p = 0.02, respectively). Conclusion: 3D-CRT seemed to provide better local control than ICBT as a salvage treatment for locally persistent nasopharyngeal carcinoma, especially in patients with initially diagnosed T3-T4 disease. CT/MRI evaluation of the extent of persistent disease is recommended for technique selection of salvage RT. Patients should be cautioned about the potentially increased complications. The optional time for salvage treatment remains controversial. (C) 2004 Elsevier Inc.
引用
收藏
页码:165 / 170
页数:6
相关论文
共 24 条
[1]  
BARKLEY HT, 1977, RADIOLOGY, V124, P493
[2]   SIGNIFICANCE AND THERAPEUTIC IMPLICATIONS OF TUMOR-REGRESSION FOLLOWING RADIOTHERAPY IN PATIENTS TREATED FOR SQUAMOUS-CELL CARCINOMA OF THE OROPHARYNX AND PHARYNGOLARYNX [J].
BATAINI, JP ;
JAULERRY, C ;
BRUNIN, F ;
PONVERT, D ;
GHOSSEIN, NA .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 1990, 12 (01) :41-49
[3]   TRANSPALATAL INSERTION OF RADIOACTIVE GOLD GRAIN FOR THE TREATMENT OF PERSISTENT AND RECURRENT NASOPHARYNGEAL CARCINOMA [J].
CHOY, D ;
SHAM, JST ;
WEI, WI ;
HO, CM ;
WU, PM .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1993, 25 (03) :505-512
[4]   Locally recurrent nasopharyngeal carcinoma: Treatment results for patients with computed tomography assessment [J].
Chua, DTT ;
Sham, JST ;
Kwong, DLW ;
Wei, WI ;
Au, GKH ;
Choy, D .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1998, 41 (02) :379-386
[5]   Salvage treatment for persistent and recurrent t1-2 nasopharyngeal carcinoma by stereotactic radiosurgery [J].
Chua, DTT ;
Sham, JST ;
Hung, KN ;
Leung, LHT ;
Cheng, PW ;
Kwong, PWK .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2001, 23 (09) :791-798
[6]  
Chua DTT, 1999, HEAD NECK-J SCI SPEC, V21, P620, DOI 10.1002/(SICI)1097-0347(199910)21:7<620::AID-HED6>3.0.CO
[7]  
2-Q
[8]  
COX DR, 1974, ANAL SURVIVAL DATA
[9]   TOXICITY CRITERIA OF THE RADIATION-THERAPY ONCOLOGY GROUP (RTOG) AND THE EUROPEAN-ORGANIZATION-FOR-RESEARCH-AND-TREATMENT-OF-CANCER (EORTC) [J].
COX, JD ;
STETZ, J ;
PAJAK, TF .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1995, 31 (05) :1341-1346
[10]  
Fleming ID, 1997, AJCC CANC STAGING MA, P31