Long-term survival and late complications of intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma

Fangfang Kong, Junjun Zhou, Chengrun Du, Xiayun He, Lin Kong, Chaosu Hu, Hongmei Ying, Fangfang Kong, Junjun Zhou, Chengrun Du, Xiayun He, Lin Kong, Chaosu Hu, Hongmei Ying

Abstract

Background: To evaluate the effectiveness and toxicities of intensity-modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC).

Methods: One hundred and eighty-four previously irradiated NPC patients with recurrent disease and re-irradiated by IMRT between February 2005 to May 2013 had been reviewed. The disease was re-staged I in 33, II in 27, III in 70 and IV in 54 patients. Seventy-five percent of the patients received cisplatin-based chemotherapy.

Results: The median survival time was 33 months. The 3-year actuarial rates of local recurrence-free survival (LRFS), distant metastases-free survival (DMFS), and overall survival (OS) rates were 85.1, 91.1, and 46.0%, respectively. About 53% of the patients experienced Grade 3-4 late toxicities. Forty-four patients died of massive hemorrhage of the nasopharynx caused by radiation induced mucosal necrosis. Multivariate analysis indicated that chemotherapy and time interval between initial radiotherapy and re-irradiation were independent predictors for DMFS.

Conclusion: IMRT is an effective method for patients with locally recurrent NPC. Massive hemorrhage of the nasopharynx is the major sever late complication and also the leading cause of death. Early recurrence is negative factor for DMFS. Combination of chemotherapy can improve DMFS, but not for OS. Optimal salvage treatment strategies focusing on improvement of survival and minimization of late toxicities are warranted.

Keywords: IMRT; Intensity-modulated radiotherapy; Late complication; NPC; Re-irradiation; Recurrent nasopharyngeal carcinoma; Survival.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Boards of Fudan University Shanghai Cancer Center, China. Written informed consent was obtained from the patients before treatment. Due to the retrospective design of the study, the local ethic committee confirmed that informed consent was not necessary from participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves showing local recurrence-free survival (LRFS), distant metastases-free survival (DMFS) and overall survival (OS) for patients with recurrent nasopharyngeal carcinoma

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