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Article: Reirradiation for recurrent nasopharyngeal carcinoma: Factors affecting the therapeutic ratio and ways for improvement

TitleReirradiation for recurrent nasopharyngeal carcinoma: Factors affecting the therapeutic ratio and ways for improvement
Authors
KeywordsLate complications
Reirradiation
Recurrent nasopharyngeal carcinoma
Local salvage
Issue Date1997
Citation
International Journal of Radiation Oncology - Biology - Physics, 1997, v. 38, n. 1, p. 43-52 How to Cite?
AbstractPurpose: To identify factors for maximizing local salvage and minimizing damages by reirradiation for recurrent nasopharyngeal carcinoma. Methods and Materials: 654 patients with recurrent nasopharyngeal carcinoma treated by reirradiation during 1976-1992 were retrospectively analyzed. Various fractionation schedules had been used during primary treatment with the total dose ranging from 45.6-70 Gy, fractional dose (at different phases) 1.5-4.2 Gy, and overall time 36-101 days. The gap between the two courses ranged from 0.5-10.6 years. Eighty-two percent of patients were reirradiated with teletherapy, 6% brachytherapy, and 12% with both. For those treated with teletherapy alone, the total dose ranged from 7.5-70 Gy, fractional dose 1.8- 5 Gy, and overall time 3-89 days. Results: The 5-year actuarial local salvage and complication-free rates were 23% and 52%, respectively. Multivariate analyses showed that the extensiveness of local recurrence was the most significant factor affecting local salvage, while T-stage of primary tumor also influenced prognosis. Choice of method for reirradiation and fractional effect during both courses affected the risk of late complications. For patients treated by teletherapy alone, the hazard of local failure decreased by 1.7% per Biological Effective Dose (assuming α/β ratio = 10) of the second course, while radiation factors during primary radiotherapy had no significant effect. On the other hand, the risk of late complications was predominantly affected by the primary treatment: the hazard increased by 4.2% per Biological Effective Dose (assuming α/β ratio = 3) of the first course, while the corresponding impact of reirradiation failed to reach statistical significance. Length of the gap between the two courses did not affect the outcome. Conclusion: Early detection of local recurrence and adequate total dose by reirradiation are crucial for improving the chance of local salvage. Combination of teletherapy and brachytherapy should be considered whenever feasible and large fractional dose avoided to minimize late complications. Optimization of biological dose during primary treatment is important.
Persistent Identifierhttp://hdl.handle.net/10722/213876
ISSN
2015 Impact Factor: 4.495
2015 SCImago Journal Rankings: 2.274

 

DC FieldValueLanguage
dc.contributor.authorLee, Anne W M-
dc.contributor.authorFoo, William-
dc.contributor.authorLaw, Stephen C K-
dc.contributor.authorPoon, Y. F.-
dc.contributor.authorSze, W. M.-
dc.contributor.authorO, S. K.-
dc.contributor.authorTung, Stewart Y.-
dc.contributor.authorLau, W. H.-
dc.date.accessioned2015-08-19T13:41:03Z-
dc.date.available2015-08-19T13:41:03Z-
dc.date.issued1997-
dc.identifier.citationInternational Journal of Radiation Oncology - Biology - Physics, 1997, v. 38, n. 1, p. 43-52-
dc.identifier.issn0360-3016-
dc.identifier.urihttp://hdl.handle.net/10722/213876-
dc.description.abstractPurpose: To identify factors for maximizing local salvage and minimizing damages by reirradiation for recurrent nasopharyngeal carcinoma. Methods and Materials: 654 patients with recurrent nasopharyngeal carcinoma treated by reirradiation during 1976-1992 were retrospectively analyzed. Various fractionation schedules had been used during primary treatment with the total dose ranging from 45.6-70 Gy, fractional dose (at different phases) 1.5-4.2 Gy, and overall time 36-101 days. The gap between the two courses ranged from 0.5-10.6 years. Eighty-two percent of patients were reirradiated with teletherapy, 6% brachytherapy, and 12% with both. For those treated with teletherapy alone, the total dose ranged from 7.5-70 Gy, fractional dose 1.8- 5 Gy, and overall time 3-89 days. Results: The 5-year actuarial local salvage and complication-free rates were 23% and 52%, respectively. Multivariate analyses showed that the extensiveness of local recurrence was the most significant factor affecting local salvage, while T-stage of primary tumor also influenced prognosis. Choice of method for reirradiation and fractional effect during both courses affected the risk of late complications. For patients treated by teletherapy alone, the hazard of local failure decreased by 1.7% per Biological Effective Dose (assuming α/β ratio = 10) of the second course, while radiation factors during primary radiotherapy had no significant effect. On the other hand, the risk of late complications was predominantly affected by the primary treatment: the hazard increased by 4.2% per Biological Effective Dose (assuming α/β ratio = 3) of the first course, while the corresponding impact of reirradiation failed to reach statistical significance. Length of the gap between the two courses did not affect the outcome. Conclusion: Early detection of local recurrence and adequate total dose by reirradiation are crucial for improving the chance of local salvage. Combination of teletherapy and brachytherapy should be considered whenever feasible and large fractional dose avoided to minimize late complications. Optimization of biological dose during primary treatment is important.-
dc.languageeng-
dc.relation.ispartofInternational Journal of Radiation Oncology - Biology - Physics-
dc.subjectLate complications-
dc.subjectReirradiation-
dc.subjectRecurrent nasopharyngeal carcinoma-
dc.subjectLocal salvage-
dc.titleReirradiation for recurrent nasopharyngeal carcinoma: Factors affecting the therapeutic ratio and ways for improvement-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0360-3016(97)00244-7-
dc.identifier.pmid9212003-
dc.identifier.scopuseid_2-s2.0-0031127830-
dc.identifier.hkuros265865-
dc.identifier.volume38-
dc.identifier.issue1-
dc.identifier.spage43-
dc.identifier.epage52-

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