Re-irradiation with Moderate Hypo-Fractionation Using Intensity Modulated Photon or Proton Radiation Therapy in Locally Recurrent Squamous Cell Carcinoma of Nasopharynx

다국어 초록 (Multilingual Abstract)

Purpose This study aimed to analyze the treatment outcomes of locally recurrent nasopharyngeal cancer (NPC) patients following moderate hypo-fractionation re-irradiation (re-RT).
Materials and Methods Sixty locally recurrent NPC patients underwent hypo-fractionation re-RT. Forty-eight point three percentage had rT3-4, and 30.0% did keratinizing squamous cell carcinoma. Intensity-modulated radiation therapy (IMRT), with or without intensity-modulated proton therapy (IMPT), was used in 66.7% of patients.
Results With the median follow-up of 22 months (range, 2 to 254 months), 31 patients (51.7%) died, 38 (63.3%) developed further treatment failure, and 30 (50.0%) developed ≥ grade 3 toxicity (including seven grade 5) at time of analysis. The 2- and 5-year rates of overall survival, local failure-free survival, and ≥ grade 3 toxicity-free survival were 57.9% and 45.8%, 64.1% and 52.5%, and 54.8% and 44.9%, respectively. In multivariate analyses, worse factors for overall survival (OS) were iT3-4 (p=0.010) and age at re-RT ≥ 53 years (p=0.003), those for local failure-free survival (LFFS) were rT3-4 (p=0.022) and rN0-1 (p=0.035), and those for toxicity-free survival (TFS) were iT3-4 (p=0.020) and re-IMRT/IMPT (p=0.030), respectively. Cumulative dose or fraction size ≥ 3 Gy at re-RT, however, showed no significance for OS, LFFS and TFS.
Conclusion Current re-RT with modern RT techniques by moderate hypo-fractionation scheme seemed feasible in treating locally recurrent NPC patients.

참고문헌 (Reference)

1 Stelow EB, "Update from the 4th edition of the World Health Organization classification of head and neck tumours : nasopharynx" 11 : 16-22, 2017

2 Quan K, "Toxicities following stereotactic ablative radiotherapy treatment of locally-recurrent and previously irradiated head and neck squamous cell carcinoma" 26 : 112-119, 2016

3 Lee AW, "Total biological effect on late reactive tissues following reirradiation for recurrent nasopharyngeal carcinoma" 46 : 865-872, 2000

4 Schwaibold F, "The effect of fraction size on control of early glottic cancer" 14 : 451-454, 1988

5 Li XY, "The development of a nomogram to predict post-radiation necro-sis in nasopharyngeal carcinoma patients : a large-scale cohort study" 11 : 6253-6263, 2019

6 Coatesworth AP, "The cause of death in patients with head and neck squamous cell carcinoma" 116 : 269-271, 2002

7 Leung TW, "Stereotactic radiotherapy for locally recurrent nasopharyngeal carcinoma" 75 : 734-741, 2009

8 Hu J, "Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma : Initial results" 124 : 2427-2437, 2018

9 Seo Y, "Robotic system-based fractionated stereotactic radiotherapy in loca-lly recurrent nasopharyngeal carcinoma" 93 : 570-574, 2009

10 Chan OS, "Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma" 39 : 533-540, 2017

11 Reddy SP, "Prognostic significance of keratinization in nasopharyngeal carcinoma" 16 : 103-108, 1995

12 Li YQ, "Prognostic model for stratification of radioresistant nasopharynx carcinoma to curative salvage radiotherapy" 36 : 891-899, 2018

13 Lin R, "Nasopharyngeal carcinoma : repeat treatment with conformal proton therapy : dose-volume histogram analysis" 213 : 489-494, 1999

14 Alfonso JCL, "Modeling the effect of intratumoral heterogeneity of radiosensitivity on tumor response over the course of fractionated radiation therapy" 14 : 88-, 2019

15 Lee AW, "Management of nasopharyngeal carcinoma : current practice and future perspective" 33 : 3356-3364, 2015

16 Lee AWM, "Management of locally recurrent nasopharyngeal carcinoma" 79 : 101890-, 2019

17 Hua YJ, "Long-term treatment outcome of recurrent nasopharyngeal carcinoma treated with salvage intensity modulated radiotherapy" 48 : 3422-3428, 2012

18 Leong YH, "Long-term outcomes after reirradiation in nasopharyngeal carcinoma with intensity-modulated radiotherapy : a meta-analysis" 40 : 622-631, 2018

19 Zhang B, "Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma : a systematic review and meta-analysis" 51 : 1041-1046, 2015

20 Le QT, "Influence of fraction size, total dose, and overall time on local control of T1-T2 glottic carcinoma" 39 : 115-126, 1997

21 신성수 ; 안용찬 ; 임도훈 ; 박원 ; 허승재, "High Dose 3-Dimensional Re-Irradiation for Locally Recurrent Nasopharynx Cancer" 연세대학교의과대학 45 (45): 100-106, 2004

22 조원경 ; 오동렬 ; 이언주 ; 김태규 ; 이혜빈 ; 남희림 ; 노재명 ; 안용찬, "Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients" 대한암학회 51 (51): 603-610, 2019

23 Yue Q, "Establishment of prognostic factors in recurrent nasopharyngeal carcinoma patients who received salvage intensity-modulated radiotherapy : a meta-analysis" 81 : 81-88, 2018

24 Ou SI, "Epidemiology of nasopharyngeal carcinoma in the United States : improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology" 18 : 29-35, 2007

25 Tian YM, "Effect of total dose and fraction size on survival of patients with locally recurrent nasopharyngeal carcinoma treated with intensity-modulated radiotherapy : a phase 2, single-center, randomized controlled trial" 120 : 3502-3509, 2014

26 Ng WT, "Dose volume effects of re-irradiation for locally recurrent nasopharyngeal carcinoma" 42 : 180-187, 2020

27 Dionisi F, "Clinical results of proton therapy reirradiation for recurrent nasopharyngeal carcinoma" 58 : 1238-1245, 2019

28 Yang K, "Clinical features of post-radiation nasopharyngeal necrosis and their outcomes following surgical intervention in nasopharyngeal cancer patients" 114 : 105180-, 2021

29 Fandi A, "Biology and treatment of nasopharyngeal cancer" 7 : 255-263, 1995

30 Ozyigit G, "A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma" 81 : e263-e268, 2011