Abstract：Objective To retrospectively analyze the long-term survival, late adverse events, and prognostic factors in patients with locally recurrent nasopharyngeal carcinoma (NPC) after re-irradiation with intensity-modulated radiotherapy (IMRT). Methods From 2001 to 2010, a total of 335 patients who were diagnosed with locally recurrent NPC and received re-irradiation with IMRT were included in the study. Among all the patients, 69(20.6%) had radiotherapy complications. There were 268 male patients (80.0%) and the median age was 45.0 years (range:21－75 years). The numbers of patients in disease stages T1, T2, T3, and T4 were 41, 36, 122, and 136, respectively. The median tumor volume was 37.5 cm3, and the median prescribed dose to the target volume was 68 Gy (range:60－70 Gy). The survival rate was determined using the Kaplan-Meier method. Prognostic factors were analyzed by the Cox proportional hazard model. Results The 5-year follow-up sample size was 290 patients. The 5-year overall survival, local-regional failure-free survival, and distant failure-free survival were 34.7%,64.2%, and 82.2%, respectively. Multivariate analysis indicated that the poor prognostic factors included age>45 years (P=0.01), presence of significant radiotherapy complications before IMRT (P=0.00), tumor stages (T2-T4)(P=0.00), tumor volume>38 cm3(P=0.01), and the mean dose of gross tumor volume (GTVnx)>68 Gy (P=0.01). The incidence rates of nasopharyngeal mucosa necrosis, epistaxis, radiation encephalopathy, cranial nerve injury, and trismus were 28.6%, 16.4%, 22.4%, 15.8%, and 13.7%, respectively. Conclusions Re-irradiation with IMRT is effective in controlling tumor and thus is a reasonable choice for patients with locally recurrent NPC. However, the incidence of severe adverse events is still high. Further investigation on how to maintain the balance between tumor control and normal organ protection is needed.
Tian Yunming,Bai Li,Xiao Weiwei et al. Evaluation of long-term efficacy of re-irradiation with intensity-modulated radiotherapy for locally recurrent nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 168-173.
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2015, Vol. 24 
