Abstract：Objective This study retrospectively analyzed the efficacy and toxicity profile of hyperfractionated intensity-modulated radiotherapy (HF-IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods Twenty-eight locally recurrent patients of NPC were enrolled,23 male and 5 female with a median of 51 years (range 25-74 years).All patients had a median recurrent time of 17.5 months and received HF-IMRT with a total dosage of 60-70 Gy,each consisting of 1.2 Gy per fraction,each of the 2 fractions were spaced 6 hours apart and lasting for 5 days. Twenty-five patients received concurrent chemotherapy of nedaplatin or two agent regimen,4 patients received Ad-p53 gene therapy and 6 patients received target therapy of EGFR monoclony antibody. Results The complete response and partial response rates were 89%(25/28) and 11%(3/28) after being treated by HF-IMRT for 3 months. The median follow-up time was 27.5 months. The 1,2,3-year overall survival rates,locoregional recurrence-free survival rates and progression-free survival rates were 100%,91%,80%;100%,80%,55%;88%,65%,55%,respectively. Three patient were observed to develop severe nasopharyngeal necrosis but recover after treatment,no patients experienced hemorrhage of nasopharynx. Multivariate analysis indicated that the poor prognostic factors included tumor stages (T3-T4)(P=0.00) and no chemotherapy (P=0.04). Conclusion HF-IMRT is feasible for locally recurrent nasopharyngeal carcinoma with satisfactory local control and controllable adverse reaction,it is worth further clinical studies.
Yin Li,Guo Wenjie,Xie Peng et al. Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2016, 25(9): 917-922.
[1] Han F,Zhao C,Huang SM,et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy[J].Clin Oncol,2012,24(8):569-576.DOI:10.1016/j.clon.2011.11.010. [2] Suárez C,Rodrigo JP,Rinaldo A,et al. Current treatment options for recurrent nasopharyngeal cancer[J].Eur Arch Oto-rhino-laryngol,2010,267(12):1811-1824.DOI:10.1007/s00405-010-1385-x. [3] Xiao WW,Liu S,Tian YM,et al. Prognostic significance of tumor volume in locally recurrent nasopharyngeal carcinoma treated with salvage intensity-modulated radiotherapy[J].PLoS One,2015,10(4):e0125351.DOI:10.1371/journal.pone.0125351. [4] 杨伟志,冯宁远.分次放射治疗的生物学基础[A]//殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].4版.北京:中国协和医科大学出版社,2008:267-268. Yang WZH,Feng NY.Biological basis of fractionated radiation therapy[A]//Yin WB,Yu ZH,Xu GZ,et al. Radiation oncology[M].4th ed. Beijing:China union medical university press,2008:267-268. [5] Xu T,Tang J,Gu M,et al. Recurrent nasopharyngeal carcinoma:a clinical dilemma and challenge[J].Curr Oncol,2013,20(5):e406-e419.DOI:10.3747/co.20.1456. [6] Chang JTC,See LC,Liao CT,et al. Locally recurrent nasopharyngeal carcinoma[J].Radiother Oncol,2000,54(2):135-142.DOI:10.1016/S0167-8140(99)00177-2. [7] Cheah SK,Lau FN,Yusof MM,et al. Treatment outcome with brachytherapy for recurrent nasopharyngeal carcinoma[J].Asian Pac J Cancer Prev,2014,14(11):6513-6518.DOI:10.7314/APJCP.2013.14.11.6513. [8] Ozyigit G,Cengiz M,Yazici G,et al. A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2011,81(4):e263-e268.DOI:10.1016/j.ijrobp.2011.02.054. [9] Dizman A,Coskun-Breuneval M,Altinisik-Inan G,et al. Reirradiation with robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma[J].Asian Pac J Cancer Prev,2014,15(8):3561-3566.DOI:10.7314/APJCP.2014.15.8.3561. [10] 周珺珺,应红梅,胡超苏,等.复发鼻咽癌调强放疗的应用疗效及预后分析[J].中国癌症杂志,2012,22(11):835-841.DOI:10.3969/j.issn.1007-3969.2012.11.007. Zhou JJ,Ying HM,Hu CS,et al. Clinical outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma with intensity modulated radiotherapy[J].China Oncol,2012,22(11):835-841.DOI:10.3969/j.issn.1007-3969.2012.11.007. [11] Qiu SF,Lu J,Zheng W,et al. Advantages of intensity modulated radiotherapy in recurrent T1-2 nasopharyngeal carcinoma:a retrospective study[J].BMC Cancer,2014,14(1):797.DOI:10.1186/1471-2407-14-797. [12] Chen HY,Ma XM,Ye M,et al. Effectiveness and toxicities of intensity-modulated radiotherapy for patients with locally recurrent nasopharyngeal carcinoma[J].PLoS One,2013,8(9):e73918.DOI:10.1371/journal.pone.0073918. [13] Roeder F,Zwicker F,Saleh-Ebrahimi L,et al. Intensity modulated or fractionated stereotactic reirradiation in patients with recurrent nasopharyngeal cancer[J].Radiat Oncol,2011,6(1):22.DOI:10.1186/1748-717X-6-22. [14] Karam I,Huang SH,McNiven A,et al. Outcomes after reirradiation for recurrent nasopharyngeal carcinoma:North American experience[J].Head Neck,2015.DOI:10.1002/hed.24166. [15] Long ZX,Wang B,Tao D,et al. Hypofractionated radiotherapy induces miR-34a expression and enhances apoptosis in human nasopharyngeal carcinoma cells[J].Int J Mol Med,2014,34(5):1388-1394.DOI:10.3892/ijmm.2014.1937. [16] Law SCK,Lam WK,Ng MF,et al. Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy:an effective means of local salvage[J].Int J Radiat Oncol Biol Phys,2002,54(4):1095-1113.DOI:10.1016/S0360-3016(02)03009-2. [17] Chua DTT,Sham JST,Kwong PWK,et al. Linear accelerator-based stereotactic radiosurgery for limited,locally persistent,and recurrent nasopharyngeal carcinoma:efficacy and complications[J].Int J Radiat Oncol Biol Phys,2003,56(1):177-183.DOI:10.1016/S0360-3016(03)00074-9. [18] Tian YM,Zhao C,Guo Y,et al. 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[J].Cancer,2014,120(22):3502-3509.DOI:10.1002/cncr.28934. [19] Tian YM,Xiao WW,Bai L,et al. Impact of primary tumor volume and location on the prognosis of patients with locally recurrent nasopharyngeal carcinoma[J].Chin J Cancer,2015,34(6):21.DOI:10.1186/s40880-015-0019-5. [20] Hua YJ,Han F,Lu LX,et al. Long-term treatment outcome of recurrent nasopharyngeal carcinoma treated with salvage intensity modulated radiotherapy[J].Eur J Cancer,2012,48(18):3422-3428.DOI:10.1016/j.ejca.2012.06.016. [21] Chan ATC,Hsu MM,Goh BC,et al. Multicenter,phase Ⅱ study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma[J].J Clin Oncol,2005,23(15):3568-3576.DOI:10.1200/JCO.2005.02.147. [22] Guan Y,Liu S,Wang HY,et al. Long-term outcomes of a phaseⅡ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma[J].Chin J Cancer,2016,35(1):247.DOI:10.1186/s40880-016-0081-7. [23] Guan Y, Li A, Xiao W, Liu S, Chen B, Lu T, Zhao C, Han F. The efficacy and safety of Endostar combined with chemoradiotherapy for patients with advanced, locally recurrent nasopharyngeal carcinoma[J].Oncotarget,2015,6(32):33926-33934.DOI:10.18632/oncotarget.5271. [24] Lu X,Wang FL,Guo X,et al. Favorable prognosis of female patients with nasopharyngeal carcinoma[J].Chin J Cancer,2013,32(5):283-288.DOI:10.5732/cjc.012.10058. [25] Ouyang PY,Zhang LN,Lan XW,et al. The significant survival advantage of female sex in nasopharyngeal carcinoma:a propensity-matched analysis[J].Br J Cancer,2015,112(9):1554-1561.DOI:10.1038/bjc.2015.70. [26] Palazzi M,Orlandi E,Bossi P,et al. Further improvement in outcomes of nasopharyngeal carcinoma with optimized radiotherapy and induction plus concomitant chemotherapy:an update of the Milan experience[J].Int J Radiat Oncol Biol Phys,2009,74(3):774-80.DOI:10.1016/j.ijrobp.2008.08.068. [27] Peng H,Chen L,Zhang Y,et al. Survival analysis of patients with advanced-stage nasopharyngeal carcinoma according to the Epstein-Barr virus status[J].Oncotarget,2016.DOI:10.18632/oncotarget.8144. [28] Chen M,Yin L,Wu J,et al. Impact of plasma Epstein-Barr virus-DNA and tumor volume on prognosis of locally advanced nasopharyngeal carcinoma[J].BioMed Res Int,2015,2015:617949.DOI:10.1155/2015/617949. [29] Zhang W,Chen Y,Chen L,et al. The clinical utility of plasma Epstein-Barr virus DNA assays in nasopharyngeal carcinoma:the dawn of a new era?:a systematic review and meta-analysis of 7836 cases[J].Medicine,2015,94(20):e845.DOI:10.1097/MD.0000000000000845.
2016, Vol. 25 
