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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2020.1349    [Accepted]
Re-irradiation with Moderate Hypo-Fractionation Using Intensity Modulated Photon or Proton Radiation Therapy in Locally Recurrent Squamous Cell Carcinoma of Nasopharynx
Heerim Nam1, Yong Chan Ahn2, Kyungmi Yang2, Dongryul Oh2, Jae Myoung Noh2
1Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence  Heerim Nam ,Tel: 82-2-2001-1171, Fax: 82-2-2001-1170, Email: heerim.nam@gmail.com
Yong Chan Ahn ,Tel: 82-2-3410-2612, Fax: 82-2-6190-5332, Email: ahnyc@skku.edu
Received: December 23, 2020;  Accepted: March 24, 2021.  Published online: March 26, 2021.
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. 48.3% 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 (2~254) 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 OS were iT3-4 (p=0.010) and age at re-RT ≥53 years (p=0.003), those for LFFS were rT3-4 (p=0.022) and rN0-1 (p=0.035), and those for TFS were iT3-4 (p=0.020) and rIMRT/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.
Key words: Nasopharyngeal carcinoma, Re-irradiation, Hypo-fractionation, Histology, Radiation therapy, Proton therapy, Intensity-modulated radiation therapy
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