Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma.

Abstract

We investigated the feasibility of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent T1 to T2 nasopharyngeal carcinoma (NPC) by assessing long-term survival and late complication rates. Sixty patients who had been previously irradiated were diagnosed with locally recurrent T1 to T2 NPC and underwent reirradiation with IMRT. Severe radiation toxicities were assessed. The median follow-up time was 40.0 months. The 5-year local failure-free survival (LFFS), distant failure-free survival (DFFS), and overall survival (OS) rates were 85.7%, 96.1%, and 67.2%, respectively. Independent prognostic factors included primary gross tumor volume >20 cm and the presence of significant complications. The most common severe complications were headache (31.6%), mucosal necrosis (30.0%), cranial neuropathy (25.0%), and temporal lobe necrosis (21.6%). Thirty-nine patients (65.0%) developed at least one severe complication and 18 patients died as a result. Excellent disease control can be achieved by reirradiation with IMRT for recurrent T1 to T2 NPC. However, the main challenge remains severe late complications.