Reirradiation of Locally Recurrent Nasopharynx Cancer With External Beam Radiotherapy With or Without Brachytherapy

Purpose To determine survival rates of patients with locally recurrent nasopharynx cancer (LRNPC) treated with modern therapeutic modalities. Methods and Materials From July 1996 to March 2008, 29 patients were reirradiated for LRNPC. Thirteen patients received combined-modality treatment (CMT), consisting of external beam radiotherapy (EBRT) followed by intracavitary brachytherapy, whereas 16 received EBRT alone. The median age was 50 years, 59% were male, 38% were Asian, 69% had World Health Organization Class III histology, and 86% were treated for their first recurrence. Nine, 6, 8, and 6 patients had recurrent Stage I, II, III, and IV disease, respectively. Patients in the EBRT-alone group had more advanced disease. Median time to reirradiation was 3.9 years. In total, 93% underwent imaging with positron emission tomography and/or magnetic resonance imaging before reirradiation, 83% received intensity-modulated radiotherapy, and 93% received chemotherapy, which was platinum-based in 85% of cases. Results The median follow-up for all patients was 45 months and for surviving patients was 54 months. Five-year actuarial local control, event-free survival, and overall survival rates were 52%, 44%, and 60%, respectively. No difference was observed between patients treated with EBRT or CMT. Overall survival was superior in patients who achieved local control ( p = 0.0003). The incidence of late Grade ≥3 events in patients re-treated with EBRT alone was significantly increased compared with those receiving CMT (73% vs. 8%; p = 0.005). Conclusions In this modern reirradiation series of patients with LRNPC, favorable overall survival compared with historical series was achieved. Patients treated with CMT experienced significantly fewer severe late effects compared with those treated with EBRT.