Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma.
PURPOSE
We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients.


METHODS AND MATERIALS
Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60-81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50-70.2 Gy), resulting in a median cumulative dose of 134 Gy (122-148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11-126).


RESULTS
The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015).


CONCLUSION
Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity.
['Puebla|F|F|', 'Lopez Guerra|J L|JL|', 'Garcia Ramirez|J M|JM|', 'Matute|R|R|', 'Marrone|I|I|', 'Miguez|C|C|', 'Sevillano|D|D|', 'Sanchez-Reyes|A|A|', 'Rivin Del Campo|E|E|', 'Praena-Fernandez|J M|JM|', 'Azinovic|I|I|']
D000328:Adult D000368:Aged D002277:Carcinoma D018572:Disease-Free Survival D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D000077274:Nasopharyngeal Carcinoma D009303:Nasopharyngeal Neoplasms D009364:Neoplasm Recurrence, Local D011879:Radiotherapy Dosage D011880:Radiotherapy Planning, Computer-Assisted D050397:Radiotherapy, Intensity-Modulated D012189:Retrospective Studies
Toxicity Helical tomotherapy Local recurrence Nasopharyngeal carcinoma Reirradiation