Long-term efficacy of hyperfractionated intracavitary brachytherapy on 69 patients with locally recurrent nasopharyngeal carcinoma

Background and purpose:Local recurrence is one of treatment failure cause for nasopharyngeal carcinoma(NPC).Further treatments for locally recurrent NPC are available,such as surgery,chemotherapy,targeted therapy and radiotherapy is the most important of all.There are several radiotherapy methods,including conventional external beam,brachytherapy,three-dimensional conformal and intensity modulated radiotherapy.This study retrospectively analyzed the long-term outcomes and late radiation injuries of locally recurrent NPC that were treated with hyperfractionated intracavitary brachytherapy or combined with external beam radiotherapy for the purpose of assessing the value of hyperfractionated intracavitary brachytherapy.Methods:Sixty-nine patients were enrolled to restaged T1(51 cases) and T2(18 cases) of locally recurrent NPC.Twenty patients received hyperfractionated intracavitary brachytherapy with a median dosage of 50 Gy(ranged 40-50 Gy).The remaining 49 patients received external beam radiotherapy with a median dosage of 50 Gy(ranged 30-65 Gy) plus hyperfractionated intracavitary brachytherapy with the median dose of 20 Gy(ranged 8-48 Gy) boosted.Two courses of brachytherapy were delivered,each consisting of 2.5-3.0 Gy per fraction,each of the 2 fractions were spaced 6 hours apart and lasting for 5 days.The second course of brachytherapy was delivered after one week of rest.Results:The 3 and 5-year overall survival rates were 59.66% and 39.66%.The 3 and 5-year local tumor control rates were 86.3% and 77.2%,respectively.After the reirradiation,the incidence rates for nasopharyngeal ulceration,trismus,lower cranial nerve palsy and radiation encephalopathy were 26.1%,39.1%,30.4% and 13.0%,respectively.Cases of trismus and nasopharyngeal ulceration in the brachytherapy group versus in the combined group were 4 versus 23(P=0.038) and 6 versus 12(P=0.636),respectively.Conclusion:Hyperfractionated intracavitary brachytherapy is feasible for locally recurrent nasopharyngeal carcinoma that is restaged early.The 5-year overall survival and local tumor control rates were 39.66% and 77.2%.Hyperfractionated intracavitary brachytherapy can be recommended for rT1 and rT2 locally recurrent nasopharyngeal carcinoma.