Treatment Outcome with Brachytherapy for Recurrent Nasopharyngeal Carcinoma

Background: To evaluate the treatment outcome and major late complications of all patients with recurrentnasopharyngeal carcinoma (NPC) treated with intracavitary brachytherapy (ICBT) in Hospital Kuala Lumpur.Materials and
Methods: This retrospective study was conducted at the Department of Radiotherapy and Oncology,Hospital Kuala Lumpur, Malaysia. All patients with histologically confirmed recurrent NPC in the absence ofdistant metastasis treated in the period 1997-2010 were included in this study. These patients were treated withICBT alone or in combination with external beam radiotherapy (EBRT). Treatment outcomes measured werelocal recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS).
Results: Thirty threepatients were eligible for this study. The median age at recurrence was 56 years with a median time to initiallocal recurrence of 27 months. Majority of patients were staged as rT1-2 (94%) or rN0 (82%). The proportionof patients categorised as stage III-IV at first local recurrence was only 9%. Twenty one patients received acombination of ICBT and external beam radiotherapy while 12 patients were treated with ICBT alone. Medianinterval of recurrence post re-irradiation was 32 months (range: 4-110 months). The median LRFS, DFS andOS were 30 months, 29 months and 36 months respectively. The 5 year LRFS, DFS and OS were 44.7%, 38.8%and 28.1% respectively. The N stage at recurrence was found to be a significant prognostic factor for LRFS andDFS after multivariate analysis. Major late complications occurred in 34.9% of our patients.
Conclusions: Ourstudy shows ICBT was associated with a reasonable long term outcome in salvaging recurrent NPC althoughmajor complications remained a significant problem. The N stage at recurrence was a significant prognosticfactor for both LRFS and DFS.