Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma

Quynh Thu Le, David Tate, Albert Koong, Iris C. Gibbs, Steven D. Chang, John R. Adler, Harlan A. Pinto, David J Terris, Willard E. Fee, Don R. Goffinet

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Purpose: Treatment of nasopharyngeal carcinoma using conventional external beam radiotherapy (EBRT) alone is associated with a significant risk of local recurrence. Stereotactic radiosurgery (STR) was used to boost the tumor site after EBRT to improve local control. Methods and Materials: Forty-five nasopharyngeal carcinoma patients received a STR boost after EBRT at Stanford University. Seven had T1, 16 had T2, 4 had T3, and 18 had T4 tumors (1997 American Joint Commission on Cancer staging). Ten had Stage II, 8 had Stage III, and 27 had Stage IV neoplasms. Most patients received 66 Gy of EBRT delivered at 2 Gy/fraction. Thirty-six received concurrent cisplatin-based chemotherapy. STR was delivered to the primary site 4-6 weeks after EBRT in one fraction of 7-15 Gy. Results: At a medium follow-up of 31 months, no local failures had occurred. The 3-year local control rate was 100%, the freedom from distant metastasis rate was 69%, the progression-free survival rate was 71%, and the overall survival rate was 75%. Univariate and multivariate analyses revealed N stage (favoring N0-N1, p = 0.02, hazard ratio HR 4.2) and World Health Organization histologic type (favoring type III, p = 0.002, HR 13) as significant factors for freedom from distant metastasis. World Health Organization histologic type (p = 0.004, HR 10.5) and age (p = 0.01, HR 1.07/y) were significant factors for survival. Late toxicity included transient cranial nerve weakness in 4, radiation-related retinopathy in 1, and asymptomatic temporal lobe necrosis in 3 patients who originally had intracranial tumor extension. Conclusion: STR boost after EBRT provided excellent local control in nasopharyngeal carcinoma patients. The incidence of late toxicity was acceptable. More effective systemic treatment is needed to achieve improved survival.

Original languageEnglish (US)
Pages (from-to)1046-1054
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume56
Issue number4
DOIs
StatePublished - Jul 15 2003
Externally publishedYes

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acceleration (physics)
radiation therapy
Radiotherapy
Radiosurgery
cancer
tumors
metastasis
toxicity
health
Neoplasms
Survival Rate
Neoplasm Metastasis
neoplasms
Survival
Cranial Nerves
necrosis
Neoplasm Staging
nerves
Temporal Lobe
chemotherapy

Keywords

  • Chemotherapy
  • Local control
  • Nasopharyngeal carcinoma
  • Stereotactic radiosurgery
  • WHO histologic type

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. / Le, Quynh Thu; Tate, David; Koong, Albert; Gibbs, Iris C.; Chang, Steven D.; Adler, John R.; Pinto, Harlan A.; Terris, David J; Fee, Willard E.; Goffinet, Don R.

In: International Journal of Radiation Oncology Biology Physics, Vol. 56, No. 4, 15.07.2003, p. 1046-1054.

Research output: Contribution to journalArticle

Le, Quynh Thu ; Tate, David ; Koong, Albert ; Gibbs, Iris C. ; Chang, Steven D. ; Adler, John R. ; Pinto, Harlan A. ; Terris, David J ; Fee, Willard E. ; Goffinet, Don R. / Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. In: International Journal of Radiation Oncology Biology Physics. 2003 ; Vol. 56, No. 4. pp. 1046-1054.
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abstract = "Purpose: Treatment of nasopharyngeal carcinoma using conventional external beam radiotherapy (EBRT) alone is associated with a significant risk of local recurrence. Stereotactic radiosurgery (STR) was used to boost the tumor site after EBRT to improve local control. Methods and Materials: Forty-five nasopharyngeal carcinoma patients received a STR boost after EBRT at Stanford University. Seven had T1, 16 had T2, 4 had T3, and 18 had T4 tumors (1997 American Joint Commission on Cancer staging). Ten had Stage II, 8 had Stage III, and 27 had Stage IV neoplasms. Most patients received 66 Gy of EBRT delivered at 2 Gy/fraction. Thirty-six received concurrent cisplatin-based chemotherapy. STR was delivered to the primary site 4-6 weeks after EBRT in one fraction of 7-15 Gy. Results: At a medium follow-up of 31 months, no local failures had occurred. The 3-year local control rate was 100{\%}, the freedom from distant metastasis rate was 69{\%}, the progression-free survival rate was 71{\%}, and the overall survival rate was 75{\%}. Univariate and multivariate analyses revealed N stage (favoring N0-N1, p = 0.02, hazard ratio HR 4.2) and World Health Organization histologic type (favoring type III, p = 0.002, HR 13) as significant factors for freedom from distant metastasis. World Health Organization histologic type (p = 0.004, HR 10.5) and age (p = 0.01, HR 1.07/y) were significant factors for survival. Late toxicity included transient cranial nerve weakness in 4, radiation-related retinopathy in 1, and asymptomatic temporal lobe necrosis in 3 patients who originally had intracranial tumor extension. Conclusion: STR boost after EBRT provided excellent local control in nasopharyngeal carcinoma patients. The incidence of late toxicity was acceptable. More effective systemic treatment is needed to achieve improved survival.",
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AU - Tate, David

AU - Koong, Albert

AU - Gibbs, Iris C.

AU - Chang, Steven D.

AU - Adler, John R.

AU - Pinto, Harlan A.

AU - Terris, David J

AU - Fee, Willard E.

AU - Goffinet, Don R.

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AB - Purpose: Treatment of nasopharyngeal carcinoma using conventional external beam radiotherapy (EBRT) alone is associated with a significant risk of local recurrence. Stereotactic radiosurgery (STR) was used to boost the tumor site after EBRT to improve local control. Methods and Materials: Forty-five nasopharyngeal carcinoma patients received a STR boost after EBRT at Stanford University. Seven had T1, 16 had T2, 4 had T3, and 18 had T4 tumors (1997 American Joint Commission on Cancer staging). Ten had Stage II, 8 had Stage III, and 27 had Stage IV neoplasms. Most patients received 66 Gy of EBRT delivered at 2 Gy/fraction. Thirty-six received concurrent cisplatin-based chemotherapy. STR was delivered to the primary site 4-6 weeks after EBRT in one fraction of 7-15 Gy. Results: At a medium follow-up of 31 months, no local failures had occurred. The 3-year local control rate was 100%, the freedom from distant metastasis rate was 69%, the progression-free survival rate was 71%, and the overall survival rate was 75%. Univariate and multivariate analyses revealed N stage (favoring N0-N1, p = 0.02, hazard ratio HR 4.2) and World Health Organization histologic type (favoring type III, p = 0.002, HR 13) as significant factors for freedom from distant metastasis. World Health Organization histologic type (p = 0.004, HR 10.5) and age (p = 0.01, HR 1.07/y) were significant factors for survival. Late toxicity included transient cranial nerve weakness in 4, radiation-related retinopathy in 1, and asymptomatic temporal lobe necrosis in 3 patients who originally had intracranial tumor extension. Conclusion: STR boost after EBRT provided excellent local control in nasopharyngeal carcinoma patients. The incidence of late toxicity was acceptable. More effective systemic treatment is needed to achieve improved survival.

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KW - Stereotactic radiosurgery

KW - WHO histologic type

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