Familial Nasopharyngeal Carcinoma 6

Management of Patients with Failure Following 19Definitive Radiation Therapy: Reirradiationin Patients with Locally RecurrentNasopharyngeal CarcinomaDaniel ChuaCONTENTS19.1 Introduction 24119.2 Prognostic Factors 24219.3 Brachytherapy 24219.3.1 Principle of Brachytherapy 24219.3.2 Intracavitary Bracytherapy 24219.3.3 Interstitial Implantation 24319.4 Stereotactic Radiotherapy 24419.4.1 Principle of Stereotactic Radiotherapy 24419.4.2 Stereotactic Radiosurgery 24419.4.3 Stereotactic Radiotherapy 24519.5 External Beam Reirradiation 24619.6 Combined Modality Approach 24819.7 Patient Selection for SalvageTreatment 24819.8 Future Directions 249References 249Daniel Chua, MDDepartment of Clinical Oncology, Queen Mary Hospital,The University of Hong Kong, Rm PB-115, 1/F, ProfessorialBlock, Queen Mary Hospital, Pok Fu Lam Road, Hong KongSAR, P.R. China19.1IntroductionAlthough excellent control rates can be achieved afterprimary treatment for NPC, local relapse still representsa major cause of treatment failure, particularlyin patients presented with advanced primary disease.In managing local failures of NPC, aggressive salvagetreatment with curative intent should always be considered,since a significant proportion of these patientscan still achieve long-term survival after successfulretreatment. In a retrospective review of a largecohort of 275 patients with local failure of NPC,patients who received salvage treatment had a significantlybetter survival compared with those withoutreceiving any salvage treatment (Yu et al. 2005).Although patients with less extensive recurrence andbetter performance were likely to be selected for salvagetreatment, this large series still showed that onlypatients who underwent surgery or reirradiation hada chance of achieving long-term disease control andsurvival. Many salvage treatments are available, andthe choice of method depends on several factorsincluding extent of disease, site of disease, any synchronousnodal relapse, cumulative radiation dosealready received by patient, patient’s general conditionand preference, and expertise available. In general,salvage treatments with curative intent can beclassified into surgery and reirradiation. This chaptercovers different approaches of reirradiation insalvaging local failures of NPC, which includebrachytherapy using intracavitary intubation, mouldapplication or gold grain implantation, stereotacticradiotherapy, and external beam radiation therapy.