Familial Nasopharyngeal Carcinoma 6

Management of Patients with Failure Following Definitive Radiation Therapy 249Table 19.5. Summary of Queen Mary Hospital’s experience of using different salvage treatment for local failures of NPCSalvage treatment Time period No. of patients Tumor control rate (%) Survival rate (%)Nasopharyngectomy 1989–2008 236 67 (5-year) 52 (5-year)Gold grain interstitialimplantation1986–1999 106 Persistent disease: 87(5-year)Recurrent disease:63 (5-year)Persistent disease: 79(5-year)Recurrent disease: 54(5-year)2D external beamradiotherapyStereotactic radiosurgery1984–1995 97 32 (5-year) 36 (5-year)1996–2005 48 52 (5-year) 47 (5-year)Intensity modulatedradiotherapy2001–2004 31 rT1–3: 43 (5-year)rT4: 27 (5-year)rT1–3: 38 (5-year)rT4: 14 (5-year)cific type of treatment. Using five prognostic factors(age, recurrent T-classification category, time periodfrom first radiotherapy, tumor volume, prior local failure),we have designed a prognostic scoring system forstereotactic radiosurgery, and the 5-year local controlrates for good, intermediate and poor prognostic scorewere 100%, 43% and 10%, respectively (Chua et al.2008). The scoring system was recently validated usingpublished data in the literature (Chua et al. 2009c).19.8Future DirectionsThe technique of external beam radiation has evolvedsubstantially over the past decade and the utilization ofnewer treatment techniques such as helical tomotherapyand proton therapy as salvage treatment of local failuresof NPC may further improve the outcome. Improvedtarget delineation using biological imaging is alsoimportant in salvage radiation due to the smaller marginthat can be safely used. Integration of chemotherapyand molecular targeted agent may also play a role in themanagement of advanced recurrence, similar to the successobserved in the treatment of newly diagnosed disease.Collaborative efforts in pooling data of salvagetreatment from multiple centers should be encouraged,since it will allow the identification of important prognosticfactors, and useful models may be developed toassist clinician in selecting the patient for a specific typeof salvage treatment. This is of particular importancesince prospective randomized trials comparing differentsalvage treatments are difficult to conduct.ReferencesAhn YC, Lee KC, Kim DY, et al (2000) Fractionated stereotacticradiation therapy for extracranial head and neck tumors.Int J Radiat Oncol Biol Phys 48:501–505Buatti JM, Friedman WA, Bova FJ, et al (1995) Linac radiosurgeryfor locally recurrent nasopharyngeal carcinoma:rationale and technique. Head Neck 17:14–19Chang JT, See LC, Liao CT, et al (2000) Locally recurrentnasopharyngeal carcinoma. Radiother Oncol 54:135–142Chen HJ, Leung SW, Su CY (2001) Linear accelerator basedradiosurgery as a salvage treatment for skull base andintracranial invasion of recurrent nasopharyngeal carcinoma.Am J Clin Oncol 24:255–258Choy D, Sham JS, Wei WI, et al (1993) Transpalatal insertion ofradioactive gold grain for the treatment of persistent andrecurrent nasopharyngeal carcinoma. Int J Radiat OncolBiol Phys 25:505–512Chua D (2009a) Phase II trial of induction chemotherapy followedby external beam re-irradiation and concurrentcetuximab for locoregionally recurrent nasopharyngealcarcinoma. Proceedings of 2nd International Conferenceon Innovative Approaches in Head and Neck Oncology,Abstract 56 *Chua DT, Hung KN, Lee V, et al (2009c) Validation of a prognosticscoring system for locally recurrent nasopharyngeal carcinomatreated by stereotactic radiosurgery. BMC Cancer9: 131Chua DT, Sham JS, Au GK (2005b) Induction chemotherapywith cisplatin and gemcitabine followed by reirradiationfor locally recurrent nasopharyngeal carcinoma. Am J ClinOncol 28:464–471Chua DT, Sham JS, Hung KN, et al (2006) Predictive factors oftumor control and survival after radiosurgery of local failuresof nasopharyngeal carcinoma. Int J Radiat Oncol BiolPhys 66:1415–1421Chua DT, Sham JS, Kwong DL, et al (1998) Locally recurrentnasopharyngeal carcinoma: treatment results for patientswith computed tomography assessment. Int J Radiat OncolBiol Phys 41:379–386