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Fares, Houda; Taouchikht, Mona; Ngbwa, édith Tatiana; Abdou, Sara; Gueddari, Rania El; Hassnaoui, Imane; Nouni, Karima; Lachgar, Amine; Elkacemi, Hanan; Kebdani, Tayeb; Hassouni, Khalid
Radiotherapy and oncology, March 2024, 2024-03-00, Letnik: 192Journal Article
The local control rate of nasopharyngeal carcinomas has increasingly increased since the routine use of intensity-modulated conformal radiotherapy. The treatment of local recurrences is essentially based on reirradiation; but it is limited by the doses previously received by the organs at risk in series. Evaluate the Efficacy and Toxicity of Reirradiation of Local Relapses of Nasopharyngeal Carcinoma This is a retrospective study, including 12 patients re-irradiated at the National Institute of Oncology in Rabat for a local or locoregional relapse between 2015 and 2020. Among 600 irradiated patients, 12 patients had a local or locoregional recurrence for which they received intensity-modulated reirradiation. The average age of patients at the time of initial diagnosis was 40.8 years (range 22 to 52 years). The tumor was initially classified according to the AJCC 2017 classification stage II, stage III and stage IV in 2 cases (16%), 4 cases (34%) and 6 cases (50%) respectively. Initial treatment was based on neoadjuvant chemotherapy followed by concomitant chemoradiotherapy in 9 patients (75%) and concomitant chemoradiotherapy alone in 3 patients (30%). Initial irradiation was using a conventional three-dimensional technique having delivered a total dose of 70 Gy at a rate of 2 Gy per session. All patients were in complete remission. The average time to local relapse was 7 years (range: 3 years – 10 years). The diagnosis was confirmed by a pathological study in all patients. Recurrence was classified stage II, stage III and stage IV respectively in 3 cases (25%), 5 cases (41%) and 4 cases (33%). Therapeutically, 5 patients (50%) received neoadjuvant chemotherapy followed by concomitant chemoradiotherapy; 6 patients (90%) received radiochemotherapy concomitant therapy alone and one patient received exclusive radiotherapy. The reirradiation was with intensity modulation by Arc Therapy, having delivered a total dose of 60 Gy in all patients at a rate of 2Gy per fraction. After a mean follow-up of 19 months (range: 10 months – 34 months), seven patients were in complete remission; two died of the disease after an average follow-up of 10 months and three patients were lost to follow-up. The late toxicity of reirradiation was an increase in hearing toxicity (grade 3 becoming grade 4) in 4 patients, trismus in two patients and cervical fibrosis in two patients. Reirradiation is the only salvage treatment for recurrences of nasopharyngeal carcinomas, precisely conformal radiotherapy with intensity modulation which makes it possible to deliver sufficient doses to the tumor volume while sparing the organs at risk already irradiated; however, given the associated toxicity, patients must be rigorously selected.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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