Re-Irradiation of Recurrent Nasopharyngeal Cancer: A 4-year Follow-up Study of Treatment using 3-Dimensional Conformal Radiotherapy

Samuel Kelvin Ruslim, Selviant Selviant, Aviciena bin Iskandar, Sielvyana Sie, Agustinus Darmadi Hariyanto, Monika Kencana Dewi

Abstract


Introduction: Nasopharyngeal cancer (NPC) is a prevalent diagnosis of head and neck cancers (HNC) in Asia. In Indonesia, it is estimated that there are 12,000 new cases per year.

 

Case Presentation: The author reports a 25-year-old male patient with recurrent NPC. This patient was first diagnosed with NPC stage IVB in 2013 and was treated by chemoradiation. In 2016, he found another mass in his neck. The biopsy result showed the recurrence of the NPC with histopathology of Undifferentiated carcinoma (WHO type III). Re-irradiation was planned, and the patient subsequently received 3D-Conformal Radiotherapy (3D-CRT) at our department. Four years after the completion of re-irradiation, the patient was alive and well with no signs of recurrence but still complained about late toxicities like trismus and fibrotic neck.

 

Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like intensity-modulated radiotherapy (IMRT). However, with careful planning, we can still obtain optimum tumor dose, minimize organs at-risk (OAR) dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on re-irradiation, especially in OAR dose tolerance guidelines.


Keywords


3D-CRT, nasopharyngeal cancer, re-irradiation, radiotherapy, radiationinduced toxicity, side effects

References


GLOBOCAN. 360 Indonesia Fact Sheets [Internet]. 2020. Available from: https://gco.iarc.fr/today/data/factsheets/populations/360-indonesia-fact-sheets.pdf

Kong L, Lu JJ. Reirradiation of locally recurrent nasopharyngeal cancer: History, advances, and promises for the future. Chinese Clin Oncol. 2016;5(2):1–8.

Ng WT, Lee MCH, Chang ATY, et al. The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT. Oral Oncol. 2014;50(5):506–12.

Li H, Yao Q, Huang X, et al. Therapeutic effect of pregabalin on radiotherapy-induced trismus in nasopharyngeal carcinoma patients. Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Sep;136(4):251–5.

Gondhowiardjo SA, Meidania L, Senoaji F, Sekarutami SM. Nasopharyngeal Carcinoma Profile in dr. Cipto Mangunkusumo Hospital Year 2013. Radioter Onkol Indones. 2019;10(1):8–11.

Xu T, Tang J, Gu M, et al. Recurrent nasopharyngeal carcinoma: A clinical dilemma and challenge. Curr Oncol. 2013;20(5).

Li JX, Lu TX, Huang Y, et al. Clinical features of 337 patients with recurrent nasopharyngeal carcinoma. Chin J Cancer. 2010;29(1):77–80.

Lee AWM, Foo W, Law SCK, et al. Recurrent nasopharyngeal carcinoma: The puzzles of long latency. Int J Radiat Oncol Biol Phys. 1999;44(1):149–56.

Bots WTC, van den Bosch S, Zwijnenburg EM, et al. Reirradiation of head and neck cancer: Long-term disease control and toxicity. Head Neck. 2017;39(6):1122–30.

Pfister DG, Spencer S, Adelstein D, Al. E. NCCN Guidelines Version 2.2018: Head and Neck Cancers. Natl Compr Cancer Netw. 2018;227.

Perri F, Della Vittoria Scarpati G, Caponigro F, et al. Management of recurrent nasopharyngeal carcinoma: Current perspectives. Onco Targets Ther. 2019;12:1583–91.

Brodin NP, Tomé WA. Revisiting the dose constraints for head and neck OARs in the current era of IMRT. Oral Oncol. 2018;86(July):8–18.

Nutting CM, Morden JP, Harrington KJ, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): A phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12(2):127–36.

Nieder C, Grosu AL, Andratschke NH, Molls M. Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys. 2006;66(5):1446–9.

Wang HZ, Luo JW, Yi JL, et al. The Tolerance of Brainstem in Reirradiation With Intensity Modulated Radiation Therapy in Recurrent Nasopharyngeal Carcinoma Impact of Tumor Volume and the Surrogate Effect of Lymph Node Location on Risk of Distant Metastases in Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys. 2016;96(2)suppl:E340.

Zheng YJ, Han F, Xiao WW, et al. Analysis of late toxicity in nasopharyngeal carcinoma patients treated with intensity modulated radiation therapy. Radiat Oncol. 2015;10(1).

Karam I, Huang S, Mcniven A, et al. Outcomes after reirradiation for recurrent nasopharyngeal carcinoma: North American experience. Head Neck. 2016;38:1102–9.

Pan R, Wang J, Qi F, Liu R. Dosimetric comparison and observation of three-dimensionalconformal radiotherapy for recurrent nasopharyngeal carcinoma. Oncol Lett. 2017;14(4):4741–5.

Purkayastha A, Sharma N, Sarin A, et al. Radiation Fibrosis Syndrome: The Evergreen Menace of Radiation Therapy. Asia-Pacific J Oncol Nurs. 2019;6(3):238.

Soldatova L, Mirza N. Long-Term Voice and Swallowing Outcomes for Oral and Oropharyngeal Cancer Following Primary or Adjuvant Chemoradiation. Ann Otol Rhinol Laryngol. 2019;128(9):802–10.

Siala W, Mnejja W, Elloumi F, et al. Late Toxicities after Conventional Radiotherapy for Nasopharyngeal Carcinoma: Incidence and Risk Factors. J Radiother. 2014;2014:1–8.


Full Text: PDF

DOI: 10.33371/ijoc.v16i1.837

Article Metrics

Abstract view : 126 times
PDF - 92 times

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Indonesian Journal of Cancer

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.