Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01

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Should high-dose-rate brachytherapy boost be used in early nasopharyngeal carcinomas?

Jose Luis Guinot1, Andrea Moya1, Miguel Angel Santos1, Marina Peña1, Beatriz Quiles1, Juan Carlos Sanchez-Relucio2, Alonso La Rosa1, Maria Isabel Tortajada1, Leoncio Arribas1
DOI: 10.1016/j.rpor.2020.04.001
Rep Pract Oncol Radiother 2020;25(4):479-483.

Abstract

Background

Radiation with or without chemotherapy is the main treatment of nasopharyngeal carcinomas (NPC). Local recurrence is difficult to manage. Local control is dose-dependent.

Aim

To analyze the effect of an endocavitary brachytherapy boost after external beam radiation (EBRT) to decrease local recurrence.

Material and methods

Thirty patients with T0-T2 NPC were treated: 70% T1, 20% T2 and 10% T0; 33.3% N0, 20% N1, 43.3% N2 and 3.3% N3; 90% were undifferentiated carcinoma. All they received a 192-Ir high dose rate brachytherapy (HDR-BT) boost after 60 Gy of EBRT. The Rotterdam applicator was used in most cases, 3-4 fractions of 3.75-3 Gy in two days.

Results

With median follow-up (FU) of 63 months, a single parapharyngeal failure resulted in local control of 100% at 3 years and 95% at 5 years. Local control for T0-1 was 100% and for T2 67% at five years (p = 0.02). Regional-free recurrence survival was 92% at 5 years. Metastasis-free survival was 84% at 5 years. All cases of metastasis had histopathology of undifferentiated. The overall and cause-specific survival was 96% and 86% at 3 and 5 years. No late complications related to brachytherapy were described.

Conclusion

A HDR-BT boost is useful to decrease the incidence of local recurrence of NPC to 5%. With a fractionated schedule of 3-4 fractions in two days, Rotterdam applicator and 3-D planning, no late complications are described. Therefore we recommend to use brachytherapy boost in all early NPC.

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