open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-12-10
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Should high-dose-rate brachytherapy boost be used in early nasopharyngeal carcinomas?

Jose Luis Guinot, Andrea Moya, Miguel Angel Santos, Marina Peña, Beatriz Quiles, Juan Carlos Sanchez-Relucio, Alonso La Rosa, Maria Isabel Tortajada, Leoncio Arribas
DOI: 10.1016/j.rpor.2020.04.001
·
Rep Pract Oncol Radiother 2020;25(4):479-483.

open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-12-10

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.

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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Keywords

Nasopharynx; Carcinoma; High-dose-rate; Brachytherapy; Boost

About this article
Title

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

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 4 (2020)

Pages

479-483

Published online

2020-07-01

DOI

10.1016/j.rpor.2020.04.001

Bibliographic record

Rep Pract Oncol Radiother 2020;25(4):479-483.

Keywords

Nasopharynx
Carcinoma
High-dose-rate
Brachytherapy
Boost

Authors

Jose Luis Guinot
Andrea Moya
Miguel Angel Santos
Marina Peña
Beatriz Quiles
Juan Carlos Sanchez-Relucio
Alonso La Rosa
Maria Isabel Tortajada
Leoncio Arribas

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