PROGNOSTIC FACTORS FOR LOCO-REGIONAL CONTROL AND OUTCOME OF REIRRADIATION FOR PATIENTS WITH POORLY-DIFFERENTIATED SQUAMOUS-CELL CARCINOMA OF THE NASOPHARYNX

Retrospective analysis was performed to evaluate the prognostic factor s for loco-regional control and the results of re-irradiation for 28 p atients with recurrent, poorly-differentiated squamous cell carcinoma (PDSCC) of the nasopharynx. Twenty-four of them received re-irradiatio n. Local, local plus regional and regional recurrences were observed i n 19, five and four patients, respectively. Except for three patients, all had Stage IV disease at the initial diagnosis. The only parameter s influencing loco-regional recurrence were T and N stage categories. The median latent period from initial treatment to recurrence was 18.5 (range, 2-100) months. There was no difference in latent period by fi rst recurrence site, although recurrent tumors confined to the nasopha rynx or those only regionally developed had a longer latent period. On ly four patients developed secondary distant bone metastases with a me dian latency of three months from loco-regional relapse. The patients with local recurrent tumors confined to the nasopharynx, and those wit h regional recurrences only, could be salvaged by re-irradiation, with five-year survival rates of 44 and 100%, respectively. Five of 28 pat ients (18%) developed severe chronic radiation sequelae: cerebrospinal complications in four patients, bilateral neck fibrosis in one. We co nclude that recurrent PDSCC of the nasopharynx can be controlled by re -irradiation with some success. Radiation therapy techniques must, how ever, be carefully planned in order to avoid the severe late post re-i rradiation sequelae. For patients with advanced non-curable local recu rrences, palliative care should be recommended instead of agressive re -irradiation.