LOCALLY RECURRENT NASOPHARYNGEAL CARCINOMA - TREATMENT RESULTS FOR PATIENTS WITH COMPUTED-TOMOGRAPHY ASSESSMENT

Purpose: To study the treatment outcome in patients with locally recur rent nasopharyngeal carcinoma as restaged by computed tomography (CT). Patients and Methods: One hundred forty patients with CT restaged loc ally recurrent nasopharyngeal carcinoma were reviewed. Patients were r c:staged at recurrence according to the AJCC stage classification with the following distribution: T1-T2:30%, T3::19%, T4:51%. Ninety-seven patients received reirradiation; among these 62 had external irradiati on, 34 had brachytherapy, and 1 had both. Twelve patients received sur gery. Thirty-one patients were treated with palliative intent and rece ived either chemotherapy or supportive treatment only. Overall surviva l (OAS) and performance-adjusted survival (PAS, defined as surviving w ith a Karnofsky performance score [KPS] > 50) were calculated by Kapla n-Meier method. Multivariate analysis was performed using the Cox mode l. Results: The median survival for all patients was 23.8 months. Afte r reirradiation, the 3-yr and 5-yr OAS rates were 46% and 36%, respect ively. The corresponding PAS rates were 40% and 28%. The 3-yr OAS rate s for recurrent T1-2, T3, and T4 disease after reirradiation were 71%, 32%, and 30%; the corresponding 5-yr OAS rates were 57%, 42%, 17%. Th e 3-yr and 5-yr OAS rates in patients receiving palliative treatments only were 19% and 0%, respectively. The 3-yr OAS rate after surgery wa s 42%. In the multivariate analysis, older age, recurrent T3-4 disease , and palliative treatment were unfavorable factors in predicting over all survival, whereas recurrent T3-4 disease, baseline KPS < 70, and p alliative treatment were unfavorable factors in predicting PAS. A high complication rate was observed after reirradiation, with 34% of patie nts developing neurological sequel. Conclusion: Aggressive treatment f or locally recurrent nasopharyngeal carcinoma is warranted especially for those with disease confined to the nasopharynx. Survival after ret reatment for more extensive disease remains poor but was still superio r to supportive treatment only. Early diagnosis of local recurrence al lows prompt administration of treatment and is associated with better outcome. Future studies should aim at improving the therapeutic ratio in the retreatment of recurrent disease especially in patients with mo re extensive local recurrence. (C) 1998 Elsevier Science Inc.