Bracytherapy for primary and recurrent nasopharyngeal carcinoma: 20 years'experience at Long Beach Memorial

Purpose: We evaluated treatment outcomes of patients with mostly locally ad vanced primary and recurrent cancer of the nasopharynx managed with interst itial and intraluminal brachytherapy. Methods and Materials: This is a retrospective analysis of 56 patients with cancer arising from the nasopharynx treated with interstitial and intracav itary afterloading brachytherapy from 1978 to 1997. Patients were divided i nto three treatment groups: 15 patients with primary cancer (Group 1), 34 p atients with recurrent or persistent disease (Group 2), and 7 patients with cancer in the nasopharynx who had history of previous definitive radiation therapy to the nasopharynx for head and neck cancer (Group 3). Fifty-three percent of patients in Group 1 had 1992 AJCC Stage IV disease, and 49% of patients in Groups 2 and 3 had extensive disease (defined as T3, T4, or par apharyngeal extension. Group 1 received megavoltage radiation to 50-60 Gy f ollowed by a boost to the primary site and neck tin cases of persistent nec k disease) with a combination of interstitial and intracavitary brachythera py (mean dose 33-37 Gy). Five patients received chemotherapy, and 6 patient s received hyperthermia. Groups 2 and 3 patients were treated with brachyth erapy implants (mean dose 50-58 Gy) without external beam radiation. Twenty -five patients received chemotherapy either before or during radiation, and 21 patients received hyperthermia. Results: The overall survival at 2, 5, and 10 years for patients in Group 1 was 79%, 61%, and 61%, respectively, and for patients in Groups 2 and 3 co mbined was 48%, 30%, and 20%, respectively. Cause-specific survival at 2, 5 , and 10 gears was 87%, 74%, and 74%, respectively, for patients in Group 1 ; and 82%, 60%, and 60%, respectively, for patients in Groups 2 and 3. Loca l control at 2, 5, and 10 years was 93%, 93%, and 77%, respectively, for pa tients in Group 1; and 81%, 59%, and 49%, respectively, for patients in Gro ups 2 and 3. Control in the neck at 2, 5, and 10 gears was achieved in 93%, 93%, and 93% of patients, respectively, in Group 1; and 88%, 81%, and 81%, respectively, for patients in Groups 2 and 3. Disease-free survival was 87 %, 74%, and 62%, respectively, for patients in Group 1, and 56%, 41%, and 3 4%, respectively, for patients in Groups 2 and 3. There were 1 peri-operati ve deaths. One death (2%) was attributable to the development of late compl ications. Forty-five percent of patients experienced some form of late comp lications. Conclusion: Interstitial afterloading brachytherapy can provide effective t reatment for nasopharyngeal cancers, especially for locally persistent/recu rrent and locally extensive lesions. (C) 2000 Elsevier Science Inc.