Long term results of radioactive gold grain implantation for the treatmentof persistent and recurrent nasopharyngeal carcinoma

BACKGROUND. Brachytherapy is useful for the reirradiation of nasopharyngeal carcinoma. In the current study, the long term treatment results of perman ent radioactive gold(198) grain interstitial implantation in patients with persistent and recurrent nasopharyngeal carcinoma were reviewed. METHODS. Gold grain implantation was performed under direct vision with a s plit palate approach to provide 60 grays (Gy) 0.5 cm away from the plane of implantation. Between August 1986 and Map 1999, 106 patients were treated with gold grain implantation (45 patients for persistent disease, 53 patien ts for first recurrence, and 8 patients for second recurrence in the nasoph arynx). All patients had histologically proven disease by biopsy before und ergoing implantation. RESULTS. Patients with persistent disease and those with first recurrence d id well with the gold grain implantation. The 5-year local control rates fo r patients with persistent disease, first recurrence, and second recurrence in the nasopharynx were 87.2%, 62.7%, and 23.4%, respectively (P = 0.0004) . The 5-year metastasis free survival rates were 68.1%, 60.3%, and 40%, res pectively, for the 3 groups (P = 0.048). The overall survival rates at 5 ye ars for the 3 groups were 79.1%, 53.6%, and 42.9%, respectively (P = 0.0047 ). Patients with computed tomography evidence of disease extension outside the nasopharynx had a lower local control rate compared with patients whose disease was confined to the nasopharynx: (5-year local control rate of 52% vs. 72.3%; P = 0.031). The size of the lesion was not found to be an indep endent prognostic factor for local control after implantation. Multivariate analysis showed only an indication for implantation (persistent disease, f irst recurrence, and second recurrence) to be a significant prognostic fact or for local control. Complications attributed to gold grain implantation i ncluded headache, palatal fistula, and mucosal radiation necrosis at the si te of implantation, and were reported to occur in 28.3%, 18.9%, and 16%, re spectively, of patients. CONCLUSIONS, For selected patients with disease confined to the nasopharynx , gold grain implantation is an effective salvage treatment for persistent and recurrent nasopharyngeal carcinoma. Cancer 2001;91:1105-13. (C) 2001 Am erican Cancer Society.