Abstract
Purpose: We analyzed treatment out in patients with nasopharyngeal carcinoma who received External Beam Radiotherapy and Chemotherapy with those with EBRT+chemotherapy + Intra Luminal High Dose Rate Brachytherapy.
Materials and Methods: Total 70 non metastic nasopharyngeal carcinomas patients treated between 2004-09 were retrospectively analyzed.
The group A consists of 48 patients who received External Beam Radiotherapy and Chemotherapy and the group B patients had EBRT+chemotherapy + Intra Luminal High Dose Rate Brachytherapy.
The EBRT dose ranged between 66-70Gy. Patients had concurrent chemotherapy with Inj.Cisplatin+5fu and adjuvant chemo. Intra Luminal High Dose Rate Brachytherapy total 3-4 fractions were delivered with minimum 6 hours gap between the two fractions, with 2 -3 Gy per fraction based on the dosage to critical normal structures.
Results: Both groups were compared in terms of Local recurrence rates were 8.34% Vs 4.5% (p value 0.4874336) , Local and regional recurrence 2.08% vs 4.5% (p value 0.131522 ), Regional recurrence 4.16% vs4.5% (p value 0.7547963), Distant metastasis 25% vs 41 % (p value 0.2994465) for group 1 and 2 respectively. Advanced nodal status and male gender were bad prognostic factors as per multivarient analysis. Administration of HDR ILRT was not significant prognostic factor in our study but none developed severe complications with brachytherapy.
Conclusion: Both acute and delayed complications in HDR ILRT group were acceptable. Despite limitations of our study being a retrospective analytical study and non uniform distribution of treatment groups, we made an attempt to treat all the patients with uniform brachytherapy protocol. This study will help to design a prospective randomized studies in centers where advanced radiotherapy technologies were not available
Key Words: Non metastatic Nasopharyngeal carcinoma, Radiotherapy, chemotherapy and Intra Luminal High Dose Rate Brachytherapy.
References
1. Cooper JS, Lee H, Torrery M et al. Improved outcome secondary to concurrent chemoradiotherapy for advanced carcinoma of the nasopharynx: Priliminary corroboration of the intergroup experience. International Journal of Radiation Oncology Biology and Physics 2000;47:861-866.
2. Al-Sarraf M, LeBlanc M, Giri S, et al Chemotherapy versusradiation in parients withadvanced carcinoma of the nasopharynx: phase III randomized Intergroup study 0099. J Clin Oncol 1998;16:1310-1317.
3. Vikram B, Mishra UB, Strong EW,et al. Patterns of failure in carcinoma of the nasopharynx:I. failure at primary site. International Journal of Radiation Oncology Biology and Physics 1985;11:1455-1459.
4. Sanguineti G, Geara F, Garden A et al, Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control. International Journal of Radiation Oncology Biology and Physics 1997;37:985-996.
5. Wang CC. Carcinoma of the nasopharynx. In: Wang CC,editor, Radiationtherapy for head and neck neoplasms: Indications, techniques and results. 2Nd ed. Chicago: Year book Medical publishers. Inc: 1990,p 261-283.
6. Bailet JW, Mark RJ, Abemayor E , etal. Nasopharyngeal carcinoma Treatment results with primary radiation therapy, Laryngoscope 1992;102:965-972.
7. Yang TS,Ng KT, Wang HM, et al, Prognostic factors of locoregionally recurrent nasopharyngeal carcinoma- a retrospective review of 182 cases. Am J Clin Oncol 1996;19:337-343
8. Mark JW,Bedwinek JM,Lee F, et al. Dose response analysis for nasopharyngeal carcinoma. Cancer 1982;50:1042-1050.
9. Perez CA, Devineni VR, Marcial-Vega V, et al. Carcinoma of nasopharynx: Factors affecting prognosis. . International Journal of Radiation Oncology Biology and Physics 1992:22:941-947.
10. Russel JD, Bleach NR, Glaser M, et al . Brachytherapy for recurrent nasopharyngeal nasoethamoidal tumors. J Laryngol Otol 1993;107:115-120.
11. Lee AWM, Poon YF, Foo W, et al. Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: Overall survival and patterns of failure. International Journal of Radiation Oncology Biology and Physics 1992;23:261-270.
12. International Nasopharynx Cancer Study Group: VMCA I Trail. Preliminary results of a randomized trail comparing neoadju-vant chemotherapy(cisplatin, epirubicin, bleomycin) plus radiotherapy vs radiotherapy alone in stage IV(>N2 Mo) undifferentiated nasopharyngeal carcino-ma: A positive effect on progression free survival. International Journal of Radiation Oncology Biology and Physics 1996;35;463-469.
13. Garden AS, Lippman SM, Morrison WH, et al. Dose induction chemotherapy have a role in the management of nasopharyngeal carcinoma? ?Result of treatment in the era of computerized tomography. International Journal of Radiation Oncology Biology and Physics 1996;36:1005-1012.
14. Syed AM, Puthawala AA ,et al. Brachytherapy for primary and recurrent nasopharyngeal carcinoma: 20 years experience at Long Beach Memorial. International Journal of Radiation Oncology Biology and Physic 2000 Jul 15;47(5):1311-21.
15. Chang JT, See LC, Tang SG, et al. The role of brachytherapy in early stage nasopharyngeal carcinoma. . International Journal of Radiation Oncology Biology and Physics 1996;36:1019-1024.
16. Lu JJ, Shakespeare TP ,Tan LK, et al. Adjuvant fractionated HDR intracavitary brachytherapy after external beam radiotherapy in T1 and T2 nasopharyngeal carcinoma. Head and Neck 2004 May;26(5):389-95.
17. Lee N, Hoffman R, Phillips TL, et al. Managing nasopharyngeal carcinoma with intracavitary brachytherapy: one institutionns’s 45-year experience. Brachytherapy 2002;1(2):74-82.
18. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Mannual. 5th edition. Philadelphia: JB Lippincott :1997.p 31-39.
19. Peter C. Levendag, Rob Peters et al. A new applicator design for endocavitary brachytherapy of cancer in cancer in nasopharynx; Radiotherapy and Oncology 1997;45:95-98.
20. Cox JD, Stetz J, et al. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)[Editorial]. International Journal of Radiation Oncology Biology and Physics 1995;31:1341-1346.
21. Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-481.
22. Cox DR. Regression model and life tables. J R Stat Soc B 1972;34:187-220.
23. Marks JE, Bedwinek JM, Lee F ,et al. Dose –response analysis for nasopha-ryngeal carcinoma. Cancer 1982; 50:1042-1050.
24. Wang CC. Improved local control of nasopharyngeal carcinoma after intracav-itary boost. Am J Clin Oncol 1991;14:5-8.
25. wang CC, Busse J, Gitterman M. A simple afterloading applicator for intracavitary irradiation for carcinoma of the nasopharynx. Radiology 1975;15:737-738.
26. Zang EP, Lian PG, Cai KL, et al. Radiation therapy of nasopharyngeal carcinoma: Prognostic factors based on a 10-year follow up of 1302 patients. International Journal of Radiation Oncology Biology and Physics 1989;16:301-305.
27. Enis Ozyer, Ferah Yildz, Fadil H. Akyol et al. Adjuvant high dose rate brachytherapy after external beam radiotherapy in nasopharyngeal carcinoma. International Journal of Radiation Oncology Biology and Physics 2002;52(1),101-108.
28. Xia P, Fu KK, Wong GW, et al . Comparison of treatment plans involving intensity modulated radiotherapy for nasopharyngeal carcinoma. International Journal of Radiation Oncology Biology and Physics 2000;48:329-337.
29. Sultanem K, Shu H.K, Xia P ,et al. 3D intensity modulated radiotherapy for nasopharyngeal carcinoma.The university of California-San Francisco experience. International Journal of Radiation Oncology Biology and Physics 2000;48:711-722.
30. The American Brachytherapy Socity Recommendations for HDR brachytherapy for Head –And-Neck carcinoma. . Int J Radiation oncology Biol Phys vol 50:2001;1190-98
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.92
