Feasibility of a second course irradiation after ?-knife radiotherapy for nasopharyngeal carcinoma / 中华放射肿瘤学杂志

ABSTRACT

Objective To investigate the feasibility of ?-knife as the only treatment or a second course radiotherapy after ?-knife radiotherapy for nasopharyngeal carcinoma(NPC).Methods From Jan.1998 to Feb.2004,2 recurrent NPC patients and 8 newly diagnosed patients with lesions in nasopharynx and skull base received ?-knife radiotherapy.Among the latter 8 newly untreatment patients,2 had poorly differentiated squamous cell carcinoma in the nasopharynx,while the other 6 patients had been misdiagnosed as nasopharyngeal tumors other than NPC,including 3 clivus chordoma and 2 caverous sinus meningioma diagnosed by MR imaging,and 1 nasopharyneal fibroangioma by direct nasopharyngoscopic examination.After ?-knife radiotherapy,all the 6 non-nasopharyngeal carcinoma patients were pathologically proved to have nasopharyngeal carcinoma.The treatment of this cohort were 8 untreated patients with ?-knife radiotherapy first as the only treatment,2 recurrent nasopharyngeal carcinoma patients with ?-knife radiotherapy as salvage treatment.Treatment after the initial ?-knife radiotherapy for these patients were 2 no further treatment,3 with induction chemotherapy followed by conventional radiotherapy,2 with conventional radiotherapy followed by chemotherapy,2 with conventional radiotherapy alone and 1 with chemotherapy alone.The chemotherapy regimen consisted of DDP 30?mg/m~2+5-Fu 500?mg/m~2,d1-3,3 week per cycle,totally 2-3 cycles.The radiotherapy regimen consisted of two opposing faciocervical portals or preauricular plus anterior nasal portals to a total dose of 60-70?Gy within 6-7 weeks for the primary lesion and 5060?Gy for the neck nodes with the residual primary lesion boosted with 500-750 ?cGy. Results No primary lesion of the 8 newly diagnosed patients for whom the ?-knife has been given first as the only treatment was controlled.In the 2 recurrent NPC patients,shrinkage of tumor and relief of symptoms were observed after ?-knife radiotherapy.Among 8 newly diagnosed patients,6 misdiagnosed ones received chemotherapy and radiotherapy before ?-knife radiotheryapy gave survival intervals of 6.0,2.5,2.0 and 1.0 years,while one patient who was refused of radiotherapy died of distant metastasis,and the other patient who received chemotherapy alone died of uncontrolled primary lesion.Conclusions ?-knife radiotherapy alone must not be chosen as the initial only treatment for nasopharyngeal carcinoma.For recurrent NPC,?-knife radiotherapy is indicated,preferably followed by a second course conventional radiotherapy with or without chemotherapy.Giving the green light for the radiation-induced complications of the second course conventional radiotherapy after ?-knife radiotherapy awaits further observation.