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. 2024 Jan 1;15(2):456-465.
doi: 10.7150/jca.88148. eCollection 2024.

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Xiao-Tang Xiao  1 , Shi-Qian Zou  1 , Yu-Pei Chen  1 , Rui Guo  1 , Ling-Long Tang  1 , Ying Sun  1 , Jun Ma  1 , Wen-Fei Li  1
Affiliations

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Xiao-Tang Xiao et al. J Cancer. .

Abstract

Objective: To investigate the patterns of local failure and prognosis in patients with locally recurrent nasopharyngeal carcinoma (rNPC) after primary intensity-modulated radiotherapy (IMRT). Methods: The data of 298 patients with locally rNPC after IMRT were retrospectively analyzed. Magnetic resonance images of the initial and recurrent tumors were reviewed and, for patients with extra-nasopharyngeal local recurrence, the gross tumor volume of local recurrence was transferred to the original IMRT plan for dosimetry analysis. Significant prognostic factors for overall survival (OS) were selected by multivariate Cox regression analysis. Results: The commonest recurrence sites were the nasopharynx (93%, 277/298) and skull base (53.7%, 160/298). Of the 21 patients with extra-nasopharyngeal recurrence (19 cases valid), 12 had in-field failures, 4 had marginal failures, and 3 had out-field failures. The ethmoid sinus (57.1%, 4/7) and nasal cavity (28.6%, 2/7) were the most frequent sites of marginal and out-field failures. After median follow-up of 37 months, the 3-year and estimated 5-year OS rates were 57.3% and 41.7%, respectively. Multivariate analysis showed that age, recurrence interval, plasma Epstein-Barr virus (EBV) DNA level, and recurrent T stage were independent prognostic factors for OS. Conclusions: Local failure after IMRT occurs most commonly in the nasopharynx and skull base. In patients with extra-nasopharyngeal recurrence, in-field failure remains the main failure pattern, and marginal and out-field failures mainly occur in the ethmoid sinus and nasal cavity. Elder age, shorter recurrence interval, detectable plasma EBV DNA, and advanced recurrent T stage are negative predictors of OS in patients with rNPC.

Keywords: IMRT; failure pattern; local recurrence; nasopharyngeal carcinoma; prognosis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow diagram of the study sample selection process (inclusion and exclusion criteria).
Figure 2
Figure 2
Light microscopic appearance of locally recurrent nasopharyngeal carcinoma. Keratinizing squamous cell carcinoma (A: H&E stain, ×40; B: H&E stain, ×400); non-keratinizing carcinoma, undifferentiated subtype (C: H&E stain, ×40; D: H&E stain, ×400).
Figure 3
Figure 3
Magnetic resonance imaging (MRI) images of three patients with local recurrence outside the nasopharynx. Marginal failure in the ethmoid sinus and nasal cavity due to the large volume of the recurrent tumor (A1-A3); marginal failure at the hypophyseal fossa due to target miss (B1-B3); and out-field failure in the ethmoid sinus and nasal cavity (C1-C3). Left: Initial diagnostic MRI. Middle: Target volume delineation and dose prescription of primary intensity-modulated radiotherapy. Right: MRI at recurrence. The green line indicates the gross recurrent tumor volume (GTVr); the red line, the gross primary tumor volume (GTVp); the pink line, the high-risk clinical target volume (CTV1); and the blue line, the low-risk clinical target volume (CTV2).
Figure 4
Figure 4
Kaplan-Meier overall survival curves for patients with different recurrent T stages.
See this image and copyright information in PMC

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