Departments of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia.
Am J Clin Oncol. 2010 Oct;33(5):469-73. doi: 10.1097/COC.0b013e3181b4b037.
Providing the primary recurrence is localized, salvage treatment is possible for nasopharyngeal carcinoma (NPC). This is a review of the experience of retreatment of this malignancy highlighting the roles of surgery and repeat radiotherapy.
The Tumor Registry of the Prince of Wales Cancer Centre was audited for patients with an initial diagnosis of squamous/nonsquamous cell NPC who had primary treatment with radiotherapy, and now presented for retreatment. Features relating to patient, disease and treatment factors were evaluated. The primary end point was subsequent local control, and secondary endpoints were overall and cancer-specific survival.
Over a 30-year period 39 patients were eligible, with 25 receiving both primary and retreatment at Prince of Wales Hospital. There were 25 males and 14 females with a median age of 50 years. Thirty-six patients had radiotherapy, 4 had stereotactic radiosurgery, 5 had brachytherapy, and the remainder had external treatment. Surgery was performed in 10 patients, of whom 3 had this as the only retreatment modality. Radiotherapy doses for retreatment ranged from 15 Gy (stereotactic radiosurgery) to 71.28 Gy (mean fractionated dose). Local control was achieved in 16 patients giving an overall rate of 41.0%, and the 5-year overall survival rate was 33.3%. Treatment modality was a significant prognostic factor for local control (P < 0.001) and cancer-specific survival (P < 0.05).
The presence of local recurrence after definitive treatment of NPC may still be salvageable. The best outcomes with reirradiation occur in the context of limited volume recurrence and a disease-free interval greater than 18 months.
如果鼻咽癌（NPC）的初次复发局限于局部，那么可进行挽救性治疗。这是对该恶性肿瘤再治疗经验的回顾，重点介绍了手术和重复放疗的作用。
审核了威尔斯亲王癌症中心肿瘤登记处的患者数据，这些患者最初被诊断为鳞状/非鳞状细胞 NPC，经放疗作为初始治疗，现在需要进行再治疗。评估了与患者、疾病和治疗因素相关的特征。主要终点是随后的局部控制，次要终点是总生存率和癌症特异性生存率。
在 30 年的时间里，有 39 名患者符合条件，其中 25 名在威尔斯亲王医院接受了初次治疗和再治疗。患者中有 25 名男性和 14 名女性，中位年龄为 50 岁。36 名患者接受了放疗，4 名患者接受了立体定向放射外科手术，5 名患者接受了近距离放射治疗，其余患者接受了外部治疗。10 名患者接受了手术，其中 3 名患者仅接受手术作为唯一的再治疗方式。再治疗的放疗剂量范围从 15 Gy（立体定向放射外科手术）到 71.28 Gy（平均分次剂量）。16 名患者实现了局部控制，总局部控制率为 41.0%，5 年总生存率为 33.3%。治疗方式是局部控制（P < 0.001）和癌症特异性生存（P < 0.05）的显著预后因素。
在 NPC 的确定性治疗后出现局部复发仍然可以挽救。在疾病复发体积较小且无疾病间隔时间大于 18 个月的情况下，再放疗的效果最佳。
