Brachytherapy for recurrent and persistent carcinoma of the nasopharynx

Purpose: To examine the local control, survival and complications in patients treated with brachytherapy for recurrent or persistent carcinoma of the nasopharynx. Materials and Methods: Eighteen brachytherapy procedures for recurrent nasopharyngeal carcinoma and four interstitial implants for persistent disease after primary therapy were performed on 21 patients at Memorial Sloan-Kettering Cancer Center between 1986 and 1992. Permanent implants with I-125 seeds, via a transnasal, transoral or transpalatal approach, were used in patients with discrete, well-demarcated lesions. Intracavitary Ir-192 or high activity I-125 were used for patients with diffuse lesions, laterally situated lesions or those involving the nasal cavity. Ten patients with recurrent, diffuse disease also received EBRT (25-54 Gy) as part of their salvage treatment. All patients were followed up to the present time or time of death (median 14 mo.). Results: Of the patients with recurrent disease, 41% are alive at 2 years with 29% locally controlled. Forty seven percent of all patients with recurrent disease remain alive 18-114 months post-treatment (median 48 mo.). Twenty nine percent are NED at a median of 49 months (range 32-89 mo.). Of the patients with persistent disease, three of the four are NED at 47, 85, 87 months. There was no statistical difference in local control or survival in respect to histology, gender, time to recurrence, age, mode of treatment (intracavitary vs. interstitial), or the addition of external beam to the salvage therapy. All 22 procedures were tolerated well without complications in the operative/immediate post-operative period. The overall severe complication rate in the follow-up period was 19%: severe mucositis(n=2), bone necrosis(n=1) and hearing loss(n=2). Conclusion: The brachytherapy techniques we have utilized are feasible and appear safe. Local control is obtainable in this group of patients with acceptable toxicity. Implant techniques should be individualized to the exact anatomic and oncologic situation