Abstract:
Long-term Efficacy of Branchytherapy through a New Type of Applicator for NasopharyngealCarcinomaLiming XU, Shuai YI, Ruiying LI, PingWANG, Qiuling GAO, PeiguoWANG, Qingsong PANG, Zhiyong YUANCorrespondence to: PingWANG, E-mail: wangping99999@yahoo.com.cnDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, ChinaAbstract Objective: To evaluate the long-term efficacy of treatment with external-beam radiotherapy ( EBR ) plus intracavitarybranchytherapy (IBT) through using a new type of applicator for nasopharyngeal carcinoma ( NPC ) patients. Methods: A total of 169NPC patients were recruited and divided into two groups. Patients in the comprehensive treatment group ( CTG ) were treated withEBR plus IBT. Patients in the control group ( CG ) were treated by EBR alone. In CTG, the 49 patients with stage T1-T2 disease re-ceived a total dose of 60-65 Gy by EBR and the 24 patients with stage T3-T4 disease received 70-75 Gy. The dose of brachytherapyranged 6-20 Gy and the median dose was 12 Gy. In the CG, patients received a total dose of 70-80 Gy by EBR. Results: Till September2009, 93.5% patients were followed up. The short-term effective rate of the treatment for T1-T2 patients was 93.9% in CTG and 78.2%in CG ( P = 0.023 ), and that for T3-T4 patients was 79.2% in CTG and 65.9% in CG ( P = 0.255 ). The 5-year overall survival rate (OSR ) and 5-year local control rate ( LCR ) of T1-T2 patietns were 85.0% and 91.4% in CTG, and 58.5% and 74.4% in CG ( P = 0.006,P = 0.031 ). The 5-year OSR and 5-year LCR of T3-T4 patients were 54.6% and 63.2% in CTG, and 47.4% and 58.1% in CG ( P =0.592, P = 0.721 ). The incidence of difficulty with opening mouth was 6.85% in CTG and 18.8% in CG ( P = 0.025 ). Patients in CGhad serious treatment related complications, including postradiation nasopharyngeal necrosis in 4 cases, nasal hemorrhea in 2 cases,brain necrosis in 2 cases, nasal hemorrhea in 2 cases, and brain necrosis in 2 recurrent cases. Two cases suffered from nasal hemorrheaand another 2 cases had brain necrosis because of undergonging the second radiotherapy after nasal and skull base recurrence. No se-rous complications were observed in CTG. Conclusion: EBR plus IBT, through a new type of applicator, can improve the 5-year OSRand LCR in NPC patients with stage T1-T2 disease, with a significant difference. IBT can lower the dose of EBR, reduce the radiationcomplications and improve patients' quality of life. NPC patients of stage T3-T4 with invasion in the bones of the skull base and for-mer-group cranial nerves can be treated wtih IBT to increase local radiational dose and in order to decrease radiation complications.Keywords Neoplasm; Nasopharyngeal; Radiotherapy; Brachytherapy; Applicator; Prognosis