Long‐term outcomes after reirradiation in nasopharyngeal carcinoma with intensity‐modulated radiotherapy: A meta‐analysis

• Published in: Head & neck Vol. 40; no. 3; pp. 622 - 631
• Main Authors: Leong, Yiat Horng, Soon, Yu Yang, Lee, Khai Mun, Wong, Lea Choung, Tham, Ivan Weng Keong, Ho, Francis Cho Hao
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2018
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Disease control; Head and neck; Humans; intensity‐modulated radiotherapy; long‐term survival; long‐term toxicities; Meta-analysis; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - mortality; Nasopharyngeal Carcinoma - pathology; Nasopharyngeal Carcinoma - radiotherapy; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Neoplasm Recurrence, Local; Radiation therapy; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Re-Irradiation - adverse effects; Re-Irradiation - methods; recurrent nasopharyngeal carcinoma; reirradiation; Survival; Survival Rate; Throat cancer; Treatment Outcome; reirradiation; recurrent nasopharyngeal carcinoma; intensity-modulated radiotherapy; long-term survival; long-term toxicities
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.24993

Background The purpose of this clinical review was to summate the published data for the long‐term outcomes of reirradiation with intensity‐modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods We searched biomedical literature databases for eligible studies published from January 2005 to September 2016. Outcomes of interests were 5‐year local failure‐free survival, distant failure‐free survival, overall survival (OS), and toxicities. Meta‐analysis was performed using a random effects model. Results We found 4 comparative and 8 noncomparative studies (n = 1768). Reirradiation was associated with pooled event rates of 72% (95% confidence interval [CI] 66%‐78%; I2 = 84%), 85% (95% CI 82%‐88%; I2 = 69%), and 41% (95% CI 36%‐47%; I2 = 80%) for 5‐year local failure‐free survival, distant failure‐free survival, and OS, respectively, with significant heterogeneity among the study results. The pooled event rate for grade 5 toxicities was 33% (95% CI 30%‐35%; I2 = 0%) with minimal heterogeneity. Conclusion Reirradiation with IMRT for locally recurrent NPC could confer long‐term disease control and survival but is associated with significant mortality.