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(Radiology. 1999;213:489-494.)
© RSNA, 1999

Radiation Oncology

Nasopharyngeal Carcinoma: Repeat Treatment with Conformal Proton Therapy- Dose-Volume Histogram Analysis1

Ray Lin, MD, Jerry D. Slater, MD, Les T. Yonemoto, MD, Roger I. Grove, MPH, Sandra L. Teichman, BSN, David K. Watt, BS and James M. Slater, MD

1 From the Department of Radiation Medicine, Loma Linda University Medical Center, 11234 Anderson St, PO Box 2000, Loma Linda, CA 92354. Received December 16, 1998; revision requested January 25, 1999; revision received February 19; accepted June 8. Address reprint requests to J.D.S. (e-mail: jdslater@dominion.llumc.edu)

PURPOSE: To analyze control, survival, and complication rates of conformal proton radiation for recurrent nasopharyngeal carcinoma.

MATERIALS AND METHODS: Sixteen patients with nasopharyngeal carcinoma initially treated with 50.0–88.2 Gy photons were re-treated with protons to additional doses of 59.4–70.2 CGE. Local-regional control and survival were correlated with extent of relapse, recurrence versus persistence, and prescribed dose and were subjected to dose-volume histogram analysis. Mean follow-up was 23.7 months (range, 4–47 months).

RESULTS: Twenty-four-month actuarial overall and local-regional progression-free survival rates were both 50%. The 24-month actuarial overall survival rates for patients with "optimal" dose-volume histogram coverage versus "suboptimal" coverage were 83% and 17%, respectively (P = .006). Doses to critical structures were low (0–22.0 Gy); no central nervous system side effects supervened.

CONCLUSION: Adequate tumor coverage, as evaluated by using dose-volume histogram analysis, was found to be the most important variable influencing local-regional control and survival. No central nervous system complications were observed; increases in the dose to adjacent critical structures are being evaluated.

Index terms: Head and neck neoplasms, 12.33, 273.373, 276.33, • Head and neck neoplasms, therapeutic radiology, 263.1269 • Nasopharynx, neoplasms, 12.33, 263.373, 276.33 • Nasopharynx, therapeutic radiology, 263.1269 • Skull, secondary neoplasms, 12.3




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