Hyperfractionation for reirradiation of recurrent nasopharyngeal carcinoma

Abstract

<p>Treatment of locoregionally recurrent nasopharyngeal carcinoma presents a profound clinical challenge. If surgical expertise is available, the consensus among international experts recommends surgery for resectable recurrence.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00389-6/abstract#">¹</a> This approach is supported by data from a randomised trial by Liu and colleagues,<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00389-6/abstract#">²</a> which reported superior 3-year overall survival with endoscopic resection compared with reirradiation because of better local control and reduced toxic effects. Unfortunately, most locoregionally recurrent nasopharyngeal carcinomas are advanced and unresectable at the time of detection, meaning that reirradiation remains the only salvage modality. However, subjecting patients to reirradiation carries a high risk of severe treatment-related adverse events, which can lead to mortality. Even with contemporary intensity-modulated radiotherapy delivered to 60 Gy in 2 Gy per day equivalent fractions, 30–40% of deaths in patients with locoregionally recurrent nasopharyngeal carcinoma are attributable to treatment-related adverse events.<br></p>