Development and Validation of Prognostic Nomograms Based on Gross Tumor Volume and Cervical Nodal Volume for Nasopharyngeal Carcinoma Patients With Concurrent Chemoradiotherapy

PurposeOur study aimed to establish and validate prognostic nomograms based on gross tumor volume (GTV) and cervical nodal volume (CNV) for nasopharyngeal carcinoma (NPC) patients treated with two cycles of concurrent chemoradiotherapy (CCRT).MethodsFrom 2012 to 2015, 620 eligible patients who received radical treatment at the Cancer Hospital of Shantou University Medical College were recruited for a nomogram study. Variables were determined in a training set of 463 patients from 2012 to 2014 by X-tile analysis, univariate and multivariate Cox proportional hazard analyses, and the least absolute shrinkage and selection operator (LASSO). Another cohort of 157 patients in 2015 was validated with bootstrap resampling. The concordance index (C-index) and calibration curves were applied to assess its predictive discriminative and accuracy ability, while decision curve analysis (DCA), X-tile analysis and Kaplan–Meier curve for clinical application.ResultsIndependent prognostic variables for overall survival (OS) were age, GTV, CNV, cranial nerve, positive cervical lymph node laterality below the caudal border of cricoid cartilage (LNBC), and were selected for the nomogram. Optimal prognostic factors including Karnofsky performance status (KPS), age, GTV, CNV, LNBC were incorporated in the nomogram for progression-free survival (PFS). In the training set, the C-index of our nomograms for OS and PFS were 0.755 (95% CI, 0.704 to 0.807) and 0.698 (95% CI, 0.652 to 0.744). The calibration curve showed good agreement between nomogram-predicted and actual survival. DCA indicated that our nomograms were of clinical benefit.ConclusionOur nomograms are capable of effective prognostic prediction for patients with NPC.

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Gross tumor volume determines toxicity and quality of life for patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy with simultaneously integrated boost technique

10.21203/rs.3.rs-29555/v1 ◽

2020 ◽

Author(s):

Tai-Lin Huang ◽

Hui-Ching Chuang ◽

Chun-Chieh Huang ◽

Chih-Yen Chien ◽

Shau-Hsuan Li ◽

...

Keyword(s):

Quality Of Life ◽

Nasopharyngeal Carcinoma ◽

Gross Tumor Volume ◽

Concurrent Chemoradiotherapy ◽

Tumor Volume ◽

Organs At Risk ◽

Integrated Boost ◽

Eortc Qlq ◽

The Impact

Abstract Background: To evaluate the impact of gross tumor volume (GTV) on toxicities and quality of life (QoL) for patients with nasopharyngeal carcinoma (NPC) treated by concurrent chemoradiotherapy with simultaneously integrated boost technique (chemo-SIB-IMRT). Methods: A total of 278 NPC patients with stage II-IVb treated by chemo-SIB-IMRT were enrolled. Toxicities were evaluated according to CTCAE version 4.03. QoL outcomes (n=219) were measured by using the EORTC QLQ-C30 and HN35 questionnaires at the time point of 12 months after chemo-SIB-IMRT. Results: A higher GTV was observed to be significantly associated with a higher mean or maximal dose in most organs at risk, together with more severe acute (mucositis, dermatitis, weight loss, and use of analgesic) and late toxicities (xerostomia, neck fibrosis, and radiation neuropathy). A linear regression model revealed that a higher GTV was significantly associated with a decline in role functioning and an increment in taste/smell, speech, social eating, opening mouth, dry mouth, and sticky saliva. Conclusion: GTV is the determining factor of some acute and late toxicities and QoL scales for NPC patients treated by chemo-SIB-IMRT.

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The Clinical Characteristics and Outcomes of Incidentally Discovered Glioblastoma

10.21203/rs.3.rs-1038263/v1 ◽

2021 ◽

Author(s):

Daisuke Kawauchi ◽

Makoto Ohno ◽

Mai Honda-Kitahara ◽

Yasuji Miyakita ◽

Masamichi Takahashi ◽

...

Keyword(s):

Clinical Characteristics ◽

Karnofsky Performance Status ◽

Performance Status ◽

Progression Free Survival ◽

Newly Diagnosed ◽

Karnofsky Performance Status Score ◽

Kaplan Meier ◽

Tumor Lesion ◽

Radiological Images ◽

The Right

Abstract Objective With an increase in the number of imaging examinations and the development of imaging technology, a small number of glioblastomas (GBMs) are identified by incidental radiological images. These incidentally discovered glioblastomas (iGBMs) are rare, and their clinical features are not well understood. Here, we investigated the clinical characteristics and outcomes of iGBM. Methods Data of newly diagnosed iGBM patients who were treated at our institution between August 2005 and October 2019 were reviewed. An iGBM was defined as a GBM without a focal sign, discovered on radiological images obtained for reasons unrelated to the tumor. Kaplan-Meier analysis was performed to calculate progression-free survival (PFS) and overall survival (OS). Results Of 234 patients with newly diagnosed GBM, four (1.7%) were classified as having iGBM. Health screening was the most common reason for tumor discovery (75.0%). The preoperative Karnofsky performance status score was 100 in three patients. Tumors were found on the right side in three cases. The mean volume of preoperative enhanced tumor lesion was 16.8 cm3. The median duration from confirmation of an enhanced lesion to surgery was 13.5 days. In all cases, either total (100%) or subtotal (95–99%) resections were achieved. The median PFS and OS were 11.5 and 20.0 months, respectively. Conclusions The iGBMs were often small and in the right non-eloquent area, and the patients had good performance status. We found that timely therapeutic intervention provided iGBM patients with favorable outcomes. This report suggests that early detection of GBM may lead to a better prognosis.

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Real-world data (RWD) reveals benefit for adjuvant chemotherapy with docetaxel, oxaliplatin and fluorouracil/leucovorin (FLOT) is limited to those with tumour regression grade (TRG) ≥3 in oesophago-gastric cancer (OGC).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.4039 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 4039-4039

Author(s):

Brindley Sonal Hapuarachi ◽

Rebecca Lee ◽

Adeel Khan ◽

Laura Woodhouse ◽

Valentinos Kounnis ◽

...

Keyword(s):

Performance Status ◽

Laboratory Data ◽

Progression Free Survival ◽

Tumour Regression ◽

Real World Data ◽

Curative Surgery ◽

Term Survival ◽

Tumour Regression Grade ◽

High Relapse Rate ◽

Kaplan Meier

4039 Background: Despite potentially curative surgery, long-term survival from OGC remains poor due to high relapse rate. Neoadjuvant (naFLOT) and adjuvant (aFLOT) FLOT is currently standard treatment for resectable OGC based on data from the FLOT-4 trial. We explored whether TRG was associated with FLOT-outcome using RWD. Methods: Pts with OGC treated with naFLOT +/- aFLOT at a tertiary UK centre were identified following institutional board approval. Clinical and laboratory data were extracted from the patient record. TRG was evaluated by a histopathologist. Median overall survival (OS) and median progression-free survival (PFS) were evaluated using Kaplan-Meier and Log-rank tests; time taken from start of naFLOT, and associations between factors with Fisher’s exact (FE) test. Results: 171 pts were identified, median FU 30 mths. 144 (84%) male; median age 66 (32-84); oesophagus 66 (38%), junctional (GOJ) 73 (43%), gastric 32 (19%); stage IB 3 (2%), stage IIB 26 (15%), stage III 91 (53%), stage IVA 47 (28%) and unknown 4 (2%). Pts had median of 2 comorbidities (range 0-6); performance status (PS) 0: 95 (56%), PS 1: 71 (41%), PS 2: 3 (2%) and PS unknown 2 (1%). 132/171 pts completed 4 cycles of naFLOT and this was significantly associated with undergoing surgery (p = 0.02). Those who had surgery (140/171) had significantly improved PFS (not reached (NR) vs. 6 mths; 95% CI 2-10; p < 0.001) and OS (NR vs. 12 mths; 95% CI 6-18; p < 0.001). TRG was reported for 126/140 patients who underwent surgery. TRG 1/2 (42/126) vs. TRG ≥3 was significantly associated with improved PFS (NR vs. 35 mths; 95% CI NR; p < 0.001) and OS (median NR either group; p < 0.001). Pts with TRG 1/2 who commenced aFLOT (≥1 cycle; n = 31/42) or completed 4 cycles of aFLOT (17/31) did not have improved PFS or OS vs. those who did not. Those with TRG ≥3 who commenced aFLOT (≥1 cycle; n = 62/85) had improved PFS (median NR vs. 22 mths; 95% CI 13-31 p = 0.006) and OS (median NR vs. 25 mths; 95% CI 18-32 p = 0.019). Those with TRG ≥3 who completed 4 cycles of aFLOT (n = 38/62) had significantly improved PFS (median NR vs. 25 mths; 95% CI 14-36 p = 0.016) and OS (median NR vs. 36 mths; 95% CI 16-55 p = 0.012). There was no difference in PFS or OS in pts with TRG ≥3 who had a dose reduction at any time during aFLOT. Conclusions: TRG is a predictor of outcome following naFLOT + surgery with superior outcomes in those with TRG 1/2. Our analyses suggest that only pts with TRG >3 following naFLOT + surgery benefit from adjuvant FLOT. Prospective randomised studies are required to confirm whether pts with TRG 1/2 require treatment with aFLOT.

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Exploration of a Novel Prognostic Risk Signature and Its Effect on the Immune Response in Nasopharyngeal Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.709931 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shuang Zhao ◽

Xin Dong ◽

Xiaoguang Ni ◽

Lin Li ◽

Xin Lu ◽

...

Keyword(s):

Immune Response ◽

Nasopharyngeal Carcinoma ◽

Risk Group ◽

Progression Free Survival ◽

Gene Signature ◽

Metastatic Carcinoma ◽

High Risk Group ◽

Molecular Characteristics ◽

Novel Gene ◽

Kaplan Meier

Nasopharyngeal carcinoma (NPC) is a highly invasive and metastatic carcinoma with different molecular characteristics and clinical outcomes. In this work, we aimed to establish a novel gene signature that could predict the prognosis of NPC patients. A total of 13 significant genes between the recurrence/metastasis (RM) group and the no recurrence/metastasis (no-RM) group were identified by machine learning from RNA-Seq data including 60 NPC tumor biopsies. Based on these genes, a 4-mRNA signature (considering U2AF1L5, TMEM265, GLB1L and MLF1) was identified. Receiver operating characteristic (ROC) and Kaplan-Meier (K-M) analyses indicated that this signature had good prognostic value for NPC. The overall survival (OS) and progression-free survival (PFS) of the patients in the high-risk group were significantly shorter than those of the patients in the low-risk group (p = 0.00126 and p = 0.000059, respectively). The area under the ROC curve (AUC) values of the 4-mRNA signature were higher than those of T stage and N stage for OS (0.893 vs 0.619 and 0.582, respectively) and PFS (0.86 vs 0.538 and 0.622, respectively). Furthermore, the 4-mRNA signature was closely associated with cell proliferation and the immune response. The expression of GLB1L and TMEM265 was associated with the level of tumor-infiltrating immune cells (r > 0.4, p < 0.05). We have validated the model through measuring the expression levels of the 4-mRNA signature by qRT-PCR, in an independent cohort of NPC patients. Here, we report a novel gene signature that can serve as a new tool for predicting the prognosis of NPC patients.

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Cumulative Intracranial Tumor Volume Augments the Prognostic Value of Diagnosis-Specific Graded Prognostic Assessment Model for Survival in Patients with Melanoma Cerebral Metastases

Neurosurgery ◽

10.1093/neuros/nyx380 ◽

2017 ◽

Vol 83 (2) ◽

pp. 237-244 ◽

Cited By ~ 7

Author(s):

Brian R Hirshman ◽

Bayard R Wilson ◽

Mir Amaan Ali ◽

Alexander J Schupper ◽

James A Proudfoot ◽

...

Keyword(s):

Prognostic Value ◽

Tumor Volume ◽

Karnofsky Performance Status ◽

Performance Status ◽

Intracranial Tumor ◽

Assessment Model ◽

Prognostic Assessment ◽

Prognostic Accuracy ◽

Graded Prognostic Assessment ◽

Independent Cohort

Abstract BACKGROUND The diagnosis-specific graded prognostic assessment scale (ds-GPA) for patients with melanoma brain metastasis (BM) utilizes only 2 key prognostic variables: Karnofsky performance status and the number of intracranial metastases. We wished to determine whether inclusion of cumulative intracranial tumor volume (CITV) into the ds-GPA model for melanoma augmented its prognostic value. OBJECTIVE To determine whether or not CITV augments the ds-GPA prognostic scale for melanoma. METHODS We analyzed the survival pattern of 344 melanoma patients with BM treated with stereotactic radiosurgery (SRS) at separate institutions and validated our findings in an independent cohort of 201 patients. The prognostic value of ds-GPA for melanoma was quantitatively compared with and without the addition of CITV using the net reclassification index (NRI > 0) and integrated discrimination improvement (IDI) metrics. RESULTS The incorporation of CITV into the melanoma-specific ds-GPA model enhanced its prognostic accuracy. Addition of CITV to the ds-GPA model significantly improved its prognostic value, with NRI > 0 of 0.366 (95% CI: 0.125-0.607, P = .002) and IDI of 0.024 (95% CI: 0.008-0.040, P = .004). We validated these findings that CITV improves the prognostic utility of melanoma ds-GPA in an independent cohort of 201 melanoma cohort. CONCLUSION The prognostic value of the ds-GPA scale for melanoma BM is enhanced by the incorporation of CITV.

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Multi-center, single arm phase II study of the dual mTORC1/mTORC2 inhibitor vistusertib for patients with recurrent or progressive grade II-III meningiomas.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.2024 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 2024-2024

Author(s):

Scott Randall Plotkin ◽

Priya Kumthekar ◽

Patrick Y. Wen ◽

Frederick G. Barker ◽

Anat Stemmer-Rachamimov ◽

...

Keyword(s):

Adverse Events ◽

Karnofsky Performance Status ◽

Performance Status ◽

Progression Free Survival ◽

Response Assessment ◽

Duration Of Treatment ◽

Cross Sectional ◽

Pathway Activation ◽

Grade Ii ◽

Correlative Studies

2024 Background: Grade II/III meningiomas represent about 20% of tumors and have increased rates of recurrence with no approved medical therapies. Historically, the progression-free survival at 6 months (PFS-6) for these tumors is 25%. The Response Assessment in Neuro-Oncology (RANO) group identified a PFS-6 rate of > 35% to be of interest for trials of grade II/III meningioma. Methods : NF2 gene inactivation occurs in the majority of meningiomas and is associated with mTORC1 activation. Human studies of everolimus for neurofibromatosis 2 patients documented growth arrest in only a minority of tumors. Based on our studies showing mTORC2/SGK1 pathway activation in NF2-deficient meningiomas and the known paradoxical activation of the mTORC2/AKT pathway in meningiomas, we hypothesized that dual inhibition of mTORC1/2 would be superior in meningiomas. Treatment of primary meningioma cells with vistusertib led to decreased cell proliferation and showed greater efficacy than rapamycin, regardless of NF2 expression. We studied the effect of vistusertib in patients with progressive or recurrent grade II/III meningiomas (NCT03071874). Vistusertib was administered orally at 125mg twice daily on two consecutive days each week. MRIs were obtained every 2 cycles (1 cycle = 28 days). Tumor size was defined as the largest cross-sectional area. Progression was defined as ≥25% increase in the sum of products of all measurable lesions over smallest sum observed. The primary endpoint was PFS-6. Secondary endpoints included toxicity, radiographic response, and correlative studies including immunohistochemistry for mTORC1/2 pathway activation and genetic biomarkers. Results: Twenty-eight patients (13 female), with a median age of 58 years (range, 32 to 77 years), were enrolled in this multicenter study. The median Karnofsky performance status was 80. Twenty-five patients have been followed to six months or to tumor progression. The median duration of treatment was 6.5 month (range, 1-18 months). Four patients chose to discontinue treatment, 1 withdrew to intercurrent illness, and 1 was withdrawn due to non-compliance. PFS-6 is 51.5% (CI, 29.3% - 70.0%). Adverse events at least possibly related to vistusertib with frequency > 10% include nausea (54%); fatigue (36%); hypophosphatemia (29%); diarrhea, anorexia, dry mouth, and hypertriglyceridemia (all 14%); hypertension, vomiting, increased ALT, constipation, and weight loss (all 11%). Conclusions: Vistusertib treatment was associated with a PFS-6 rate that exceeds the RANO target of 35% for recurrent high-grade meningioma. The follow-up data continue to mature. Adverse events were tolerable in this patient population. Correlative studies to identify biological factors that correlate with response are under way. These data support the initiation of larger randomized studies of vistusertib in this setting. Clinical trial information: NCT03071874.

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Management and outcome of primary CNS lymphoma in the modern era

Neurology ◽

10.1212/wnl.0000000000008900 ◽

2020 ◽

Vol 94 (10) ◽

pp. e1027-e1039 ◽

Cited By ~ 10

Author(s):

Caroline Houillier ◽

Carole Soussain ◽

Hervé Ghesquières ◽

Pierre Soubeyran ◽

Olivier Chinot ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Real Life ◽

Primary Cns Lymphoma ◽

Whole Brain Radiotherapy ◽

Progression Free Survival ◽

Population Based ◽

Cns Lymphoma ◽

High Dose ◽

Population Based Study

ObjectiveReal-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL.MethodsThe French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed.ResultsWe identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis.ConclusionsOur study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.

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Prognostic factors in glioblastoma multiforme

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1625613 ◽

2010 ◽

Vol 29 (04) ◽

pp. 121-125 ◽

Cited By ~ 1

Author(s):

Leonardo Welling ◽

José Carlos Lynch ◽

Celestino Pereira ◽

Ricardo Andrade ◽

Fabiana Polycarpo Hidalgo ◽

...

Keyword(s):

Prognostic Factors ◽

Glioblastoma Multiforme ◽

Retrospective Analysis ◽

Tumor Volume ◽

Standard Treatment ◽

Karnofsky Performance Status ◽

Performance Status ◽

Surgical Techniques ◽

The Other ◽

Tumor Removal

Abstract Objective: To study if the prognosis variables such as age, the Karnofsky Performance Status (KPS), extension of tumor removal by surgery, radiotherapy and tumor volume influenced the survival of patients with glioblastoma multiforme (GBM). Method: Retrospective analysis of GBM patients operated at Hospital dos Servidores do Estado between 1998 and 2008. Results: We could observe that age, the KPS and radiotherapy influenced the survival. The other variables did not have any prognosis implications. Conclusions: Despite many researches and many improvements regarding the diagnosis and the surgical techniques, the survival of patients with GBM has not changed in the last 30 years and is a therapeutic challenge. The surgical resection followed by radiotherapy is the standard treatment for patients with GBM. The importance of each variable in the patient's prognosis is still to be established in the multivariate analyzes.

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Survival benefits of hypofractionated radiotherapy combined with temozolomide or temozolomide plus bevacizumab in elderly patients with glioblastoma aged ≥ 75 years

Radiation Oncology ◽

10.1186/s13014-019-1389-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 6

Author(s):

Makoto Ohno ◽

Yasuji Miyakita ◽

Masamichi Takahashi ◽

Hiroshi Igaki ◽

Yuko Matsushita ◽

...

Keyword(s):

Elderly Patients ◽

Dna Methyltransferase ◽

Karnofsky Performance Status ◽

Performance Status ◽

Methylation Status ◽

Progression Free Survival ◽

Promoter Hypermethylation ◽

Hypofractionated Radiotherapy ◽

Methylguanine Dna Methyltransferase ◽

Grade 3

Abstract Background and purpose The purpose of this study was to evaluate the outcomes of elderly patients (aged ≥75 years) with newly diagnosed glioblastoma (GBM), who were treated with hypofractionated radiotherapy comprising 45 Gy in 15 fractions combined with temozolomide (TMZ) or TMZ and bevacizumab (TMZ/Bev). Materials and methods Between October 2007 and August 2018, 30 patients with GBM aged ≥75 years were treated with hypofractionated radiotherapy consisting of 45 Gy in 15 fractions. Twenty patients received TMZ and 10 received TMZ/Bev as upfront chemotherapy. O-6-methylguanine DNA methyltransferase (MGMT) promoter methylation status was analyzed by pyrosequencing. The cutoff value of the mean level of methylation at the 16 CpG sites was 16%. Results Median overall survival (OS) and progression-free survival (PFS) were 12.9 months and 9.9 months, respectively. The 1-year OS and PFS rates were 64.7 and 34.7%, respectively. Median OS and PFS did not differ significantly between patients with MGMT promoter hypermethylation (N = 11) and those with hypomethylation (N = 16) (17.4 vs. 11.8 months, p = 0.32; and 13.1 vs. 7.3 months, p = 0.11, respectively). The median OS and PFS were not significantly different between TMZ (N = 20) and TMZ/Bev (N = 10) chemotherapy (median OS: TMZ 12.9 months vs. TMZ/Bev 14.6 months, p = 0.93, median PFS: TMZ 8.5 months vs TMZ/Bev 10.0 months, p = 0.64, respectively). The median time until Karnofsky performance status (KPS) score decreasing below 60 points was 7.9 months. The best radiological responses included 11 patients with a partial response (36.7%). Grade 3/4 toxicities included leukopenia in 15 patients (50%), anorexia in 4 (13.3%), and hyponatremia during concomitant chemotherapy in 3 (10%). Conclusion Our hypofractionated radiotherapy regimen combined with TMZ or TMZ/Bev showed benefits in terms of OS, PFS, and KPS maintenance with acceptable toxicities in elderly patients with GBM aged ≥75 years.

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Local and Lymph Node Relapse of Nasopharyngeal Carcinoma: A Single-Center Experience

Ear Nose & Throat Journal ◽

10.1177/0145561320908955 ◽

2020 ◽

pp. 014556132090895

Author(s):

Nabil Toumi ◽

Sana Ennouri ◽

Ilhem Charfeddine ◽

Jamel Daoud ◽

Afef Khanfir

Keyword(s):

Nasopharyngeal Carcinoma ◽

Lymph Nodes ◽

Concurrent Chemoradiotherapy ◽

Performance Status ◽

Locally Advanced ◽

World Health ◽

Late Relapse ◽

Good Performance Status ◽

Relapsed Disease ◽

Neck Lymph Nodes

Objectives: The study aimed to investigate the epidemiological and clinical characteristics as well as the therapeutic results in patients with locoregional (LR) relapse after treatment of nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed the medical records of patients with local and/or regional recurrent NPC over 13 years (2003-2015). Results: Twenty-five patients were treated for local or/and local–regional recurrence of NPC. The rate of LR relapse was 7.2%. The mean age of the patients was 46 ± 13.9 years. The median time to relapse was 25 months. The recurrence was nasopharyngeal in 17 patients, nasopharyngeal and neck lymph nodes in 7 patients, and neck lymph nodes in 1 patient. Fifteen relapsed patients had a locally advanced disease (rT3-rT4). Patients who had initially T1 or T2 tumor had a locally advanced relapsed disease (rT3rT4) in 27.3% and patients whose disease was initially classified as T3 or T4 had a locally advanced relapsed disease (rT3T4) in 85.7% ( P = .005, Fisher test). Twelve patients had chemotherapy after relapse. Chemotherapy was followed by concurrent chemoradiotherapy in 3 patients and by radiotherapy (RT) in 4 patients. Nine patients had concurrent chemoradiotherapy and 1 patient had exclusive RT. The overall survival (OS) at 1 year, 3 years, and 5 years was, respectively, 58%, 18%, and 10%. The OS was significantly higher in patients with good performance status at the time of relapse (World Health Organization = 1; P = .01) and in patients with late relapse (after 2 years; P = .03). Conclusions: Locoregional relapse rate in our study was 7.2%. Locoregional reirradiation was the mainstay treatment modality in relapsed NPC. Relapsed NPC had a poor prognosis with a 5-year survival rate of 18%. The OS was significantly higher in patients with good performance status and in patients with late relapse (after 2 years).

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