Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram

Vittorio Rampinelli; Marco Ferrari; Davide Mattavelli; Pierluigi Bonomo; Alessia Lambertoni; Mario Turri-Zanoni; Elisa D'Angelo; Daniela Alterio; Marco Cianchetti; Barbara Vischioni; Roberta Rosati; Michele Tomasoni; Marco Alparone; Stefano Taboni; Davide Tomasini; Marta Maddalo; Michela Buglione di Monale Bastia; Nicola Alessandro Iacovelli; Francesco Dionisi; Maurizio Bignami; Paolo Battaglia; Paolo Bossi; Alberto Deganello; Cesare Piazza; Alberto Schreiber; Piero Nicolai; Paolo Castelnuovo; Ester Orlandi

doi:10.3389/fonc.2023.1157584

Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram

Front Oncol. 2023 May 16:13:1157584. doi: 10.3389/fonc.2023.1157584. eCollection 2023.

Authors

Vittorio Rampinelli¹, Marco Ferrari², Davide Mattavelli¹, Pierluigi Bonomo³, Alessia Lambertoni⁴, Mario Turri-Zanoni⁴, Elisa D'Angelo⁵, Daniela Alterio⁶, Marco Cianchetti⁷, Barbara Vischioni⁸, Roberta Rosati¹, Michele Tomasoni¹, Marco Alparone¹, Stefano Taboni², Davide Tomasini⁹, Marta Maddalo⁹, Michela Buglione di Monale Bastia⁹, Nicola Alessandro Iacovelli¹⁰, Francesco Dionisi¹¹, Maurizio Bignami⁴, Paolo Battaglia⁴, Paolo Bossi¹², Alberto Deganello¹³, Cesare Piazza¹, Alberto Schreiber¹, Piero Nicolai², Paolo Castelnuovo⁴, Ester Orlandi⁸

Affiliations

¹ Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
² Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy.
³ Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
⁴ Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy.
⁵ Radiotherapy Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
⁶ Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
⁷ Proton Therapy Unit, Azienda Provinciale Per i Servizi Sanitari, Trento, Italy.
⁸ Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁹ Department of Radiation Oncology, Brescia University, Brescia, Italy.
¹⁰ Radiotherapy 2 Unit, Fondazione IRCCS IstitutoTumori, Milan, Italy.
¹¹ Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
¹² Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
¹³ Otolaryngology Head and Neck Surgery, IRCCS National Cancer Institute (INT), Milan, Italy.

Abstract

Introduction: The study assessed outcomes and toxicities of different treatment modalities for local and/or regional recurrent nasopharyngeal carcinoma (NPC) in a non-endemic area.

Methods: Patients treated with curative intent for recurrent NPC with salvage surgery, photon-based radiotherapy, proton therapy (PT), with or without chemotherapy, at different Italian referral centers between 1998 and 2020 were included. Adverse events and complications were classified according to the Common Terminology Criteria for Adverse Events. Characteristics of the patients, tumors, treatments, and complications are presented along with uni- and multivariate analysis of prognostic factors. A survival predictive nomogram is also provided.

Results: A total of 140 patients treated from 1998 to 2020 were retrospectively assessed. Cases with lower age, comorbidity rate, stage, and shorter disease-free interval (DFI) preferentially underwent endoscopic surgery. More advanced cases underwent re-irradiation, fairly distributed between photon-based radiotherapy and PT. Age and DFI were independent factors influencing overall survival. No independent prognostic effect of treatment modality was observed. No significant difference in the morbidity profile of treatments was observed, with 40% of patients experiencing at least one adverse event classified as G3 or higher.

Conclusion: Recurrent NPC in a non-endemic area has dissimilar aspects compared to its endemic counterpart, suggesting the need for further studies that can guide the choice of the best treatment modality.

Keywords: IMRT; nasopharyngeal carcinoma; non-endemic cancer; proton therapy; recurrent tumor; salvage treatment.

Copyright © 2023 Rampinelli, Ferrari, Mattavelli, Bonomo, Lambertoni, Turri-Zanoni, D’Angelo, Alterio, Cianchetti, Vischioni, Rosati, Tomasoni, Alparone, Taboni, Tomasini, Maddalo, Bastia, Iacovelli, Dionisi, Bignami, Battaglia, Bossi, Deganello, Piazza, Schreiber, Nicolai, Castelnuovo and Orlandi.