• Nasopharyngeal carcinoma
• Radiotherapy
• Recurrent
• Surgery

• Humans
• Nasopharyngeal Carcinoma
• Radiotherapy, Intensity-Modulated/adverse effects
• Nasopharyngeal Neoplasms
• Retrospective Studies
• Neoplasm Recurrence, Local/pathology

• Male
• Humans
• Female
• Nasopharyngeal Carcinoma/radiotherapy
• Radiotherapy, Intensity-Modulated/adverse effects
• Neoplasm Recurrence, Local/radiotherapy
• Nasopharyngeal Neoplasms/radiotherapy
• Hemorrhage

• minimally invasive skull base surgery
• nasopharyngeal carcinoma
• nasopharyngectomy
• salvage surgery
• transoral robotic surgery

• Multi-institutional review
• Nasopharyngeal carcinoma
• Nasopharyngectomy
• Neck Dissection
• Re-irradiation
• Recurrence
• Surgical salvage

• Head and neck cancer
• Prognostic nomogram
• Radiotherapy
• Recurrence

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Nasopharyngeal Carcinoma/radiotherapy
• Nasopharyngeal Neoplasms/radiotherapy
• Neoplasm Recurrence, Local/radiotherapy
• Re-Irradiation/adverse effects
• Re-Irradiation/methods
• Retrospective Studies
• Treatment Outcome
• Young Adult

Re-irradiation (re-RT) has the active effect of relieving clinical symptoms and prolonging the survival of patients with recurrent esophageal squamous cell carcinoma (ESCC). However, the optimal re-RT dose is still uncertain. Here, we analyzed the prognostic factors associated with survival and explored the optimal re-RT dose for patients with recurrent ESCC following definitive radiotherapy.

The data of 47 patients with recurrent ESCC who were retreated between 2010 and 2014 were retrospectively analyzed. All patients received a radiation dose > 50 Gy during the primary treatment. The median time to recurrence after primary radiotherapy was 26 months (range 6–120 months). All patients had in-field recurrence in the esophagus. Recurrence within the local site was observed in 37 patients (78.7%), and recurrence in both the local site and regional nodes were observed in 10 patients (21.3%). All patients received 3D conformal re-RT with a median dose of 58 Gy (range 26–64 Gy). Chemotherapy was sequentially used in 27.7% of the patients. Survival curves were constructed according to the Kaplan-Meier method and were compared by log-rank tests. The factors predictive of survival were identified with univariate and multivariate analyses.

Dysphagia relief after re-RT was achieved in 20 of the 35 symptomatic patients (57.1%). The median survival time (MST) of all patients was 17 months, and the 1-, 2-, 3- and 5-year overall survival (OS) rates were 72.3, 25.5, 17.0 and 2.1%, respectively. In the univariate analysis, an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0–1 (P = 0.014), recurrence at the local site (P = 0.048), time to recurrence ≥24 months (P = 0.006) and re-RT dose ≥50 Gy (P < 0.001) were associated with favorable OS. In the multivariate analysis, only re-RT dose was an independent factor for OS (P = 0.007). Severe complications were observed in 7 patients, two of whom received a re-RT dose > 60 Gy.

Our results demonstrated that patients with recurrent ESCC following definitive radiotherapy had unfavorable OS. Re-RT could be considered a feasible and effective treatment modality. A re-RT dose > 50 Gy could improve the survival outcomes, and a dose > 60 Gy should be administered with caution due to the risk of severe complications.

• Esophageal squamous cell carcinoma
• Local recurrence
• Prognostic factors
• Re-irradiation dose

To identify the specific dose advantage of intensity-modulated carbon-ion radiation therapy (IMCT) over photon-based intensity-modulated radiation therapy (IMRT) in the treatment of locally recurrent nasopharyngeal carcinoma (NPC).

Ten patients with locally recurrent NPC underwent IMCT and IMRT planning. Target definition followed the recommendations of the International Commission on Radiation Units and Measurements (ICRU) reports no. 50, 62 and 83. The real treatment plans which were delivered to patients were designed on the Siemens Syngo planning system while the control plans for dosimetric comparison were generated from the Varian Medical Systems. The optimization constraints of the two designs were basically the same. Target coverage was evaluated using the following parameters: Dmin, Dmax, D1, D2, D50, D95, D98 and D99. Target dose distribution and conformality were evaluated using the homogeneity index and conformity index. Normal tissue sparing of organs at risk (OARs) were evaluated using Dmean, D1 and Dmax. SPSS 22.0 software was used for data analysis.

Both IMCT and IMRT plans met clinical prescription dose requirements. Target coverage of D1, D2, D50, D95, D98, D99 were not significantly different between the two plans (P>0.05). The two plans showed satisfactory coverage of the target without significant difference. There was no significant difference in terms of the homogeneity and conformability between the two plans. Dosimetric parameters for the brain stem, spinal cord, parotid gland, optic chiasm, eyeball, lens, temporal lobe and inner ear were significantly reduced in the IMCT plan (P<0.05).

As compared with photon-based IMRT, IMCT significantly reduces radiation dose to the OARs in the treatment of locally recurrent NPC while maintaining the dose coverage to the target volumes. Such a feature is particularly important for patients who experienced previous high-dose irradiation.

• carbon ion
• dosimetry comparison
• locally recurrent nasopharyngeal carcinoma

Locally residual nasopharyngeal carcinoma (NPC) is associated with increased risk of local failure, if additional treatment is not applied. The objective of this paper was to report the treatment effect of fibre-optic endoscope-guided three-dimensional high-dose-rate interstitial brachytherapy (3D HDR ISBT) boost, integrated with radical external beam radiotherapy (EBRT) for deep-seated NPC residual lesion.

A 52-year-old female, with a diagnosis of NPC and biopsy-proven low-differentiated squamous cell carcinoma (SCC) in left nasopharynx; the tumor size was 3.9 × 2.2 × 2.6 cm³ before treatment (T2N0M0). Three months after completion of EBRT, with a dose of 69.96 Gy in 33 fractions and concurrent chemotherapy with cisplatin, the residual tumor (3.3 × 1.8 × 2.2 cm³) was treated with 3D HDR ISBT boost under fibre-optic endoscope guidance. The brachytherapy dose was 14 Gy in 2 fractions of 7 Gy each.

The removal of deep-seated residual tumor was securely achieved by 3D HDR ISBT, guided with fibre-optic endoscope. The refractory tumor in the patient healed uneventfully after fibre-optic endoscope-guided 3D HDR ISBT, without a recurrence during 26 months of follow-up.

Fibre-optic endoscope-guided 3D HDR ISBT boost could be an additional treatment strategy for locoregional residual NPC after radical EBRT, especially for deep invasive lesion.

• high-dose-rate brachytherapy
• interstitial brachytherapy
• nasopharyngeal carcinoma
• residual disease

The objectives of this study were to report the oncologic outcomes and the treatment-related toxicities after reirradiation (re-RT) for recurrent nasopharyngeal carcinoma (rNPC) at our institution and to apply a recently published prognostic model for survival in rNPC in our cohort.

Thirty-two patients with rNPC treated at the authors' institution with re-RT were retrospectively reviewed. Treatment modalities for re-RT were intensity-modulated radiotherapy (n = 14), three-dimensional conformal radiotherapy (n = 9), single-fraction stereotactic radiosurgery (n = 6), fractionated stereotactic radiotherapy (n = 2), and high dose rate intracavitary brachytherapy (n = 1). Twenty-seven patients received re-RT with curative intent, whereas five patients were treated palliatively.

Median follow-up time was 15.5 months (range, 1 to 123 months) for the entire cohort and 20 months (range, 3 to 123 months) for patients treated with curative intent. For the entire cohort, median locoregional recurrence-free survival (LRRFS) was 14 months, with actuarial 1- and 2-year LRRFS estimates of 67.5% and 44.0%, respectively. Median overall survival (OS) time was 38 months, with actuarial 1- and 2-year estimates of 74.2% and 57.2%, respectively. For patients treated with curative intent, median LRRFS was not reached. Actuarial 1- and 2-year LRRFS estimates were 68.2% and 54.5%, respectively. Median OS time after curative intent re-RT was 42 months, with actuarial 1- and 2-year estimates of 75.4% and 63.8%, respectively. One- and 2-year OS estimates based on risk stratification were 68.6% for high risk compared with 80.8% for low risk and 34.3% for high risk compared with 70.7% for low risk, respectively (P = .223). Three patients (9.4%) developed symptomatic temporal lobe necrosis. There was no reported grade 5 treatment-related toxicity.

Results of the study suggest that re-RT is an effective and safe salvage treatment strategy for rNPC. Re-RT to a maximum equivalent dose in 2-Gy fractions of 60 Gy may yield good LRRFS and translate to prolonged OS.

• Epithelial-to-mesenchymal transition
• Extracellular matrix protein
• Fibronectin
• Motility
• Nasopharyngeal cancer

• Animals
• Cell Line, Tumor
• Cell Movement/physiology
• Cell Proliferation/physiology
• Female
• Fibronectins/metabolism
• Humans
• Mice
• Mice, Inbred BALB C
• Mice, Nude
• Nasopharyngeal Neoplasms/metabolism
• Nasopharyngeal Neoplasms/pathology
• RNA, Small Interfering
• Xenograft Model Antitumor Assays/methods

Background: To assess the prognosis of neck residue nasopharyngeal carcinoma (NPC) patients and the efficacy of neck dissection in the treatment of these patients.

Methods: We recruited 68 neck residue NPC patients. For each neck residue patient we had three matched NPC patients without neck residue as controls (n = 204). The primary endpoint was progression-free survival (PFS). The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), and multivariable analysis was used to test the independent statistical significance of NPC patients.

Results: Compared to controls, the neck residue patients showed significantly lower 3-year PFS (46.7% vs. 87.6%; P < 0.001). Multivariable analysis showed that neck residue was an independent prognostic factor for PFS.

Conclusions: NPC patients who had pathologically proven neck residue are associated with poor prognosis. Management with neck dissection alone seems not to be sufficient for these patients.

• case-cohort study
• nasopharyngeal carcinoma
• neck dissection
• neck residue
• prognosis

• Meta-analysis
• Nasopharyngeal carcinoma
• Overall survival
• Prognostic factors
• Recurrent
• Salvage intensity-modulated radiotherapy

• Immunostimulation
• Nasopharyngeal
• Pembrolizumab
• Radiotherapy, immunotherapy

Effective treatments for patients with advanced locally recurrent nasopharyngeal carcinoma (NPC) are limited. This investigation was to determine the potential benefits from re-irradiation by intensity-modulated radiotherapy (IMRT) on survival and the effects of severe late toxicities.

A retrospective study was conducted in 245 patients diagnosed with locally recurrent T3–T4 NPC who had undergone re-irradiation with IMRT. Follow-up data was colleted and factors associated with survival and severe late toxicities were analyzed.

The 5-year local-regional failure-free survival, distant failure-free survival and overall survival rates were 60.9%, 78.3% and 27.5%, respectively. The presence of severe late complications, recurrent T4 disease and gross tumor volume >30 cm³ were associated with poor survival. The incidences of mucosal necrosis, temporal lobe necrosis, cranial neuropathy and trismus were 22.0%, 14.6%, 27.0% and 14.6% respectively. Conclusions: Re-irradiation with IMRT is an effective choice in patients with locally recurrent T3–T4 NPC. However, the survival benefits can be partly offset by severe late complications and optimum treatments in these patients remain a challenge.

• intensity-modulated radiotherapy
• late complications
• local recurrence
• nasopharyngeal carcinoma

• endoscopic
• exposure volume
• image guidance
• maxillary swing
• nasopharyngectomy

• intensity-modulated radiotherapy
• long-term survival
• long-term toxicities
• recurrent nasopharyngeal carcinoma
• reirradiation

The aim of the study was to investigate the effect of three-dimensional conformal radiation therapy (3D-CRT) on nasopharyngeal carcinoma (NPC) and the incidence of complications. Between May 2010 and June 2012, 141 patients diagnosed with local recurrence of NPC due to cranial base lesions or cranial nerve symptoms, confirmed by pathology biopsy and/or by CT/MRI, were included in the present study. In accordance with the principle of randomized control, the patients were divided into three groups and treated with three different doses of 3D-CRT. The planned radiotherapy doses of 3D-CRT were 58/1.8–2 Gy, 62/1.8–2 Gy and 68/1.8–2 Gy, respectively. The survival rate, disease-free survival (DFS) rate and local control rate of the three groups of patients were compared as well as the adverse reactions observed after radiotherapy. The prognoses of NPC patients were analyzed by univariate and multivariate analyses. The follow-up rate of the study was 100%. The 5-year overall survival, DFS, and locoregional recurrence-free survival rates were: 43.2 vs. 64.53 vs. 75%, 29.13 vs. 42.82 vs. 39.7% and 30.76 vs. 44.19 vs. 45.4%, respectively. In addition, 62/1.8–2 Gy was similar in treatment effects to 68/1.8–2 Gy, but 68/1.8–2 Gy showed more adverse reactions than 62/1.8–2 Gy. Thus, 62/1.8–2 Gy can be used as a safe and effective dose for 3D-CRT treatment of NPC. Univariate and multivariate analyses showed that age may be the main prognostic factor of patients with NPC. In conclusion, 3D-CRT with a dose of 62/1.8–2 Gy is a safe, effective and tolerable treatment for NPC patients with good clinical value.

• 3D-CRT
• local recurrence
• nasopharyngeal carcinoma
• re-irradiation

• conformal radiotherapy
• recurrent
• reirradiation
• retropharyngeal
• stereotactic body radiotherapy

• 125I brachytherapy
• 125I seeds
• complications
• local control
• quality of life
• recurrent nasopharyngeal carcinoma

• Endoscopic skull base surgery
• Nasopharyngeal carcinoma
• Nasopharyngectomy

Background: Nasopharyngeal carcinoma is associated with Epstein-Barr virus (EBV). The current study investigated change in the plasma EBV DNA load in the first 3 months after treatment and its clinical significance in NPC.

Methods: A total of 273 patients with non-metastatic, histologically-proven NPC treated with radiotherapy or chemoradiotherapy were retrospectively reviewed.

Results: EBV DNA was detectable in 19/273 (7.0%) patients at the end of therapy (end-DNA). Three months later, 16/273 (5.9%) patients had detectable EBV DNA (3-month-DNA). To investigate risk stratified by the pattern of change in post-treatment EBV-DNA, we divided patients into four subgroups: Group 1, undetectable end-DNA and 3-month-DNA (n = 244); Group 2, detectable end-DNA and undetectable 3-month-DNA (n = 13); Group 3, undetectable end-DNA and detectable 3-month-DNA (n = 7); and Group 4, detectable end-DNA and 3-month-DNA (n = 2). Patients with delayed remission of EBV DNA after treatment (Group 2) had significantly poorer 3-year DFS (48.6% vs. 89.7%, P < 0.001), DMFS (48.6% vs. 94.6%, P < 0.001) and OS (91.7% vs. 97.5%, P < 0.001) than those with persistently undetectable EBV DNA post-treatment (Group 1). Five of the seven patients with re-emergent EBV DNA (Group 3) and both patients with persistent EBV DNA post-treatment (Group 4) developed disease failure.

Conclusion: Plasma EBV DNA load continues to change during the first 3 months after treatment. The pattern of change in EBV DNA load post-treatment could help identify patients with different prognoses.

• DNA
• Epstein-Barr virus
• biological
• nasopharyngeal neoplasms
• tumor markers

The study aimed to evaluate the long-term outcome in patients with advanced local recurrent nasopharyngeal carcinoma (NPC) treated with or without reirradiation.

A total of 44 patients treated without reirradiation (non-RT + chemotherapy) were matched with 44 patients treated with reirradiation (re-RT+/-chemtherapy) by age, sex, Karnosky performance score (KPS), rT stage, rN stage, and time interval between initial radiation and recurrence (TI). Overall survival (OS) rate and time to progression (TTP) rate were assessed using Kaplan–Meier method, log-rank test, and Cox regression analysis.

From March 2008 to December 2013, a total of 88 well-balanced rT3–4 N0-1 NPC patients were retrospectively analyzed. After a median follow-up of 27 months (range: 6–85), the 5-year OS rate and TTP rate was 23.4 %, 39.0 % in the non-RT + chemotherapy group and 27.5 %, 49.8 % in the re-RT+/-chemtherapy group, respectively. Multivariate analysis showed that significant toxic effect was the only significant prognosticator correlated with OS (HR: 2.15, 95 % CI = 1.02–4.53, p = 0.044). No statistically significant survival differences were observed between the two treatment groups in either univariate or multivariate analyses.

Compared with reiradiation, treating advanced local recurrent NPC with chemotherapy alone warrants further validation in the view of its similar survival and more acceptable toxicities.

The online version of this article (doi:10.1186/s12885-016-2803-2) contains supplementary material, which is available to authorized users.

• Chemotherapy
• Recurrent nasopharyngeal carcinoma
• Reirradiation

• Cisplatin
• fluorouracil
• nasopharyngeal carcinoma
• paclitaxel

• Adult
• Aged
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Nasopharyngeal Neoplasms/radiotherapy
• Nasopharyngeal Neoplasms/surgery
• Neoplasm Recurrence, Local
• Prospective Studies
• Salvage Therapy
• Survival Rate

• Adolescent
• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Nasopharyngeal Neoplasms/radiotherapy
• Radiometry
• Radiotherapy Dosage
• Radiotherapy Planning, Computer-Assisted/methods
• Radiotherapy, Intensity-Modulated/methods
• Recurrence
• Young Adult

• R01 CA133474 NCI NIH HHS
• R01 CA176553 NCI NIH HHS

• nasopharyngeal carcinoma
• nasopharyngectomy
• neck dissection
• recurrent disease
• residual disease

Salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC) is complicated and relatively limited. Radiotherapy, combined with effective concomitant chemotherapy, may improve clinical treatment outcomes. We conducted a phase II randomized controlled trial to evaluate the efficacy of intensity-modulated radiotherapy with concomitant weekly cisplatin on locally recurrent NPC.

Between April 2002 and January 2008, 69 patients diagnosed with non-metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group (n = 34) or radiotherapy alone group (n = 35). All patients received intensity-modulated radiotherapy. The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days (range 23–53 days). The concomitant chemotherapy schedule was cisplatin 30 mg/m² by intravenous infusion weekly during radiotherapy.

The median follow-up period of all patients was 35 months (range 2–112 months). Between concomitant chemoradiotherapy and radiotherapy groups, there was only significant difference in the 3-year and 5-year overall survival (OS) rates (68.7% vs. 42.2%, P = 0.016 and 41.8% vs. 27.5%, P = 0.049, respectively). Subgroup analysis showed that concomitant chemoradiotherapy significantly improved the 5-year OS rate especially for patients in stage rT3–4 (33.0% vs. 13.2%, P = 0.009), stages III–IV (34.3% vs. 13.2%, P = 0.006), recurrence interval >30 months (49.0% vs. 20.6%, P = 0.017), and tumor volume >26 cm³ (37.6% vs. 0%, P = 0.006).

Compared with radiotherapy alone, concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC, especially those with advanced T category (rT3–4) and stage (III–IV) diseases, recurrence intervals >30 months, and tumor volume >26 cm³.

Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC. Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC. Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment. Traditional form of retreatment was to employ a second course of radiation. The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal. Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications.

Surgical salvage, on the other hand, could spare the patients from complications of re-treatment. Due to the difficult access of the nasopharynx, various surgical approaches had been devised for nasopharyngectomy. The maxillary swing approach had the largest published experience with over 300 cases from various centers. In the recent decade, the endoscopic approach with or without robotic assistance had gained popularity for resecting small, centrally located recurrences. This minimally invasive approach further reduced the morbidity for treating locally recurrent NPC.

Nodal recurrences had been a rare entity after the introduction of modern radiotherapy technique and concurrent chemotherapy. Treatment of nodal failure with second radiation has dismal results. Surgical removal of the lymph node harboring the recurrence should be in the form of a formal radical neck dissection. In cases of extensive nodal recurrence where microscopic disease may be present after a formal neck dissection, additional radiotherapy can be delivered with after-loading brachytherapy.

Surgical treatment played a definitive role in salvage of loco-regional failures of nasopharyngeal carcinoma.

• Nasopharyngeal carcinoma
• Nasopharyngectomy
• Recurrent cancer
• Salvage surgery

The properties of a tumor itself were considered the main factors determining the survival of patients with locally recurrent nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). However, recurrent tumors were mainly evaluated by using the American Joint Committee on Cancer staging system, which was modeled on primary tumors and did not incorporate the tumor volume. This study aimed to investigate the prognostic values of the primary tumor location and tumor volume, and to determine whether evaluating these parameters could improve the current staging system.

Magnetic resonance (MR) images for 229 patients with locally recurrent NPC who underwent IMRT were analyzed retrospectively.

The skull base, parapharyngeal space, and intracranial cavity were the most common sites of tumors. There was a difference in the survival between patients with T1 and T2 diseases (77.6 % vs. 50.0 %, P < 0.01) and those with T3 and T4 diseases (33.0 % vs. 18.0 %, P = 0.04) but no difference between patients with T2 and T3 diseases (50.0 % vs. 33.0 %, P = 0.18). Patients with a tumor volume ≤38 cm³ had a significantly higher survival rate compared with those with a tumor volume >38 cm³ (48.7 % vs. 15.2 %, P < 0.01).

A new staging system has been proposed, with T3 tumors being down-staged to T2 and with the tumor volume being incorporated into the staging, which may lead to an improved evaluation of these tumors. This new system can be used to guide the treatment strategy for different risk groups of recurrent NPC.

• early-stage
• intensity-modulated radiotherapy (IMRT)
• late complications
• local recurrence
• nasopharyngeal carcinoma (NPC)

¹²⁵I seed implantation is a new method in treatment of nasopharyngeal carcinoma (NPC), and it is worthwhile to evaluate its feasibility. In this study, we performed brachytherapy with computed tomography (CT)-guided permanent implantation of ¹²⁵I seeds in the treatment of patients with the recurrence of NPC.

A total 30 patients (20 male and ten female) at the median age of 55 (range 25–80) years were diagnosed with recurrent nonkeratin NPC, with a total 38 lesions and a short disease-free interval (mediañ11 months) after primary radiotherapy alone or combined with chemotherapy. Patients received CT scan, starting from 2 months after the treatment. Follow-up was conducted for ~2–38 months to observe the local control rate and overall survival rate. We also analyzed the possible correlation between survival periods and the status of recurrent tumors.

The local control rates at 6, 12, 24, 30, and 36 months after the procedure of ¹²⁵I seed implantation were 86.8%, 73.7%, 26.3%, 15.8%, and 5.3%, respectively. The overall 1-, 2-, and 3-year survival rates were 80.0% (24/30), 30.0% (9/30), and 6.7% (2/30), respectively, with a median survival period of 18 months (17.6±8.6 months). Interestingly, the survival periods of the patients who had primary radiotherapy with or without chemotherapy were 15.8±7.9 and 24.3±7.9 months, respectively. Kaplan–Meier survival analysis demonstrated that χ² (log rank) was 7.555, with very significant difference (P<0.01). The survival periods of patients in tumor stages I, II, III, and IV were 25.4±8.7, 19.8±9.4, 16.1±4.5, and 12.8±7.8 months, respectively, with significant differences (P<0.05).

Our data suggest that the survival period of recurrent NPC patients after ¹²⁵I seed implantation is inversely related to the tumor stages of the recurrence but not to chemotherapy after the primary radiotherapy. Therefore, CT-guided ¹²⁵I seed implantation can be set for treatment of recurrent NPC, for better survival rate with minimal damage.

• CT-guided 125I seed
• NPC
• radiochemotherapy

• EBV molecular biology
• Epstein-Barr virus
• Head and neck cancer
• Nasopharyngeal carcinoma

• Carcinoma
• Carcinoma, Squamous Cell/etiology
• Carcinoma, Squamous Cell/therapy
• Epstein-Barr Virus Infections/complications
• Epstein-Barr Virus Infections/virology
• Herpesvirus 4, Human/isolation & purification
• Humans
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms/etiology
• Nasopharyngeal Neoplasms/therapy
• Prognosis

• nasopharyngeal carcinoma
• recurrence
• disease-free interval to recurrence

• Apoptosis/physiology
• Biomarkers, Tumor/biosynthesis
• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/metabolism
• COP9 Signalosome Complex
• Carcinoma
• Female
• Humans
• In Situ Nick-End Labeling
• Intracellular Signaling Peptides and Proteins/biosynthesis
• Intracellular Signaling Peptides and Proteins/metabolism
• Ki-67 Antigen/biosynthesis
• Male
• Middle Aged
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms/genetics
• Nasopharyngeal Neoplasms/pathology
• Neoplasm Recurrence, Local/genetics
• Neoplasm Recurrence, Local/pathology
• Peptide Hydrolases/biosynthesis
• Peptide Hydrolases/metabolism
• Prognosis
• Proto-Oncogene Proteins c-akt/biosynthesis
• Proto-Oncogene Proteins c-akt/metabolism
• Retrospective Studies
• STAT3 Transcription Factor/biosynthesis
• STAT3 Transcription Factor/metabolism
• Transcription Factor CHOP/biosynthesis
• Transcription Factor CHOP/metabolism

• R01 CA090853 NCI NIH HHS
• R01-CA90853 NCI NIH HHS

• fraction size
• intensity-modulated radiotherapy (IMRT)
• late complications
• local recurrence
• nasopharyngeal carcinoma
• total dose