Recurrent nasopharyngeal carcinoma: hyperfractionation of IMRT improves outcomes

Up to 20% of patients who receive definitive radiotherapy for nasopharyngeal carcinoma have local disease recurrence. Reirradiation is the only curative-intent treatment option for unresectable, locally advanced recurrent tumours, but the therapeutic benefits are largely negated by severe and often fatal toxicities. Now, new data from a phase III trial conducted in China indicate that hyperfractionation improves the safety of salvage radiotherapy and, thus, patient outcomes.

The trial involved 144 patients with locally advanced recurrent nasopharyngeal carcinomas (stage II–IVa) arising ≥12 months after initial radical radiotherapy. These patients were randomly assigned 1:1 to receive intensity-modulated radiotherapy (IMRT) with either hyperfractionation (65 Gy in 54 twice-daily fractions; interfractional interval ≥ 6 h) or standard fractionation (60 Gy in 27 daily fractions). The co-primary end points were the incidence of grade ≥3 late radiation-induced complications (occurring ≥3 months after completion of IMRT) and overall survival (OS).