Effectiveness of brachytherapy and fractionated stereotactic radiotherapy boost for persistent nasopharyngeal carcinoma

Background. Nasopharyngeal carcinoma (NPC) with local persistence after primary radiotherapy carries a high risk of treatment failure. We compared the effectiveness of brachytherapy and a fractionated stereotactic radiotherapy (SRT) boost in improving tumor control. Methods. We retrospectively reviewed the records of 755 patients with NPC treated from 1994 to 2001. Fifty‐two patients (7%) had persistent local disease, but seven of them were unsuitable for radiotherapy boost. Overall, 24 patients received brachytherapy boost at a median dose of 20 Gy, and 21 patients received an SRT boost at a median dose of 15 Gy. Results. Despite the radiotherapy boost, the overall 3‐year local failure–free control rate was still significantly lower for patients with persistent disease than for the rest (71% vs 86%, p < .01). Only the SRT subgroup achieved a local failure–free control rate close to that of the complete responders (82% vs 86%, p = .71). Conclusions. SRT boost is more effective in reverting the poor prognostic influence of local persistent disease. © 2004 Wiley Periodicals, Inc. Head Neck 26: 1024–1030, 2004