Re-Irradiation of Recurrent Nasopharyngeal Cancer: A 4-year Follow-up Study of Treatment using 3-Dimensional Conformal Radiotherapy

Introduction: Nasopharyngeal cancer (NPC) is a prevalent diagnosis of head and neck cancers (HNC) in Asia. In Indonesia, it is estimated that there are 12,000 new cases per year. Case Presentation: The author reports a 25-year-old male patient with recurrent NPC. This patient was first diagnosed with NPC stage IVB in 2013 and was treated by chemoradiation. In 2016, he found another mass in his neck. The biopsy result showed the recurrence of the NPC with histopathology of Undifferentiated carcinoma (WHO type III). Re-irradiation was planned, and the patient subsequently received 3D-Conformal Radiotherapy (3D-CRT) at our department. Four years after the completion of re-irradiation, the patient was alive and well with no signs of recurrence but still complained about late toxicities like trismus and fibrotic neck.  Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like intensity-modulated radiotherapy (IMRT). However, with careful planning, we can still obtain optimum tumor dose, minimize organs at-risk (OAR) dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on re-irradiation, especially in OAR dose tolerance guidelines.