Current treatment options for recurrent nasopharyngeal cancer

Abstract

Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation.

Fig. 1

a Tumor in the roof of the nasopharynx. b Facial degloving and osteotomies including the anterior, medial and lateral walls of the maxillary sinus. c Once removed the posterior wall access is gained to the nasopharynx and infratemporal fossa. d Reposition of removed bones at the end of procedure

Fig. 2

a Axial CT showing an advanced tumor involving the lateral wall od nasopharynx, infratemporal fossa, pterygoid plates and posterior wall of maxillary sinus. b The coronal CT shows an extension into the sphenoid sinus. c Postoperative CT after a facial translocation approach. The anterior maxillary sinus wall and orbito-zygomatic bones are repositioned and a temporalis muscle flap fills the operative cavity

Fig. 3

Facial translocation approach performed through a facial degloving and a hemicoronal incision. a Translocated facial bones in a single piece. b Bilateral facial degloving. c Reposition of the anterior segment of translocated bones. d Reposition of the orbito-zygomatic bones and part of the temporalis muscle

Fig. 4

Different nasopharyngeal recurrent tumors operated by a subtemporal–preauricular approach. a Right lateral wall tumor involving the infratemporal fossa and skull base extradurally. b Right lateral wall tumor involving the infratemporal fossa. c Left lateral wall tumor involving the infratemporal fossa

Fig. 5

Subtemporal–preauricular approach. a Hemicoronal–preauricular incision with optional neck extension. b Exposition of the orbito-zygomatic complex before its removal. c The nasopharyngectomy is completed. d Reposition of the orbito-zygomatic bones and part of the temporalis muscle

Fig. 6

Mandibular swing approach. Nasopharyngeal recurrence (a) extended to the oropharynx (b). c Anterior mandibulotomy and approach to the oropharynx and nasopharynx. d Osteosynthesis of the mandible

Fig. 7

Guidelines for treatment of recurrent nasopharyngeal cancer