Management of recurrent nasopharyngeal carcinoma: current perspectives

Abstract

Nasopharyngeal carcinoma is a rare disease in Western countries. Nevertheless, its incidence in China, Singapore, and other Eastern countries reaches 20 cases per 100,000 people. Being an extremely chemo- and radiosensitive disease, upfront treatment often consists in the association of intensity-modulated radiation therapy and concurrent cisplatin. Unfortunately, about 20% of the patients suffer from a radioresistant disease which recurs after upfront therapy. For these patients, mainly available therapeutic options consist in systemic therapy, in particular poly-chemotherapy. In those showing a single locoregional recurrence, chemotherapy is not considered to be the preferred approach and other different strategies may be employed. Re-irradiation and surgery are strategies that are always used more often, albeit related to high risk of morbidity. Immunotherapy and targeted therapy, such as heavy ions-based re-irradiations, are experimental but very intriguing options.

Keywords: immunotherapy; nasopharyngeal carcinoma; poly-chemotherapy; radioresistant; re-irradiation.

Figure 1

Flowchart illustrating the optimal approach in patients with a diagnosis of recurrent NPC. Abbreviations: NPC, nasopharyngeal carcinoma; chemo-RT, chemo-radiotherapy; MTD, multidisciplinary team management; GC, cisplatin-gemcitabine; IMRT, intensity-modulated radiation therapy; Cht, chemotherapy; rT1, recurrent T1; rT2, recurrent T2; rT3, recurrent T3; rT4, recurrent T4.