Treatment of Recurrent Nasopharyngeal Carcinoma: A Sequential Challenge

Abstract

Recurrent nasopharyngeal carcinoma (NPC), which occurs in 10-20% of patients with primary NPC after the initial treatment modality of intensity-modulated radiation therapy (IMRT), is one of the major causes of death among NPC patients. Patients with recurrent disease without distant metastases still have a chance to be saved, but re-treatment often carries more serious toxicities or higher risks. For this group of patients, both otolaryngologists and oncologists are committed to developing more appropriate treatment regimens that can prolong patient survival and improve survival therapy. Currently, there are no international guidelines for the treatment of patients with recurrent NPC. In this article, we summarize past publications on clinical research and mechanistic studies related to recurrent NPC, combined with the experience and lessons learned by our institutional multidisciplinary team in the treatment of recurrent NPC. We propose an objective protocol for the treatment of recurrent NPC.

Keywords: biomarkers; management; nasopharyngeal carcinoma; recurrent; treatment modality.

Figure 1

The common sites of tumor involvement in recurrent NPC. NPC, nasopharyngeal carcinoma; ICA, internal carotid artery.

Figure 2

(A) HRCT and MRI images of bone necrosis in recurrent NPC patients. (B) HRCT and MRI images of soft tissue necrosis in recurrent NPC patients. An “air bubble shadow” can be seen in the soft tissue shadow on CT.

Figure 3

Flowchart for the diagnosis and treatment of recurrent NPC with post-treatment management. ENT, ear nose and throat; MO, medical oncology; ICA, internal carotid artery; BOT, balloon occlusion test; P, positive; N, negative; EEN, endoscopic endonasal nasopharyngectomy; ICT, induction chemotherapy; IMRT, intensity-modulated radiation therapy.

Figure 4

Related molecules and pathways affecting NPC recurrence and progression, such as invasive metastasis and radio resistance.