Salvage Endoscopic Nasopharyngectomy for Locally Recurrent T1 and T2 Nasopharyngeal Carcinoma

Abstract

Assessment of salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma (rNPC). This is a retrospective study of ten rNPC who underwent salvage endoscopic nasopharyngectomy. Recurrent status for each recurrence was determined before surgery and only recurrent T1 (rT1) and recurrent T2 (rT2) were taken up for surgery after review with radiation oncology colleagues. There were seven rT2 and three rT1 patients. Two patients have undergone simultaneous radical neck dissection (RND) together with endoscopic nasopharyngectomy for associated neck nodes. Outcome of the study was done in turn of disease free, disease residual and disease recurrence. Locally disease free and overall survival rates were 40% (4/10) and 50% (5/10) respectively. Locally disease free till the last follow up was achieved in 4 patients while one patient is on palliative chemotherapy post-surgery for locally positive disease for the last three years. Of the four patients that are locally disease free, two patients received chemoradiation (CTRT) post-surgery while two patients only underwent endoscopic nasopharyngectomy for rT1. There were no any major operative complications except nasal crusting. Recurrent T1 and T2 can be manage with endoscopic nasopharyngectomy and post-surgery ctrt should be given in feasible patients. To detect early recurrent and improve the survival, regular endoscopic follow up is needed.

Keywords: Endoscopic nasopharyngectomy; Nasopharyngeal carcinoma; Recurrent; Salvage.

Fig. 1

Pre-operative axial CECT scan showing the recurrent tumor in the nasopharynx

Fig. 2

Pre-operative coronal CECT scan showing the recurrent tumor in the nasopharynx

Fig. 3

Post-operative axial CECT scans of the nasopharynx

Fig. 4

Post-operative coronal CECT scans of the nasopharynx

Fig. 5

Endoscopic picture of post endoscopic nasopharyngectomy, arrow pointing the resected eustachian tube right side

Fig. 6

Histological picture-Interconnecting trabeculae with little keratinization, stromal lymphocytic infiltration. Cells with eosinophilic cyptoplasm with round nucleoli with vesicular chromatin