Salvage surgery for nasopharyngeal cancer

Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatm...

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Autores principales:	Raymond K. Tsang, William I. Wei
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2015
Materias:	Otorhinolaryngology RF1-547 Surgery RD1-811
Acceso en línea:	https://doaj.org/article/551ceba89b8a4d0ab5529fd14a38d399
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spelling	oai:doaj.org-article:551ceba89b8a4d0ab5529fd14a38d3992021-12-02T13:23:40ZSalvage surgery for nasopharyngeal cancer2095-881110.1016/j.wjorl.2015.09.006https://doaj.org/article/551ceba89b8a4d0ab5529fd14a38d3992015-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095881115300214https://doaj.org/toc/2095-8811Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC. Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC. Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment. Traditional form of retreatment was to employ a second course of radiation. The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal. Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications.Surgical salvage, on the other hand, could spare the patients from complications of re-treatment. Due to the difficult access of the nasopharynx, various surgical approaches had been devised for nasopharyngectomy. The maxillary swing approach had the largest published experience with over 300 cases from various centers. In the recent decade, the endoscopic approach with or without robotic assistance had gained popularity for resecting small, centrally located recurrences. This minimally invasive approach further reduced the morbidity for treating locally recurrent NPC.Nodal recurrences had been a rare entity after the introduction of modern radiotherapy technique and concurrent chemotherapy. Treatment of nodal failure with second radiation has dismal results. Surgical removal of the lymph node harboring the recurrence should be in the form of a formal radical neck dissection. In cases of extensive nodal recurrence where microscopic disease may be present after a formal neck dissection, additional radiotherapy can be delivered with after-loading brachytherapy.Surgical treatment played a definitive role in salvage of loco-regional failures of nasopharyngeal carcinoma. Keywords: Nasopharyngeal carcinoma, Nasopharyngectomy, Salvage surgery, Recurrent cancerRaymond K. TsangWilliam I. WeiKeAi Communications Co., Ltd.articleOtorhinolaryngologyRF1-547SurgeryRD1-811ENWorld Journal of Otorhinolaryngology-Head and Neck Surgery, Vol 1, Iss 1, Pp 34-43 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Otorhinolaryngology RF1-547 Surgery RD1-811
spellingShingle	Otorhinolaryngology RF1-547 Surgery RD1-811 Raymond K. Tsang William I. Wei Salvage surgery for nasopharyngeal cancer
description	Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC. Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC. Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment. Traditional form of retreatment was to employ a second course of radiation. The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal. Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications.Surgical salvage, on the other hand, could spare the patients from complications of re-treatment. Due to the difficult access of the nasopharynx, various surgical approaches had been devised for nasopharyngectomy. The maxillary swing approach had the largest published experience with over 300 cases from various centers. In the recent decade, the endoscopic approach with or without robotic assistance had gained popularity for resecting small, centrally located recurrences. This minimally invasive approach further reduced the morbidity for treating locally recurrent NPC.Nodal recurrences had been a rare entity after the introduction of modern radiotherapy technique and concurrent chemotherapy. Treatment of nodal failure with second radiation has dismal results. Surgical removal of the lymph node harboring the recurrence should be in the form of a formal radical neck dissection. In cases of extensive nodal recurrence where microscopic disease may be present after a formal neck dissection, additional radiotherapy can be delivered with after-loading brachytherapy.Surgical treatment played a definitive role in salvage of loco-regional failures of nasopharyngeal carcinoma. Keywords: Nasopharyngeal carcinoma, Nasopharyngectomy, Salvage surgery, Recurrent cancer
format	article
author	Raymond K. Tsang William I. Wei
author_facet	Raymond K. Tsang William I. Wei
author_sort	Raymond K. Tsang
title	Salvage surgery for nasopharyngeal cancer
title_short	Salvage surgery for nasopharyngeal cancer
title_full	Salvage surgery for nasopharyngeal cancer
title_fullStr	Salvage surgery for nasopharyngeal cancer
title_full_unstemmed	Salvage surgery for nasopharyngeal cancer
title_sort	salvage surgery for nasopharyngeal cancer
publisher	KeAi Communications Co., Ltd.
publishDate	2015
url	https://doaj.org/article/551ceba89b8a4d0ab5529fd14a38d399
work_keys_str_mv	AT raymondktsang salvagesurgeryfornasopharyngealcancer AT williamiwei salvagesurgeryfornasopharyngealcancer
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Salvage surgery for nasopharyngeal cancer

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