Surgical Salvage Of Recurrent Nasopharyngeal Cancer

Abstract

While primary radiotherapy is the treatment of choice for treatment naïve nasopharyngeal carcinoma (NPC), surgery plays an important role in salvaging recurrent diseases. Due to the anatomical location of the nasopharynx, many approaches have been proposed by various authors in the last 30 years to resect locally recurrent tumors in the nasopharynx. There are advantages and disadvantages of various approaches. Of all the approaches, the anterolateral approach with the maxillary swing operation has the largest published experience of over 300 cases from multiple centres. The approach provides wide exposure with minimal postoperative morbidities. Technological advances in the last decade enabled surgeons to resect small recurrent tumors in the nasopharynx with an endoscopic approach or robotic approach, further reducing the morbidities. With the relatively short follow up time of these minimally invasive approaches, the long term oncological outcome could not be compare to open approaches at this stage. Nodal recurrences in NPC is now are after the introduction of concurrent chemoradiation. Nodal recurrence can still be salvaged with a standard radical neck dissection. More extensive disease with invasion to soft tissue of the neck can be salvaged with extended neck dissection together with after-loading brachytherapy as second radiation and reconstruction of the surgical defect with flaps. With advanced imaging technologies, small isolated metastasis to the liver and lung can be detected early. Early experience in resection of these isolated metastasis to the liver and lung showed survival benefits in this group of advanced stage NPC patients. Larger scale studies would be needed to define the role of surgical resection in managing NPC patients with isolated metastasis.