Abstract
ObjectiveRecurrent nasopharyngeal carcinoma (rNPC) can be salvaged with re-irradiation, open nasopharyngectomy, and more recently endoscopic nasopharyngectomy. However, long-term outcomes of endoscopic approaches are lacking. Thus, we report 5-year outcomes following endoscopic nasopharyngectomy for rNPC.MethodsPatients who underwent endoscopic nasopharyngectomy for rNPC between January 2000 and January 2012 were retrospectively reviewed. Patients were included if they had their first endoscopic nasopharyngectomy at least 5 years prior to this study. Presenting (cTNM) status and recurrent (rTNM) status for each recurrence was determined. Outcomes included margin status, disease recurrence, death, and complication rates.ResultsThirteen patients were included. Four patients had a prior open nasopharyngectomy. Mean time follow-up was 74.3 months (range = 56.4–96 months). Negative margins were achieved in 77% of initial cases. Positive margins were associated with higher rT stages. Re-recurrence was seen in 6 patients, which was also associated with a higher cStage and rStage. All patients with positive margins had re-recurrence. Four patients required repeat endoscopic nasopharyngectomy and two received chemoradiation. All four with a second endoscopic procedure had further disease recurrence. Five-year local disease-free and overall survival rates were 53.9 and 84.6%, respectively. The minor complication rate was 52.6%, major operative complication rate was 0.0%, and late complication rate was 23.1%.ConclusionEndoscopic nasopharyngectomy demonstrates promising 5-year overall survival rate for rT1 and rT2 cases of rNPC with favorable complication rates. Lower rStages were associated with a higher disease-free rate, and lower cStages were associated with improved overall prognosis. Close surveillance and prompt management of recurrences can be associated with favorable long-term tumor control.Level of evidence4Graphical abstract
Highlights
Surgical management of local, recurrent nasopharyngeal carcinoma has gained favor as a treatment alternative to re-irradiation
For lower staged recurrent nasopharyngeal carcinoma (rNPC), this approach can potentially allow for similar outcomes as open nasopharyngectomy while limiting the morbidity associated with open surgical techniques
Patient characteristics and presenting status Twenty-five patients with recurrent, localized nasopharyngeal carcinoma were treated with endoscopic nasopharyngectomy; only 13 patients met eligibility for 5-year follow-up
Summary
Recurrent nasopharyngeal carcinoma (rNPC) has gained favor as a treatment alternative to re-irradiation. Traditional surgical options such as trans-palatal, trans-infratemporal fossa, trans-cervical, mid-face degloving, and maxillary swing approaches have been associated with 5-year overall survival (OS) ranging from 30 to 62%, favorable to reirradiation [1,2,3]. Such surgical techniques have been associated with a high degree of morbidity such as palatal defects, trismus, dysphagia, and nasal regurgitation [1, 3, 4]. We update our previously reported series with 5-year outcomes following endoscopic nasopharyngectomy for rNPC in North America
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