Targeted Endoscopic Nasopharyngectomy for Recurrent NPC

Abstract

Objective: Evaluate targeted endoscopic nasopharyngectomy as a viable oncologic alternative to open nasopharyngectomy or radiation for recurrent nasopharyngeal carcinoma (NPC). Method: A retrospective analysis at an academic medical center was performed for 13 patients who underwent endoscopic nasopharyngectomy for recurrent NPC (August 2005 to August 2010). Three patients had neck metastases for which a neck dissection was concurrently planned. Outcomes measured included 2-year disease-free survival, 2-year overall survival, and complication rates. Results: Including resections for subsequent recurrences, 19 endoscopic procedures were performed. Average age was 55.7 years, with mean follow-up period 24.2 months. Mean OR time was 278 minutes, mean estimated blood loss was 197 ml, and mean hospitalization was 1.0 day. Negative margins were obtained in 78.9%: positive margins involved the parapharyngeal space, oropharynx, fossa of Rosenmuller, and infratemporal fossa. Four patients required repeat endoscopic nasopharyngectomy for re-recurrence, despite having margins cleared or controlled with adjuvant treatment. Two-year local disease-free and overall survival rates were 69.2% and 100.0%, respectively. The complication rate was 52.6%, with no major complications. Conclusion: Targeted endoscopic nasopharyngectomy is beneficial in recurrent NPC, with favorable morbidity and complication rates. Endoscopic surveillance facilitates identification of re-recurrences, which often may be treated with additional directed resection. Stereotactic radiation may serve as an appropriate adjunct modality for disease control at positive margins.