Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial

Liu, You‐Ping; Wen, Yihui; Tang, Jun; Yi, Wei; You, Rui; Zhu, Xiaolin; Li, Jian; Chen, Lin; Li, Ling; Zhang, Ning; Zou, Xiong; Hua, Yi-Jun; Chen, You-Mou; Chen, Lei; Lü, Lixia; Chen, Ming‐Yuan; Wen, Wang

doi:10.1016/s1470-2045(20)30673-2

Cited by 103 publications

(129 citation statements)

References 31 publications

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“…Its main treatment modality is radiotherapy (1)(2)(3)(4). With the development of diagnostic and treatment techniques, the 5-year OS rate of NPC reaches 50% to 64%, but 10% to 20% of patients still experience recurrence after the first treatment and improvement of their disease (5). According to National Comprehensive Cancer Network (NCCN) guidelines, surgical excision of the lesion or local radiotherapy is recommended for resectable head and neck squamous carcinoma after recurrence that has been treated with radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…According to National Comprehensive Cancer Network (NCCN) guidelines, surgical excision of the lesion or local radiotherapy is recommended for resectable head and neck squamous carcinoma after recurrence that has been treated with radiotherapy. Chemotherapy alone is usually reserved for palliative patients who are not candidates for radiotherapy or surgery ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…For patients with locally advanced rT3-4, endoscopic surgical resection of the lesion requires a high level of surgical skill on the lead surgeons, and the probability of subsequent complications is higher than that of early-stage patients if they are treated with re-radiotherapy ( 7 , 8 ). The survival and prognosis studies of ES and IMRT for recurrent NPC have been reported in the literatures ( 5 , 9 , 10 ), but there is no literature comparing the efficacy of the two treatment modalities for locally advanced recurrent rT3-4 NPC.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

Peng

Wang

et al. 2021

Front. Oncol.

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BackgroundThis meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC).MethodsRelevant studies were retrieved in six databases from 02/28,2011 to 02/28,2021. The 2-year, 3-year, 5-year overall survival (OS) rates and 2-year disease-free survival (DFS) rates were calculated to compare the survival outcomes of the two treatments of IMRT and ES. Combined odds ratios (ORs) and 95% confidence interval (C Is) were measured as effect size on the association between high T-stage and 5-year OS rates.ResultsA total of 23 publications involving 2,578 patients with recurrent NPC were included in this study. Of these, 1611 patients with recurrent rT3-4 NPC were treated with ES and IMRT in 358 and 1,253 patients, respectively. The combined 2-year OS and 5-year OS rates for the two treatments were summarized separately, and the 2-year OS and 5-year OS rate for ES were 64% and 52%, respectively. The 2-year OS and 5-year OS rate for IMRT were 65% and 31%, respectively. The combined 2-year DFS rates of IMRT and ES were 60% and 50%, respectively. Combined ORs and 95% confidence intervals for 5-year survival suggest that ES may improve survival in recurrent NPC with rT3-4. In terms of complications, ES in the treatment of high T-stage recurrent NPC is potentially associated with fewer complications.ConclusionsThe results of our study suggest that ES for rT3-4 may be a better treatment than IMRT, but the conclusion still needs to be sought by designing more studies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

Peng

Wang

et al. 2021

Front. Oncol.

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“…(3) distant metastasis; (4) unresectable neck lymph node metastasis. The tumor margin to the ICA of less than 0.5 cm was considered as tumor invasion into the ICA (7). The current study was approved by the Institutional Review Board of the Affiliated Eye, Ear, Nose, and Throat Hospital at Fudan University.…”

Section: Study Populationmentioning

confidence: 99%

“…Several recent studies have investigated the employment of salvage endoscopic nasopharyngectomy in the management of rNPC, in view of the fact that it might have better survival prognosis and fewer complications, compared to re-irradiation (5,6). Liu et al reported that endoscopic surgery significantly improved the overall survival (OS), compared to IMRT, in the patients with early stage rNPC (tumors confined to the nasopharyngeal cavity, the postnaris or nasal septum, the superficial parapharyngeal space, or the base of the sphenoid sinus) (7). Furthermore, a previous study by the authors on patients with rNPC showed that the site-specific and sinonasalrelated quality of life were maintained after endoscopic nasopharyngectomy, compared to the preoperative quality of life.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Salvage Endoscopic Nasopharyngectomy for Patients With Advanced Recurrent Nasopharyngeal Carcinoma

Zhang

et al. 2021

Front. Oncol.

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BackgroundSalvage endoscopic nasopharyngectomy has better survival prognosis and fewer complications in the management of early stage rNPC, compared to re-irradiation. However, the treatment modality of advanced recurrent nasopharyngeal carcinoma (rNPC) remains controversial. Thus, the purpose of this study was to investigate the demographics, clinical outcomes, and prognostic factors associated with salvage endoscopic nasopharyngectomy in advanced rNPC.MethodsThis study conducted a retrospective analysis of advanced rNPC patients who underwent salvage surgery betweenm January 2014 and December 2019. The overall survival (OS) and progression-free survival (PFS) were analyzed. Univariable and multivariable analyses of OS and PFS were performed using the Cox regression model. The predicted values of the parameters were determined by means of the receiver operating characteristic (ROC) curve analysis.ResultsAmong the 120 patients included, there were 75 patients with rT3 stage and 45 patients with rT4 stage. With the median follow-up time of 18 months,the 3 -year OS and PFS were 55.2% and 29.4%, respectively. Multivariate analyses showed that the rNPC patients with older age, low BMI (Body Mass Index), rT4 stage, tumor necrosis, and tumor invasion into the ICA was predictive of worse OS, whereas low BMI and rT4 stage were associated with worse PFS. In addition, the rT stage was identified as a better predictor of OS (area under the ROC curve: 0.669; P=0.003) than the other clinical features.ConclusionsSalvage treatment using endoscopic nasopharyngectomy appears to be an effective treatment in the management of patients with advanced rNPC. In addition, case matching studies and prospective studies with larger clinical samples are required to further evaluate the efficacy of endoscopic surgery compared with re-irradiation in advanced rNPC.

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Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case‐matched comparison

Liu

Wang

et al. 2021

Int Forum Allergy Rhinol

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Background:The efficacy and safety of internal carotid artery (ICA) embolization as a treatment strategy in recurrent nasopharyngeal carcinoma (rNPC) patients with tumors invading the ICA remain unclear. Methods: We enrolled all rNPC patients with tumors invading the ICA, who underwent salvage endoscopic surgery. Using propensity scores to adjust for specific potential prognostic factors, a well-balanced cohort of 42 patients with limited rNPC was formed by matching each patient who underwent ICA embolization (study group) with one who did not (control group). The survival rates and common treatment-related complications were compared between the 2 groups. Results:The cohort included patients with the following tumor stages: rT2 (n = 3), rT3 (n = 24), and rT4 (n = 15). During a median follow-up of 15 (range, 2-63) months, the 2-year overall survival and progression-free survival rates were significantly higher in the ICA embolization group than in the ICA nonembolization group (90.5% vs 53.3% and 71.3% vs 33.0%, respectively; and p = 0.022 and p = 0.006, respectively). In addition, the incidence of treatment-related complications, such as nasal obstruction, nasopharyngeal hemorrhage, and nasopharyngeal necrosis, was significantly lower in the ICA embolization group than in the nonembolization group (p = 0.001, p = 0.014, and p = 0.038, respectively). Conclusion:The innovative application of ICA embolization in endoscopic surgery in patients with rNPC invading the ICA significantly improved patient 838

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Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial

Cited by 103 publications

References 31 publications

Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

Clinical Outcomes of Salvage Endoscopic Nasopharyngectomy for Patients With Advanced Recurrent Nasopharyngeal Carcinoma

Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case‐matched comparison

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