Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic

Abstract

Recurrent nasopharyngeal carcinoma represents an extremely challenging therapeutic situation. Given the vulnerability of the already pretreated neurological structures surrounding the nasopharynx, any potential salvage retreatment option bears a significant risk of severe complications that result in high treatment-related morbidity, quality of life deterioration, and even mortality. Yet, with careful patient selection, long-term survival may be achieved after local retreatment in a subgroup of patients with local or regional relapse of nasopharyngeal cancer. Early detection of the recurrence represents the key to therapeutic success, and in the case of early stage disease, several curative treatment options can be offered to the patient, albeit with minimal support in prospective clinical data. In this article, an up-to-date review of published evidence on modern surgical and radiation therapy treatment options is summarized, including currently recommended treatment modifications of both therapeutic approaches during the coronavirus disease 2019 pandemic.

Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts

“…Three-year survival rates up to 60% after salvage surgery was observed mostly in T1 and T2 recurrent disease. Advanced stages with skull base, cranial nerve, and dural or brain involvement are associated with poor prognosis ( 62 ). It has been proven that surgical salvage may be superior to re-irradiation using intensity modulated radiation therapy (IMRT) (re-IMRT) in terms of laryngeal cancer (LC), OS, and QoL.…”

Comparison of Radiotherapy Combined with Nimotuzumab vs. Chemoradiotherapy for Locally Recurrent Nasopharyngeal Carcinoma

“…Following treatment of patients with LR-NPC with re-irradiation using IMRT, the incidence range of grade ≥ 3 advanced radiation injury was reported to be 0-74%, while the range of treatment-associated mortality (grade 5 toxicity) reached 0-65% [23]. In the present study, the incidence of grade ≥ 3 late radiation injury was 56.3%, whereas that of grade 5 late radiation injury was 29.9%, which was similar to the results of a recently reported meta-analysis [8].…”

SEOM-TTCC clinical guideline in nasopharynx cancer (2021)

“…Locoregional recurrences may be curable, so a local treatment is often recommended [II, B], albeit expecting significant sequeale. The main therapeutic options are surgery (open or endoscopic nasopharyngectomy [44]) and/or reirradiation (IMRT, brachytherapy, radiosurgery (SRS) and stereotactic-body RT (SBRT) with or without concurrent chemotherapy [45].…”

“…There is no strong evidence to choose between reirradiation and surgery [46]. Recurrence volume, disease-free interval, performance status and comorbidities [45][46][47] are important decision factors. For the evaluation of surgery, referral of the patient to a high-volume center would be desirable.…”