Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma – A case-matched comparison

You, Rui; Zou, Xiong; Hua, Yi; Han, Fei; Li, Li; Zhao, Chong; Hong, Ming; Chen, Ming Yuan

doi:10.1016/j.radonc.2015.04.024

Cited by 115 publications

(113 citation statements)

References 21 publications

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“…Based on our patterns of care, it is obvious that surgery is literally regarded as the treatment of choice for patients with operable disease (82.3% of stage I and 38.1% of stage II), 13,14 whereas re-RT is mainly considered in the setting of more advanced local recurrence. As >90% patients with NPC were managed in the public sector, this study not only reflects the contemporary practice in Hong Kong but also represents the treatment preferences of clinicians in the care of locally recurrent NPC.…”

Section: Discussionmentioning

confidence: 99%

“…As >90% patients with NPC were managed in the public sector, this study not only reflects the contemporary practice in Hong Kong but also represents the treatment preferences of clinicians in the care of locally recurrent NPC. 14,16,17 Only two cases of perioperative mortality were reported-one died of fatal bleeding and another of respiratory failure. The most likely explanations are the availability of surgical expertise in Hong Kong and the fear of cumulative side effects related to the second course of RT.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Wong

Cheung

et al. 2019

Head & Neck

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Background This study evaluates the contemporary care for patients with locally recurrent nasopharyngeal carcinoma after failure of the primary course of intensity modulated radiotherapy. Methods Eligible patients were identified through the Hong Kong Cancer Registry database. Patterns of care and treatment outcomes were analyzed. Results Two hundred seventy‐two patients with locally recurrent tumors were identified. Of them, 30.9% received surgery, whereas 35.7% received re‐irradiation (re‐RT). The 5‐year overall survival (OS) for the whole group was 30.2%. Old age and advanced rT classification were adverse prognostic factors, whereas surgery (mainly in resectable recurrence) was associated with favorable survival outcome. The 5‐year OS rates for patients who received surgery and re‐RT were 56.3% and 21.8%, respectively. Conclusions Early detection of resectable recurrence is of paramount importance as surgery for resectable tumors offers the potential to achieve excellent outcomes. Re‐RT could be considered in selected patients with unresectable disease and favorable prognostic features.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Wong

Cheung

et al. 2019

Head & Neck

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“…However, patients receiving repeat radiotherapy have a poorer quality of life than those who undergo surgery (You et al, 2015). A number of studies have supported the claim that patients who test negative for EBV-DNA have better prognoses (Shen et al, 2015; Stoker et al, 2016), and have advocated surgery as the main treatment method (You et al, 2015). Unlike other studies in which the pretreatment EBV-DNA levels of recurrent NPC have been found to be predominantly positive (Chan et al, 2012), only 27 patients tested positive for EBV-DNA in our patient group.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike NPC at the initial diagnosis, the preferred treatment for recurrent NPC is often surgery, because it provides a better prognosis than CRT (You et al, 2015). Furthermore, in terms of resectable lesions, surgery is essentially able to achieve complete resection of the observable tumor.…”

Section: Discussionmentioning

confidence: 99%

“…However, complete surgical resection may not be achieved in NPC because of the complex anatomical location of the nasopharynx, the presence of important nerves and vessels in the vicinity, and the wide area of invasion in local late-stage recurrence. Therefore, previous studies have advocated that surgical treatment should mainly be reserved for rT1-T2 patients (You et al, 2015). With regard to local early-stage NPC, a previous study has reported that CRT can achieve satisfactory efficacy (Qiu et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of residual or recurrent nasopharyngeal carcinoma treated with endoscopic nasopharyngectomy plus chemoradiotherapy or with chemoradiotherapy alone: a retrospective study

Weng

Wei

et al. 2017

PeerJ

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BackgroundLocal residual and recurrent nasopharyngeal carcinoma (NPC) generally shows treatment failure after standard radiotherapy with or without concurrent chemotherapy. Whether endoscopic nasopharyngectomy might provide an additional therapeutic advantage remains controversial. Therefore, we retrospectively compared the clinical prognoses of patients with residual or recurrent NPC treated with endoscopic nasopharyngectomy combined with chemoradiotherapy (CRT) with those of patients treated with CRT alone.Methods and MaterialsA total of sixty-two patients with local residual or recurrent NPC were studied retrospectively: 36 patients received endoscopic nasopharyngectomy combined with CRT, whereas 26 patients who refused the surgery or had surgical contraindications received CRT alone. Serum Epstein-Barr virus (EBV) DNA levels were measured pre- and post-treatment. The differences in prognosis between the two treatment regimens and the pre- and post-treatment changes in EBV-DNA levels were analyzed.ResultsThe median follow-up time was 31 months, with a 3-year overall survival (OS) of 51.40% and a 3-year disease-free survival (DFS) of 46.86%. The surgery + CRT group had a better OS than the CRT alone group did (χ2 = 4.054, P = 0.044). The pretreatment EBV-DNA levels showed a positive correlation with the clinical staging of recurrent NPC (χ2 = 11.674, P = 0.009). Patients with negative pretreatment serum EBV-DNA levels showed a superior OS to those of patients who tested positive for EBV-DNA (>0 copy/mL) (χ2 = 9.833, P = 0.002). The post-treatment EBV-DNA levels, compared with the pretreatment levels, decreased significantly in the surgery + CRT group (Z = − 3.484, P = 0.000). In contrast, the EBV-DNA levels after CRT alone did not decrease significantly (Z = − 1.956, P = 0.051). Multivariate analysis indicated that local staging, pretreatment EBV-DNA load, and the treatment method were independent risk factors for OS. Subgroup analysis indicated that the patients who tested negative for EBV-DNA before the treatment and those who received surgery + CRT showed a better OS than those who received CRT alone.ConclusionsThe pretreatment serum EBV-DNA level was associated with disease prognosis. The combination therapy preceded by surgery can effectively decrease the copy number of EBV-DNA. Patients with local intermediate- and late-stage NPC, especially those negative for EBV-DNA, may consider opting for surgery followed by post-operative adjuvant radiotherapy or chemotherapy.

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Nasopharyngeal Carcinoma in Nonendemic Populations

McDowell

Lim

Corry

2017

Textbook of Uncommon Cancer

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Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma – A case-matched comparison

Cited by 115 publications

References 21 publications

Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Clinical outcomes of residual or recurrent nasopharyngeal carcinoma treated with endoscopic nasopharyngectomy plus chemoradiotherapy or with chemoradiotherapy alone: a retrospective study

Nasopharyngeal Carcinoma in Nonendemic Populations

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