Surgical Resection of Pulmonary Metastases From Nasopharyngeal Carcinoma

Abstract

Background: Nasopharyngeal carcinoma (NPC), unlike other head and neck cancers, is known for its propensity for distant metastases. Chemotherapy remains the mainstay of treatment because of this and the chemosensitivity of the tumour, but long‐term control is rare. The surgical management of pulmonary metastases of other extrathoracic malignancies prompted this review of surgical management of patients with NPC. Methods: Thirteen thoracotomies were performed in 12 patients with pulmonary metastases as the first and only site of relapse of nasopharyngeal carcinoma. Postoperative chemotherapy was given in four patients, radiotherapy to the mediastinum in one patient and both chemotherapy and radiotherapy in two patients. The survival pattern of this group of 12 patients was compared with a historical control group consisting of 65 patients without surgical resection. Results: Lymph node involvement was documented in four patients during operation. Four patients relapsed after surgical resection, two of them were from the group of three patients with lymph node involvement. The site of subsequent relapse was the lung for three patients and the skeletal system for the fourth. The 2 year actuarial survival of the surgically resected group compared favourably with the historical control group (80% and 24.1 %, respectively; P= 0.0002 by Mantel‐Cox test). Conclusions: Surgical resection of pulmonary metastases from NPC seems to be a promising approach though the effect of case selection cannot be excluded and further studies are indicated. The importance of exploration and dissection of mediastinal nodes in the surgical management of pulmonary metastases from NPC was demonstrated.

Locoregional radiotherapy in patients with distant metastases of nasopharyngeal carcinoma at diagnosis

“…However, the survival of NPC patients with metachronous metastasis after primary radiotherapy was shown to increase following local treatment of solitary liver or pulmonary metastatic lesions[28]–[31]. Notably, it was reported that a NPC patient with a synchronous solitary bone metastasis gained more than 5 years of disease-free survival after a combination of systemic chemotherapy, locoregional radiotherapy, and radiotherapy for metastatic bone disease[32].…”

Factors determining the survival of nasopharyngeal carcinoma with lung metastasis alone: does combined modality treatment benefit?

“…Our results concurred closely with another study of lung metastasis of NPC in Hong Kong that NPC patients with lung metastasis(es) alone ( n = 41) appeared to have a distinctively better prognosis, with a hazards ratio (HR) of 0.41 compared with other types of metastasis(es) [7]. In other studies, intrathoracic metastasis(es) (lung and/or mediastinal nodes) was considered as a good prognostic factor in metastatic NPC [8,20,21]. However, to our knowledge, no literature has identified the precise predictive factors for the prognosis in this specific group.…”

“…Although several publications have shown in small cohorts that NPC patients with lung metastasis(es) alone may benefit from combined therapy, no data exists in larger patient cohorts [8,20-22]. We set out this retrospective study thought to add more evidences to help define the predictive factors of this group in a large cohort, and to facilitate the selection of the appropriate group to receive combined modality treatment for a better survival.…”

Staging computed tomography of the thorax for nasopharyngeal carcinoma

“…First, mediastinal and hilar lymphadenopathy constitute a significant component of intrathoracic metastases, which developed after localregional treatment of NPC. 13 Moreover, patients with intrathoracic metastases, including mediastinal nodal metastases, are known to have a prognosis distinctly better than other distant metastatic sites, 8,18,19 and some of the patients with mediastinal nodal metastases had prolonged survival after mediastinal radiation therapy. 18 Second, the orderly spread of nodal metastases in the cephalad-caudal direction in NPC 5 suggests the possibility that the superior mediastinal and axillary nodes could be the next echelon for lymphatic spread after supraclavicular nodal metastases.…”