The Management of rNPC: Salvage Surgery vs. Re-irradiation

Hao, Chung-Yu; Hao, Sheng‐Po

doi:10.1007/s11912-020-00949-0

Cited by 18 publications

(21 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

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.

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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.

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

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.

show abstract

“…It originates from the epithelial lining of the nasopharynx and occurs in association with EBV infection ( 1 ). NPC is sensitive to radiation therapy, and with the development of diagnostic and radiation therapy techniques, the 5-year survival rate reaches 50–64.4%, but there are still 10–20% of patients who experience regional recurrence after improvement ( 2 , 3 ). Complications occurring after radiation are also a major factor that seriously affects patients' survival and quality of life ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Currently, re-irradiation is still the most widely used treatment modality, but the local control rate of re-radiotherapy is only 50%, and the toxic effects of re-irradiation are a concern ( 3 ). Comparing with endoscopic endonasal nasopharyngectomy (EEN), the patients with re-irradiation often suffer from severe complications such as multiple cranial nerve palsies, osteonecrosis, and internal carotid artery (ICA) dissection ( 2 , 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Preliminary Efficacy Report and Prognosis Analysis of Endoscopic Endonasal Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma

Peng

Wang

et al. 2021

Front. Surg.

View full text Add to dashboard Cite

Background: Compared with radiotherapy, endoscopic endonasal nasopharyngectomy (EEN) is increasingly used to treat recurrent nasopharyngeal carcinoma (NPC) because of its good prognosis and mild complications. This study aims to investigate the efficacy of EEN in the treatment of recurrent NPC and factors affecting prognosis.Methods: This study included all patients who received EEN for recurrent nasopharyngeal carcinoma from April 2016 to April 2020. All operations were performed in Xiangya Hospital Central South University. The patient's 2-year overall survival (OS) rate, disease-free survival (DFS) rate and significant prognostic factors are reported.Results: There were 38 (67.9%) males and 28 (32.1%) females, with a median age of 43 (range, 24–69 years).43 (76.8%) of the patients in our study were in advanced rT3-rT4 stage and 32 (74.4%) of the patients in the advanced stage had tumor growth closely related to the internal carotid artery (ICA). During a mean follow up period of 44 month (range 1–65 months) post-surgery. The 2-year OS rate was 48.6%, 2-year DFS rate was 42.6%. The 2-year OS rates of rT1-2 and rT3-4 recurrent NPC were 83.9 and 35.6%, respectively. The 2-year DFS rates of rT1-2 and rT3-4 recurrent NPC 76.2 and 56.3%. The advanced T stage were associated with a poor prognosis in terms of OS and DFS.Conclusions: Data indicate that T staging may be an independent prognostic factor for OS and DFS. Through proper preoperative evaluation, EEN is an alternative treatment option for advanced recurrent NPC that ensures a certain level of efficacy and is relatively safe with few complications. However, additional studies with long-term follow-up and a larger sample size are required.

show abstract

The Management of rNPC: Salvage Surgery vs. Re-irradiation

Cited by 18 publications

References 26 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

Preliminary Efficacy Report and Prognosis Analysis of Endoscopic Endonasal Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma

Contact Info

Product

Resources

About