Abstract
Objective: Salvage surgery and radiotherapy showed positive and similar survival outcomes in rT1/2 local recurrent nasopharyngeal carcinoma (rNPC) but no curative value in rT3/4 ones in the past. We will evaluate new techniques such as endoscopic surgery and intensity-modulated radiotherapy (IMRT) to compare with conventional radiotherapy (CRT) and chemotherapy in rNPC.
Method: We did a retrospective review of 493 rNPC patients from January 2000 to December 2009. IMRT, CRT, and/or chemotherapy were suitable to all rT stage cases, but endoscopic surgery was applied to rT1 and some selected rT2/T3 cases. The 5-year overall survival rate (OS) and other oncological outcomes were summarized.
Results: Among 493 cases, 120, 82, 132, and 159 were restaged in rT1N0M0, rT2N0M0, rT3N0M0, and rT4N0M0 according to AJCC/UICC 2002 TNM stage system. The 5-year OS was 73.0%, 37.0%, 17.3%, and 16.5% in rT1, rT2, rT3, and rT4 patients (P < .05). Adjusted for rT stages, the salvage surgery and IMRT showed a better survival curve than conventional radiotherapy and chemotherapy (P < .01). In rT1 patients, the 5-year OS of patients who received salvage endoscopic surgery was better than that of ones who received IMRT (89.3% vs 69.0%, P < .01). Cox analysis showed that age, stage, and salvage treatment were significant independent predictors for OS.
Conclusion: Although patients in the earlier rT stage showed better survival than ones in the advanced rT stage, new salvage treatments based on endoscopic surgery and IMRT benefited all rT stage rNPC compared with CRT and chemotherapy. Futhermore, salvage endoscopic surgery may be a more promising option than IMRT in rT1 patients.
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