[Salvage surgery for nasopharyngeal carcinoma after irradiation failure]

To study the salvage surgery for nasopharyngeal carcinoma after irradiation failure.

One hundred and twenty-one full-dose-irradiation-uncontrolled cases of nasopharyngeal carcinoma had undergone salvage surgery since 1965 till 1992, in which 41 had primary lesion and 80 neck lesion. All patients received radiation before surgery with the dose of 60Gy-145Gy. The patient selection for this report limited to those with recurrent tumors at the primary sites with no apparent bony involvement and no cranial nerve palsy, or cases with resectable neck recurrences.

It showed that palatal fenestration was the best choice of approach for recurrent tumors located at the vault of the nasopharyngeal cavity. When the tumor invaded the parapharyngeal space or, owing to the after-effect of radiotherapy, the patient presented with severe occlusion of the mandible, we preferred the lateral approach through partial mandi-bulectomy. The lateral rhinotomy was only indicated for cases with tumor remnant at the posterior nares. Lymph node excision was performed for cases with single movable node on the neck, and RND for the cases with multiple nodes. The complication rate of after surgery was low (10%), considering the heavy dose of irradiation. The three- and five-year survival rate were 49% (59/121) and 38% (38/100) respectively.

It suggests that the surgery should be considered as a salvage procedure for cases of nasopharyngeal cancer after irradiation failure. Because of high rate of distant metastasis (62 cases or 45% died after surgery), chemotherapy or other measures should be adopted after local treatment.