Patterns of failure after radical neck dissection for recurrent nasopharyngeal carcinoma

Radical neck dissection (RND) for recurrent nasopharyngeal carcinoma (NPC) after radiotherapy was retrospectively evaluated in 38 patients treated between April 1986 and December 1991. Thirty patients (79%) had advanced-stage disease. Four patients required nasopharyngectomy as well as RND. The mortality was 0%, and the morbidity was 13%. The actuarial survival rates at 5 years from the time of initial radiotherapy and RND were 50% and 25%, respectively. Of the 21 patients with relapses after surgical salvage, 5 had recurrences in the nasopharynx, 3 had recurrences in the neck, and 13 had distant metastases. We conclude that RND for recurrent NPC is safe and efficacious; however, it is associated with a significant (34%) incidence of distant metastases. These results can be improved by evaluating patients for distant metastases and excluding those with distant metastases. Improvement in the treatment of distant metastases is also needed.