Value of clinical follow-up for local nasopharyngeal carcinoma relapse

Three hundred seventy-nine new patients with nasopharyngeal carcinoma (NPC) were followed clinically and the physical examination, including that of the nasopharynx by indirect mirror for symptoms after treatment. At the time of analysis, with a median follow-up of 34.8 months, 47 patients had developed recurrent disease in the nasopharynx and in the immediately adjacent regions. In 31 patients the first clinical features to suggest local recurrence were progressive symptoms (group A). In another 13 patients recurrence of tumor in the nasopharynx was detected by indirect mirror examination (group B). In the remaining three patients, the diagnosis was made during investigation for neck node recurrence. The more common symptoms at diagnosis of local recurrence were headache; cranial nerve palsy involving the third, fourth, fifth, and sixth nerves; and ear and nasal symptoms. Group B patients tended to have less of these symptoms. The presence of tumor was confirmed by fiberscopic examination and biopsy in all group B patients and 14 of 31 group A patients, the tumor was submucosal in the remaining 17 group A patients. The recurrence in group B patients was diagnosed significantly earlier than the group A patients (p = 0.0294), and group A patients suffered from more invasive and extensive disease in comparison with group B patients (p = 0.0044). There were significantly less patients in group A who were amenable to curative brachytherapy (p = 0.0280). Clinical follow-up for local NPC recurrence was found to be useful. More frequent use of fiberscopic examination in the follow-up, especially for those not adequately examined by indirect mirror examination, will improve the detection rate. Cross-sectional imaging techniques and the monitoring of tumor markers may supplement clinical and fiberscopic examinations. An algorithm for diagnosing recurrent NPC and possible treatment are suggested.