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Updated: May 27, 2026
08:59
A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
Extracapsular lymph node spread in recurrent nasopharyngeal carcinoma.
Yu Wai Chan1, Victor Ho Fun Lee, Velda Ling Yu Chow
1Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. chanjyw@gmail.com
The Laryngoscope
|November 25, 2011
Summary
Combined neck dissection and brachytherapy effectively treat recurrent nasopharyngeal carcinoma (NPC) with extracapsular spread (ECS). This approach, including mandatory flap reconstruction, yields satisfactory outcomes for nodal metastasis in NPC patients.
Area of Science:
- Oncology
- Head and Neck Surgery
- Radiation Oncology
Background:
- Recurrent nasopharyngeal carcinoma (NPC) presents challenges, particularly with nodal metastasis involving extracapsular spread (ECS).
- Optimal treatment strategies for recurrent NPC with ECS remain an area of active investigation.
- Previous treatments, including radiotherapy, influence subsequent management options.
Purpose of the Study:
- To evaluate the efficacy of combined neck dissection and brachytherapy for recurrent NPC with nodal metastasis and extracapsular spread (ECS).
- To compare treatment outcomes between patients with and without ECS.
- To identify and mitigate potential postoperative complications.
Main Methods:
- A prospective study involving 158 patients with regional recurrent NPC after radiotherapy.
- Patients with ECS underwent extended radical neck dissection (RND) followed by brachytherapy.
- Patients without ECS were treated with RND alone; outcomes were compared.
Main Results:
- Macroscopic ECS was present in 25.9% of patients.
- No significant difference in 5-year nodal control (62% vs. 65%) or disease-free survival (38% vs. 44%) was observed between patients with or without ECS.
- Regional flap reconstruction was utilized in 41 patients to prevent wound necrosis and carotid blowout; nerve palsies occurred at low rates.
Conclusions:
- Combined surgery and brachytherapy offer satisfactory results for recurrent NPC with ECS.
- Mandatory reconstruction with regional flaps is crucial to prevent severe complications such as wound necrosis and carotid artery blowout.
- This aggressive treatment strategy demonstrates acceptable safety profiles, with no cases of cerebral ischemia from accelerated atherosclerosis.
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