Evaluation and decision making for continued curative treatment in patients who failed chemoradiotherapy for nasopharyngeal carcinoma

Abstract

Approximately 10% of NPC patients have local failure after primary chemoradiation treatment and 5% have nodal failure. Local failures can be detected with endoscopy or imaging and should be confirmed with biopsy. Small local failures (rTl-rT2) could be treated with surgical resection; the current surgical approach of choice is the maxillary swing approach nasopharyngectomy. Alternatively, re-irradiation by brachytherapy is feasible with small recurrences. Larger local failures required re-irradiation by external beam, which is associated with increased morbidities. External beam re-irradiation for nodal failures has poor control rates and severe complications. Surgery, in the form of radical neck dissection, has a 5-year disease control rate of 68%. Additional brachytherapy in form of after-loading tubes placed during neck dissection is feasible in extensive disease with extra-capsular spread or involvement of the soft tissue of the neck. Current chemotherapy regimens have not shown long-term survival benefit and are regarded as palliative therapeutic options.