Surgical options for continuing treatment of recurrent nasopharyngeal carcinoma

Abstract

Nasopharyngeal carcinoma is a radiosensitive tumor, and the primary treatment modality is external radiotherapy. When the carcinoma recurs either in the neck or at the nasopharynx after irradiation, then salvage treatment with further doses of radiotherapy is associated with morbidities. Continuing management with surgery is the logical option. When the recurrent tumor is localized in the neck, surgical salvage by radical neck dissection contributes to good tumor control in the neck, and the operation has acceptable morbidity rates. For tumor localized only in the nasopharynx, significant tumor control is possible by direct implantation of radioactive gold grains into the tumor using a split palate approach. This procedure is applicable when the size of the recurrent tumor is small and when it is located at accessible positions in the nasopharynx. When recurrent tumor extends to the paranasopharyngeal space or when its position is at a site where implantation of gold grains is difficult, then surgical resection is mandatory for salvage. Tumor extirpation by removing the nasopharynx together with the paranasopharyngeal tissue is possible with the anterolateral approach to the nasopharynx. This surgical procedure is not difficult, and the associated morbidity rate is low. © 2000 Lippincott Williams & Wilkins, Inc.