Salvage of local recurrence

Abstract

© 2019 Elsevier Inc. All rights reserved. Advancements in diagnostic imaging, radiation therapy, and the use of chemotherapy have vastly increased the cure rate of nasopharyngeal carcinoma (NPC). However, local recurrence is still a significant problem for locally advanced disease. It usually occurs within the first 5 years of initial treatment and is associated with devastating outcomes. Various salvage treatments are employed for locally recurrent disease. These include surgery and nonoperative means such as reirradiation, chemotherapy, or a combination of both. Nasopharyngectomy is recommended for early resectable disease, but for more advanced recurrences, reirradiation is the only chance of cure. Due to the close proximity of the recurrent tumor (rT) to critical organs at risk and previous high radiation exposure to these regions, the therapeutic ratio for reirradiation is notoriously narrow. The achievement of local control of recurrent disease is often associated with catastrophic and potentially life-threatening complications. Pretreatment assessment to identify the most suitable candidates is thus needed. This chapter reviews the current management of locally recurrent NPC and explores areas of interest for future development.