Management of locally recurrent nasopharyngeal carcinoma. (September 2019)

• Record Type: Journal Article
• Authors: Lee, Anne W.M.; Ng, Wai Tong; Chan, Jimmy Y.W.; Corry, June; Mäkitie, Antti; Mendenhall, William M.; Rinaldo, Alessandra; Rodrigo, Juan P.; Saba, Nabil F.; Strojan, Primož; Suárez, Carlos; Vermorken, Jan B.; Yom, Sue S.; Ferlito, Alfio
• Is Part Of: Cancer treatment reviews. Volume 79(2019)
• Publication Date: 2019-09
• Subjects: Nasopharyngeal carcinoma -- Recurrent -- Nasopharyngectomy -- Radiotherapy -- Prognostic factor; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2019.101890
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: Regular surveillance monitoring is needed for early detection of local recurrence. Surgery should be considered whenever feasible due to its lower complication risk. The therapeutic margin in re-irradiation is narrow. Most common fatal radiotherapy toxicities include mucosal necrosis and haemorrhage. Role of systemic treatment is unclear, may only be chosen in conservative settings. Abstract: As a consequence of the current excellent loco-regional control rates attained using the generally accepted treatment paradigms involving intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC), only 10–20% of patients will suffer from local and/or nodal recurrence after primary treatment. Early detection of recurrence is important as localized recurrent disease is still potentially salvageable, but this treatment often incurs a high risk of major toxicities. Due to the possibility of radio-resistance of tumors which persist or recur despite adequate prior irradiation and the limited tolerance of adjacent normal tissues to sustain further additional treatment, the management of local failures remains one of the greatest challenges in this disease. Both surgical approaches for radical resection and specialized re-irradiation modalities have been explored. Unfortunately, available data are based on retrospective studies, and the majority of them are based on a small number of patients or relatively short follow-up. In this article, we will review the different salvage treatment options and associated prognostic factors for each of them. We will also propose a treatment algorithm based on the latest available evidence and discuss the future directions of treatment for locally recurrent NPC.