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Factors Affecting the Overall Survival After Salvage Surgery in Patients With Recurrent Nasopharyngeal Carcinoma at the Primary Site
Experience With 60 Cases
Mow-Ming Hsu, MD;
Ruey-Long Hong, MD;
Lai-Lei Ting, MD;
Jend-Yuh Ko, MD;
Tzun-Shiahn Sheen, MD, PhD;
Pei-Jen Lou, MD, PhD
Arch Otolaryngol Head Neck Surg. 2001;127:798-802.
Objective To analyze the factors affecting overall survival after salvage surgery
in patients with recurrent nasopharyngeal carcinoma at the primary site after
a full course of radiotherapy.
Design Retrospective analysis of 60 consecutive patients treated by surgical
resection of the recurrent tumors, with a mean follow-up of 43.1 months (range,
19-96 months).
Setting Academic tertiary referral center.
Results The overall survival and locoregional relapse–free survival were
56% and 60% at 2 years, respectively, and 30% and 40% at 5 years. Twenty-nine
(81%) of 36 patients died with uncontrolled local disease. The T stage of
the recurrent tumors appeared to be an important prognostic factor. Age, sex,
pathologic findings, and disease-free interval (time between previous radiotherapy
and local recurrence) were not significant prognosis-affecting factors by
the log-rank test. Multivariate analysis showed that patients with recurrent
tumors of undifferentiated carcinoma, sarcoma, or small cell carcinoma had
unfavorable prognoses. Uncontrolled local disease and the emergence of distant
metastasis predicted grave results as well. Postoperative irradiation showed
some benefit to patients, but the difference was not statistically significant.
Conclusions The T stage of the recurrence was the prominent prognosis-affecting
factor in patients with recurrent nasopharyngeal carcinoma who received salvage
surgery. Patients with local recurrence should be carefully selected for the
salvage surgery. We recommend this surgery for patients with rT1, rT2, or
limited rT3 lesions. The results of surgical resection in terms of local control
and overall survival were slightly better than those of high-dose reirradiation,
with fewer late complications.
From the Departments of Otolaryngology (Drs Hsu, Ko, Sheen, and Lou),
Oncology (Dr Hong), and Radiation Therapy (Dr Ting), National Taiwan University
Hospital, Taipei, Taiwan.
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