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Current treatment options for recurrent nasopharyngeal cancer.

Suárez C, Rodrigo JP, Rinaldo A, Langendijk JA, Shaha AR, Ferlito A - Eur Arch Otorhinolaryngol (2010)

Bottom Line: The best salvage treatment for local recurrent NPC remains to be determined.In this article we will discuss the different options for salvage of locally recurrent NPC.For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported.

View Article: PubMed Central - PubMed

Affiliation: Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.

ABSTRACT
Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation.

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a Tumor in the roof of the nasopharynx. b Facial degloving and osteotomies including the anterior, medial and lateral walls of the maxillary sinus. c Once removed the posterior wall access is gained to the nasopharynx and infratemporal fossa. d Reposition of removed bones at the end of procedure
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Fig1: a Tumor in the roof of the nasopharynx. b Facial degloving and osteotomies including the anterior, medial and lateral walls of the maxillary sinus. c Once removed the posterior wall access is gained to the nasopharynx and infratemporal fossa. d Reposition of removed bones at the end of procedure

Mentions: For tumors arising from the nasopharynx and extending to neighboring regions, such as nasal cavity, maxillary sinus, sphenoid sinus, and infratemporal fossa, the facial translocation approach can be the simplest and most direct way to expose these areas and to facilitate extensive tumor removal. If the tumor is confined to the nasopharynx or has paranasal, retromaxillary or moderate infratemporal extension, a temporary removal of the anterior, superior and medial walls of the maxillary sinus will suffice (Fig. 1). The procedure is carried out with midfacial degloving in order to avoid facial scars, which in addition allows an excellent exposure [44, 58, 61, 64, 65]. In extensive tumors of the nasopharynx and the infratemporal fossa, especially when the tumor involves the nasal cavity and the posterior wall of the maxillary sinus, a standard facial translocation approach is the method of choice, allowing the surgeon a better exposure than that obtained by other infratemporal fossa procedures, such the subtemporal–preauricular approach (Figs. 2, 3). In this case the procedure is carried out with midfacial degloving and a hemicoronal–preauricular incision. When a facial translocation is performed, the possibility of osteomyelitis or late bone resorption exists [64]. Open standard facial translocation carries very noticeable sequelae, such as lower lid ectropion, epiphora, medial canthus misalignment, nasolacrimal duct obstruction, frontal muscle palsy, and visible facial scars. Most of these sequelae, with the exception of nasolacrimal obstruction, can be avoided with the use of midfacial degloving combined with a hemicoronal preauricular incision that is hidden in the hair.Fig. 1


Current treatment options for recurrent nasopharyngeal cancer.

Suárez C, Rodrigo JP, Rinaldo A, Langendijk JA, Shaha AR, Ferlito A - Eur Arch Otorhinolaryngol (2010)

a Tumor in the roof of the nasopharynx. b Facial degloving and osteotomies including the anterior, medial and lateral walls of the maxillary sinus. c Once removed the posterior wall access is gained to the nasopharynx and infratemporal fossa. d Reposition of removed bones at the end of procedure
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2966947&req=5

Fig1: a Tumor in the roof of the nasopharynx. b Facial degloving and osteotomies including the anterior, medial and lateral walls of the maxillary sinus. c Once removed the posterior wall access is gained to the nasopharynx and infratemporal fossa. d Reposition of removed bones at the end of procedure
Mentions: For tumors arising from the nasopharynx and extending to neighboring regions, such as nasal cavity, maxillary sinus, sphenoid sinus, and infratemporal fossa, the facial translocation approach can be the simplest and most direct way to expose these areas and to facilitate extensive tumor removal. If the tumor is confined to the nasopharynx or has paranasal, retromaxillary or moderate infratemporal extension, a temporary removal of the anterior, superior and medial walls of the maxillary sinus will suffice (Fig. 1). The procedure is carried out with midfacial degloving in order to avoid facial scars, which in addition allows an excellent exposure [44, 58, 61, 64, 65]. In extensive tumors of the nasopharynx and the infratemporal fossa, especially when the tumor involves the nasal cavity and the posterior wall of the maxillary sinus, a standard facial translocation approach is the method of choice, allowing the surgeon a better exposure than that obtained by other infratemporal fossa procedures, such the subtemporal–preauricular approach (Figs. 2, 3). In this case the procedure is carried out with midfacial degloving and a hemicoronal–preauricular incision. When a facial translocation is performed, the possibility of osteomyelitis or late bone resorption exists [64]. Open standard facial translocation carries very noticeable sequelae, such as lower lid ectropion, epiphora, medial canthus misalignment, nasolacrimal duct obstruction, frontal muscle palsy, and visible facial scars. Most of these sequelae, with the exception of nasolacrimal obstruction, can be avoided with the use of midfacial degloving combined with a hemicoronal preauricular incision that is hidden in the hair.Fig. 1

Bottom Line: The best salvage treatment for local recurrent NPC remains to be determined.In this article we will discuss the different options for salvage of locally recurrent NPC.For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported.

View Article: PubMed Central - PubMed

Affiliation: Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.

ABSTRACT
Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1-T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation.

Show MeSH
Related in: MedlinePlus