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Background:The choice between endoscopic surgery and re-radiotherapy as the main treatment modality in patients with advanced recurrent nasopharyngeal carcinoma (rNPC) remains controversial. Therefore, in this study, we compared the efficacies of endoscopic surgery and intensity-modulated radiotherapy (IMRT) in patients with rNPC. Methods: All patients with advanced rNPC (T3 and T4) who underwent salvage treatment were enrolled from January 2009 to December 2020. Overall survival (OS) was analyzed using a log-rank analysis. Univariate and multivariate analyses of OS were performed using a Cox regression model. Common treatment-related complications of endoscopic surgery were compared with those of IMRT. Results:The numbers of patients with T3 and T4 tumors were 163 (64.2%) and 91 (35.8%), respectively; 192 patients underwent endoscopic surgery, 51 received IMRT, and 11 received three-dimensional conformal radiotherapy (3D-CRT). The 3-year OS of patients treated with endoscopic surgery was 59.3%, which was significantly higher than that of patients treated with IMRT (34.7%, p < 0.001) or 3D-CRT (43.6%, p = 0.012). Multivariate analyses showed that IMRT was an independent risk factor for OS compared with endoscopic surgery (hazard ratio, 2.068; 95% confidence interval, 1.395-3.069, p < 0.001). Complications of aural fullness (p = 0.001), nasopharyngeal necrosis (p = 0.004), nasopharyngeal hemorrhage (p = 0.004), dysphagia (p < 0.001), and cerebral infarction (p = 0.030) were significantly lower in the endoscopic surgery group than in the IMRT group. Conclusion:Endoscopic surgery may be a more promising salvage treatment than IMRT to maximize survival and minimize treatment-related complications Wanpeng Li, Qianqian Zhang, and Fu Chen contributed equally to this work.

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Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor of the nasopharyngeal mucosa with a high incidence rate in southern China and Southeast Asia and an evident ethnic and geographical distribution. Circular RNAs (circRNAs) are single‐stranded noncoding RNAs with covalent, closed‐loop structures. They are characterized by high stability and abundance, are evolutionarily conserved, and exhibit tissue/developmental stage specificity. Previous studies have shown that circRNAs are associated with the occurrence and development of various malignant tumors. However, the expression patterns and clinical significance of circRNAs in NPC remain ambiguous. Hence, the present review focuses on the biogenesis and regulation of circRNAs, and the functional roles of abnormally expressed circRNAs in NPC. In addition, the current review discusses the possibility of utilizing circRNAs as potential clinical biomarkers for the diagnosis and prognosis of NPC.