A Ten-year Experience of the Multidisciplinary Management of the Regional Failure of Nasopharyngeal Carcinoma in the Era of IMRT

Abstract

Objective: To evaluate clinical outcomes of cervical node recurrence/residual tumor of nasopharyngeal carcinoma (NPC) with treatment decisions made by a multidisciplinary treatment (MDT) team. Methods: Between March 2010 and July 2019, patients who had previously undergone definitive intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and presented with residual or recurrent cervical lymph nodes were enrolled in our study. Clinical features and treatment modalities were retrospectively reviewed, and survival outcomes were analyzed. Results: A total of 183 patients were enrolled in the study, among whom 139 underwent neck dissection, and the remaining 44 were either considered not eligible for surgery or refused surgery. For the two groups of patients, the 3-year overall survival (OS) was 73.4% vs 36.8% (p=0.000), and the progression-free survival (PFS) was 57.1% vs 32.3% (p=0.004), respectively. Patients who underwent neck dissection had a significantly better clinical outcome and shorter latency between the prior treatment and detection of neck recurrence/residual tumor than those who did not. Conclusion: For regional failure cases that have no contradictions for surgery and are predicted to benefit from surgery by the MDT team, neck dissection could be the best choice. It is important for an experienced MDT team to choose the optimum treatment modalities for patients for the cervical failure of NPC. Regular follow-up after prior treatment contributes to the early detection of regional failure and provides a chance for surgery.