Efficacy and Safety of Endoscopic Nasopharyngectomy Combined With Low-Dose Radiotherapy for Primary T1-2 Nasopharyngeal Carcinoma

Abstract

Aim: Intensity-modulated radiotherapy (IMRT) is a widely accepted therapy for nasopharyngeal carcinoma (NPC), but it inevitably brings out radiation-related complications and seriously affects the quality of life (QoL). Endoscopic nasopharyngectomy (ENPG) has been successfully conducted in locally recurred NPC, but few studies evaluated its application in early NPC. This study aims to assess the feasibility and safety of ENPG combined with low-dose radiotherapy (LDRT) in T1-2 NPC. Patients and Methods: We recruited 37 newly diagnosed localized T1-2 NPC patients who voluntarily accepted ENPG +LDRT from June 2013 to September 2016. Meanwhile, the data of 132 T1-2 NPC patients treated with IMRT were collected and used as control group. The survival outcomes, QoL score and late RT-related sequelaes were compared between the 2 groups. Results: After a median follow-up of 54 months, only 1 patient in ENPG+LDRT group died along with hepatic metastases. The 5-year overall survival, distant metastasis-free survival, local relapse-free survival and regional relapse-free survival in ENPG+LDRT group were 97.3%, 97.3%, 100% and 100%, which were not statistically different from the control group (97.7%, 90.2%, 95. 5%, 97.0%, respectively, all P > 0.05). In comparison with IMRT group, ENPG+LDRT exhibited better QoL and less rate of late RT-related sequlaes including hearing loss (53.8% vs 27.0%, P = 0.005), xerostomia (46.2% vs 24.3%, P = 0.023) and dysphagia (25.8% vs 8.1%, P = 0.024). Conclusions: ENPG+LDRT provided satisfactory survival outcomes, and improved the QoL and reduced the incidence of sequelae for T1-2 NPC patients.

Surgical resection of the primary tumor improves survival in patients with locoregional stage T1 nasopharyngeal carcinoma: a propensity score-based matched analysis

“…In a recent study by Liu et al [20], which explored the possibility of "replacing" radiotherapy with surgery in patients with early-stage NPC, no serious complications or deaths related to surgery were observed in this study, and crucially, the investigators did not observe any tumor recurrence, elaborating that surgery alone in newly diagnosed stage I NPC has more promising survival outcomes and improves patient quality of life. Zhang et al [22] demonstrated the feasibility of surgery combined with adjuvant low-dose radiotherapy in patients with newly diagnosed T1-2 stage NPC. Our study found no statistically signi cant differences in OS and CSS between pharyngectomy and local tumor resection for stage T1 NPC, which is consistent with a previous study based on the SEER database on the bene ts of local tumor resection and pharyngectomy for survival of patients with NPC.…”

“…NCCN guidelines do not recommend surgery on the primary tumor, and physicians usually do not consider doing so. However, current evidence suggests that primary tumor surgery can improve survival for patients with NPC [20][21][22]. Therefore, in our study, we intend to further retrospectively evaluate the survival bene ts of newly diagnosed primary NPC patients at the T1N0-3M0 stage undergoing surgical resection at the primary site based on the SEER database with a larger sample and multiple centers, a better extrapolation of the results to the general population is possible than in single-center studies.…”

Nasopharyngeal carcinoma. A “different” head and neck tumour. Part B: treatment, prognostic factors, and outcomes

“…In order to avoid or reduce post-attinic toxicity, a recent study proposed a different strategy: ENPG combined with low-dose radiotherapy (LDRT) in T1-2 NPC. Zhang et al 34 recruited 37 newly diagnosed T1-2 NPC patients who voluntarily accepted ENPG+LDRT. Meanwhile, the data of 132 T1-2 NPC patients treated with IMRT were collected and used as a control group.…”

Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma

“…Zhang et al16 explored the feasibility and safety of ENPG combined with low-dose radiotherapy (LDRT) in the treatment of early NPC by referring to the above surgical methods 12,15. A total of 37 patients with localized T1-2 NPC in the experimental group were treated with ENPG+LDRT program (ENPG+LDRT group), meanwhile, they recruited 132 T1-2 NPC patients in the control group treated with IMRT (IMRT group).…”

“…Although endoscopic surgery for rNPC has been accepted by the public and has achieved good results, there are still few studies on endoscopic surgery for early-stage NPC,10,15–17 may due to the more practical clinical problems: first, radiotherapy is still the first-line therapy for early-stage NPC, and its high cure rate cannot be ignored; second, the anatomical position of the nasopharynx is hidden and adjacent to important blood vessels and nerves, so the anatomical theory and surgical skills of the operator are highly required. Third, in the existing reports, the sample size of endoscopic surgery for early-stage NPC is small, and there is no convincing big data or multicenter clinical trials to confirm its reliability.…”