Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case‐matched comparison

Abstract

Background:The efficacy and safety of internal carotid artery (ICA) embolization as a treatment strategy in recurrent nasopharyngeal carcinoma (rNPC) patients with tumors invading the ICA remain unclear. Methods: We enrolled all rNPC patients with tumors invading the ICA, who underwent salvage endoscopic surgery. Using propensity scores to adjust for specific potential prognostic factors, a well-balanced cohort of 42 patients with limited rNPC was formed by matching each patient who underwent ICA embolization (study group) with one who did not (control group). The survival rates and common treatment-related complications were compared between the 2 groups. Results:The cohort included patients with the following tumor stages: rT2 (n = 3), rT3 (n = 24), and rT4 (n = 15). During a median follow-up of 15 (range, 2-63) months, the 2-year overall survival and progression-free survival rates were significantly higher in the ICA embolization group than in the ICA nonembolization group (90.5% vs 53.3% and 71.3% vs 33.0%, respectively; and p = 0.022 and p = 0.006, respectively). In addition, the incidence of treatment-related complications, such as nasal obstruction, nasopharyngeal hemorrhage, and nasopharyngeal necrosis, was significantly lower in the ICA embolization group than in the nonembolization group (p = 0.001, p = 0.014, and p = 0.038, respectively). Conclusion:The innovative application of ICA embolization in endoscopic surgery in patients with rNPC invading the ICA significantly improved patient 838

Innovative Fudan rT staging in endoscopic surgery for recurrent nasopharyngeal carcinoma

“…In 2017, we found the risk of tumor invading the ICA, and applied the ICA embolization technique to rNPC patients with ICA invasion for the first time internationally, and improved the survival rate of such patients 14 . In 2022, we further reported that after pretreating the ICA with coil embolization before surgery, the 2‐year OS and PFS of these patients were as high as 90.5% and 71.3%, respectively, which were significantly higher than the rates of 53.3% and 33.0% in the nonembolization group, respectively 18 . Therefore, ICA embolization would further improve the survival rate of advanced rNPC in the Fudan rT staging.…”

“…14 In 2022, we further reported that after pretreating the ICA with coil embolization before surgery, the 2-year OS and PFS of these patients were as high as 90.5% and 71.3%, respectively, which were significantly higher than the rates of 53.3% and 33.0% in the nonembolization group, respectively. 18 Therefore, ICA embolization would further improve the survival rate of advanced rNPC in the Fudan rT staging. However, most medical institutions did not use the ICA embolization technique for patients with ICA invasion and even considered that rNPC with ICA invasion was contraindications to endoscopic surgery.…”

“…Our team previously defined ICA invasion as a distance from the tumor margin to the ICA less than 1.8 mm. Through a case‐matching study, it was found that in rNPC invading the ICA, patients undergoing preoperative ICA embolization had better overall survival (OS) and progression‐free survival (PFS) than nonembolization patients 18 . In addition, many studies believe that a distance of less than 5 mm from the tumor margin to the ICA is the standard for unresectable endoscopic surgery 8,19 .…”

“…Through a case-matching study, it was found that in rNPC invading the ICA, patients undergoing preoperative ICA embolization had better overall survival (OS) and progression-free survival (PFS) than nonembolization patients. 18 In addition, many studies believe that a distance of less than 5 mm from the tumor margin to the ICA is the standard for unresectable endoscopic surgery. 8,19 As is commonly known, dural invasion is considered a negative predictive for the survival of patients with skull base tumors.…”

Letter to the editor “Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case‐matched comparison”

“…We read with great interest the article by Li and colleagues. 1 The authors described a novel technique for the management of large, recurrent nasopharyngeal cancers (NPC), and proposed surgical management of recurrent tumor stage 3 (rT3) and 4 (rT4) lesions adjacent to and invading the carotid artery. The study showed that employing long-segment carotid artery coil embolization from the parapharyngeal to the paraclival segments improved oncologic and perioperative outcomes.…”