Salvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta‐analysis

Abstract

The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2‐, 3‐, and 5‐year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5‐year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2‐, 3‐, and 5‐year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment‐related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes to re‐irradiation, while offering a better safety profile for selective patients with resectable IrNPC.

A protocol for a randomized trial evaluating the role of carbon‐ion radiation therapy plus camrelizumab for patients with locoregionally recurrent nasopharyngeal carcinoma

“…Various treatment modalities have been attempted to salvage recurrent nasopharyngeal carcinoma failed previous definitive radiotherapy. 24 In selected patients with early disease, endoscopic surgery could provide excellent clinical outcome with a 3-year OS rate of 85.8%. 1 Brachytherapy and stereotactic radiation therapy could also grant acceptable disease control for LR-NPC with limited extension.…”

“…Various treatment modalities have been attempted to salvage recurrent nasopharyngeal carcinoma failed previous definitive radiotherapy 24 . In selected patients with early disease, endoscopic surgery could provide excellent clinical outcome with a 3‐year OS rate of 85.8% 1 .…”

Recurrent Nasopharyngeal Carcinoma and the Role of Surgery

“…3 Treatment-associated mortality from IMRT was 32% compared to 3% for either open or endoscopic surgery. 1 While several approaches to endoscopic nasopharyngectomy have been described, the Castelnuovo schema 4 is widely used. Type 1 and type 2 nasopharyngectomy are indicated for smaller nasopharyngeal tumors with dissection extending from the level of the superior nasopharynx down to the level of C1.…”

“…There are several treatment options for locally rNPC, including: reirradiation, proton beam therapy, endoscopic nasopharyngectomy, and open nasopharyngectomy. 1 For metastatic disease, systemic therapy is the mainstay. In the absence of metastatic disease, the 2019 International Consensus Statements on Allergy and Rhinology suggests that endoscopic nasopharyngectomy is a reasonable approach for rT1 and rT2 NPC.…”

Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram

“…The recent literature and international recommendations seem to lean in favor of surgical treatment for resectable recurrences ( 4 , 6 , 7 ). Indeed, contemporary case series based on endoscopic surgery have reported similar-to-higher survival outcomes with lower morbidity compared with re-irradiation (re-RT) ( 8 , 9 ).…”