Surgery as an alternative to radiotherapy in early‐stage nasopharyngeal carcinoma: innovation at the expense of uncertainty

Hy, Luo; Chua, Melvin L.K.

doi:10.1002/cac2.12015

Cited by 10 publications

(3 citation statements)

References 14 publications

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“…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. In addition, some researchers23 pointed out that most of the cases reported in the current literature were carefully selected, and the screening process was very complicated, especially for the specific requirements of lymph node size, which might not be universally applicable.…”

Section: Challenges and Prospects Of Minimally Invasive Surgery For E...mentioning

confidence: 99%

Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma

Liu

Zeng

Wang

et al. 2022

Journal of Craniofacial Surgery

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According to the National Comprehensive Cancer Network guidelines, the preferred treatment for early-stage nasopharyngeal carcinoma (NPC) is radiotherapy, however, the toxic effects associated with radiotherapy have been a nuisance for patients. Minimally invasive surgery for recurrent NPC has been widely recognized as an effective way to completely remove the tumor and free the patient from or mitigate the toxicity of radiotherapy. Therefore, some researchers hope that minimally invasive surgery can be used to treat early-stage NPC. It is a bold and controversial attempt, and the researchers’ efforts have achieved initial results. This article reviews the preliminary results of minimally invasive surgery for NPC, especially the feasibility and challenges of minimally invasive surgery for early-stage NPC.

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Section: Challenges and Prospects Of Minimally Invasive Surgery For E...mentioning

confidence: 99%

Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma

Liu

Zeng

Wang

et al. 2022

Journal of Craniofacial Surgery

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“…While it must be emphasized that this cohort has been strictly selected for, and it remains to be seen if the quality were repeatable by other centers of different levels. The contemporaneous review by Melvin et al from the National Cancer Centre Singapore [28] stated that the results are impressive with regard to the possibility of replacing IMRT with ENPG in early-stage NPC patients without compromising the excellent prognosis, but the generalized application of ENPG for low-risk NPC should still be approached prudently, and prospective clinical trials are needed to further verify the results.…”

Section: Minimally Invasive Surgery Alone For Newly Diagnosed Npcmentioning

confidence: 99%

Clinical advances in nasopharyngeal carcinoma surgery and a video demonstration

et al. 2021

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Nasopharyngeal carcinoma (NPC) is highly radiosensitive, and radiotherapy is recommended for newly diagnosed NPC. Because of the poor visual surgical field, narrow operating space, difficulty protecting the internal carotid artery (ICA) and poor wound healing, the development of NPC surgery has been severely limited. For recurrent NPC, some open surgical approaches, such as the maxillary swing, successfully solve the above major problems. However, these operations are traumatic and lead to many postoperative complications. With the development of minimally invasive surgery, two concepts, the “third-hand technique” and “dumpling making technique”, have been proposed, combining with the intraoperative navigation systems and multiple anatomical landmarks for identifying ICA. Endoscopic nasopharyngectomy (ENPG) can also break through the above restrictions and has become a first-line treatment for locally recurrent NPC. Moreover, a new surgical staging system for recurrent NPC was devised to aid clinicians in choosing the most suitable treatment for these patients. A current study on ENPG alone for newly diagnosed stage I NPC shows that the long-term survival outcomes after ENPG are similar to those after IMRT. ENPG was associated with low medical costs and satisfactory QOL and might be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refuse radiotherapy.

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“…However, NPC patients continue to suffer from a high rate of severe RT-related complications because of high doses of radiation. 4 Recently, several studies reported that low-dose radiotherapy (LDRT) can achieve long-term tumor control with mild late toxicities for T1-2 NPC patients, but the rate of reoccurrence is relatively high. 5 , 6 With the popularity of health education and the development of early cancer screening methods such as narrow band imaging technique, plasma Epstein-Barr virus (EBV) DNA screening and nasopharyngeal brushing samples detection, the detection rate of early-stage NPC in high-risk groups has been greatly improved, making it possible to perform endoscopic nasopharyngectomy (ENPG) for these NPC patients.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Weng

et al. 2021

Technol Cancer Res Treat

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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.

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Surgery as an alternative to radiotherapy in early‐stage nasopharyngeal carcinoma: innovation at the expense of uncertainty

Cited by 10 publications

References 14 publications

Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma

Minimally Invasive Surgery for Early-Stage Nasopharyngeal Carcinoma

Clinical advances in nasopharyngeal carcinoma surgery and a video demonstration

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

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