Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection

Abstract

Objective To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure. Methods A total of 294 recurrent T0N1‐3M0 NPC patients who underwent neck dissection in Sun Yat‐Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well‐balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence‐free survival (LRFS), regional recurrence‐free survival (RRFS), and distant metastasis‐free survival (DMFS). Results Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extracapsular spread (ECS) (hazard ratio [HR] 3.49, 95% confidence interval [CI] 2.30–5.29, P < 0.001), recurrent N stage (rN stage) (HR 1.96, 95% CI 1.29–2.97, P = 0.002), and positive margins (HR 3.67, 95% CI 2.40–5.62, P < 0.001) were independent poor prognostic factors for OS. The interaction effects between the dissection style and each independent factor were not significant for OS, LRFS, RRFS, or DMFS (P > 0.05). Furthermore, no survival differences were found between SND and CND in the case‐matched cohort in terms of OS, LRFS, RRFS, or DMFS (P = 0.550, 0.930, 0.214, and 0.146, respectively). Conclusion With a similar radical dissection extent around the tumor rather than dissection of extensive lymph region distal to the lesion, SND is not inferior to CND for patients with NPC with only cervical failure. ECS, rN stage, and positive margins were adverse independent prognostic factors for patients with NPC. Level of Evidence 4 Laryngoscope, 129:387–395, 2019

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

“…It is notable that according to our data and consistent with other studies 7 , the distribution of recurrent or residual nodes was not as extensive as in primary NPC cases; 60.7% of patients presented with a comparatively limited range of recurrence, involving only one level on one side, and 86.3% presented with lymph nodes with diameters less than 3 cm. Level II (84.2%) was the most common site of nodal recurrence.…”

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma

“…Liu et al analyzed the survival effect of comprehensive compared to selective neck dissections for the treatment of regional recurrence in 294 patients with nasopharyngeal carcinoma. 12 The authors conclude that a selective neck dissection is not inferior to the comprehensive surgical approach when a similar radical dissection extent around the tumor is achieved. In our study, we only had one case of nasopharyngeal carcinoma; therefore, this study is not fully comparable to ours.…”

“…Adjuvant CRT provides a superior regional control, but also leads to a higher complication rate. 12,17 The feasibility and extent of the salvage therapy depends on the initial treatment, the extension of the regional recurrence, the overall health, and performance status of the patient. 18 According to the high incidence of occult additional metastasis and the worsened outcome of regional recurrence affecting the caudal neck levels, we suggest the inclusion of these levels during salvage neck dissection and performance of at least a selective neck dissection of the levels I to V in these patients at risk.…”

Transcervical endoscopic retropharyngeal lymph node (RPLN) dissection in nasopharyngeal carcinoma with RPLN recurrence

“…During dissection, branches of the facial nerve, such as the marginal mandibular branch, were usually preserved using the Hayes‐Martin maneuver, which consisted of ligating the anterior facial vein approximately 2 inches below the mandibular border and overturning the vein and the overlying tissues where the marginal mandibular nerve runs to create a fold to protect the nerve 15 . The region of neck dissection could be expanded if positive lymph nodes were seen in the neck 16 …”