Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site.

Nine patients have undergone transpalatal resection of recurrent nasopharynx cancer 10 to 56 months following a full course of external beam irradiation. Seven patients were treated for cure, and two were treated palliatively because of nasal airway obstruction, recurrent epistaxis, and severe headaches. Of the patients treated for cure, five are living free of disease 6 to 48 months (mean, 22.2 months) after their surgery. Disease recurred in two patients at 5 and 7 months. Both underwent secondary procedures and are alive with disease at 25 months and 11 months, respectively. The mean hospital stay was 8.7 days (range, 2 to 30 days) for all patients. The average time to swallowing was 2 days (range, 1 to 3 days). Six patients required resection of their soft palate and a soft palate obturator; two patients had intact functioning soft palates without velopharyngeal insufficiency. Of the two patients treated for palliation, one patient died 1 year postoperatively and, although she received some benefit from the resection (diminished headaches), in retrospect, surgery was not worthwhile. The second patient is alive 3 years following her resection and remained symptom-free for 2 years.