Nasopharyngectomy after failure of 2 courses of radiation therapy.

BACKGROUND

Recurrence of nasopharyngeal carcinoma after initial therapy has been reported to range between 18% and 54%. As an alternative to surgical salvage, patients with recurrent nasopharyngeal carcinoma are offered a second course of radiation therapy. If this second course fails, patients may be candidates for surgical resection.

OBJECTIVE

To identify the effectiveness and morbidity of surgical resection of recurrent nasopharyngeal carcinoma in patients who have received 2 cycles of external beam radiation.

DESIGN AND

SETTING

Retrospective survey of 6 patients in a university-based practice who underwent resection of recurrent nasopharyngeal carcinoma after 2 courses of radiation therapy.

PATIENTS: Our study group comprised 4 women and 2 men aged between 35 and 67 years. All patients underwent 2 courses of radiation with a mean total dose of 11 500 rad (115 Gy) (range, 9500-13 200 rad [95-132 Gy]) delivered to the nasopharynx prior to resection. The mean duration between the second course of radiation and resection is 21 months (range, 8-52 months). The mean follow-up period is 7.2 years (range, 4.2-11.5 years).

INTERVENTION: Nasopharyngectomy after failure of 2 courses of radiation therapy.

MAIN OUTCOME MEASURES: Postoperative clinical outcome and morbidity.

RESULTS

Five years after resection, 1 patient died of disease. The remaining 5 patients (83%) are alive with no evidence of disease. Osteomyelitis is the most common complication, affecting 5 patients. Three of the 5 patients with osteomyelitis required operative debridement of the nasopharynx and split-thickness skin grafting. Other complications include oronasal fistula (2 patients), chronic otitis media (2 patients), and nasopharyngeal stenosis (1 patient).

CONCLUSION

Although poor wound healing is evident, the overall 5-year survival of 83% is encouraging.