CLINICAL QUESTION
How does salvage endoscopic nasopharyngectomy (ENPG) compare with intensity-modulated radiotherapy (IMRT) in terms of clinical outcomes and complications in patients with locally advanced recurrent nasopharyngeal carcinoma (rNPC)?
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June 2024BOTTOM LINE
Salvage ENPG exhibits comparable efficacy but less toxicity than IMRT in carefully screened patients with locally advanced rNPC.
BACKGROUND: Since the popularization of IMRT, clinical outcomes of patients with NPC have improved, but many patients still experience locoregional recurrences post-treatment. In these cases, reirradiation with IMRT is effective but also carries a risk of radiation-induced toxicity of normal tissues. Therefore, the role of salvage surgery in rNPC has become increasingly prominent.
STUDY DESIGN: Multicenter retrospective study.
SETTING: Department of Otolaryngology and Head and Neck Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
SYNOPSIS: Researchers identified patients from four hospitals in South China (where cases of NPC are concentrated) who were diagnosed with rNPC between January 2013 and December 2019. After applying inclusion and exclusion criteria, they studied 106 patients (84% male, median age 48 years) matched based on propensity score into an IMRT group and an ENPG group. The oncological outcomes and treatment-related complications were compared between the groups. Results showed comparable outcomes in the three-year overall survival rate, cancer-specific survival rate, locoregional failure-free survival rate, and progression-free survival rate. The incidence of severe treatment-related complications of patients in the ENPG group was significantly lower than that in the IMRT group (37.7% versus 67.9%). The most common complications were post-perioperative hemorrhage in the ENPG group and temporal lobe necrosis in the IMRT group. Although theirs appears to be the first multicenter, case-matched study to compare ENPG with IMRT in efficacy and safety in treating locally advanced rNPC, authors emphasize the influence of selection bias (e.g., the exclusion of patients with unresectable tumors in the ENPG arm) and potential noncomparability of some patient characteristics on their findings, and note that future prospective, randomized-controlled clinical studies are indicated.
CITATION: Liu Y, Huang N, Gao J, et al. Endoscopic surgery versus intensity-modulated radiotherapy in locally advanced recurrent nasopharyngeal carcinoma: a multicenter, case-matched comparison. J Otolaryngol Head Neck Surg. 2023;52:72.