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

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Arch Otolaryngol Head Neck Surg. 2002 Oct;128(10):1196-7. Related Articles, Links
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Nasopharyngectomy after failure of 2 courses of radiation therapy.

Ibrahim HZ, Moir MS, Fee WW.

Department of Otolaryngology & Bronchoesophagology, Rush-Presbyterian-Sain Luke's Medical Center, Chicago, IL 60602, USA.
ibrahimhani@xxxxxxxxxxx

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. R

ESULTS: 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.

PMID: 12365893 [PubMed - indexed for MEDLINE]

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