Recurrence of nasopharyngeal carcinoma and application of endoscopic surgery

Yan JIANG

Journal of Otolaryngology and Ophthalmology of Shandong University 2019, 33 (2): 1-11. DOI: 10.6040/j.issn.1673-3770.1.2019.011

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Radiotherapy is the conventional treatment for nasopharyngeal carcinoma. Although the 5-year survival rate has greatly improved, there are still several cases of recurrent or residual nasopharyngeal carcinoma. The treatment principles of recurrent or residual lesions include second-course radiotherapy, chemotherapy, and surgery. The complications following radical radiotherapy and second-course radiotherapy seriously affect the quality of life in patients. The current surgical methods include open surgery and endoscopic surgery. Open surgery can provide a sufficiently open field of operation, but is associated with some serious damage. Endoscopic nasopharyngeal carcinoma resection has been carried out lately, and only few medical institutions in China perform these operations. However, with the emergence of the concept of endoscopic skull base surgery and new medical instruments and equipment, endoscopic nasopharyngeal carcinoma surgery has become a good surgical choice. However, this requires strict surgical indications, skills of endoscopic skull-base surgery, and long-term follow-up.

Fig.6 A 38-year-old man with differentiated non-keratinized carcinoma (T₃N₀M₀) underwent endoscopic surgical resection, postoperative radiotherapy, and chemotherapy (DT: 7 623 cGy/33 f, only 25 times; 3 675 cGy/15 f; TP: docetaxel 140 mg/dl + nedaplatin 140 mg/dl), with follow-up for 48 months
A-D. Preoperative magnetic resonance (MR) shows that nasopharyngeal carcinoma tissue invaded the sphenoid sinus and saddle region, pushing up on the optic chiasm, causing impaired vision in the patient; E-H. No recurrence of nasopharyngeal carcinoma lesions seen 24 months postoperatively; I. The tumor tissue surrounding the internal carotid artery (white arrow refers to the internal carotid artery) is removed; G. The tumor tissue on the surface of the optic nerve tube is removed (white arrow refers to the optic chiasm); K. The nasopharynx shows local dryness after radiotherapy and chemotherapy; L. The nasopharynx shows less dryness during 24 months of follow-up.

原发癌肿瘤瘤体大，或位置紧邻视神经、视交叉、斜坡骨质、颈内动脉骨管破坏者，根治性放疗剂量会导致严重并发症(失明、放射性脑病、脊髓损伤、大出血等)，可先行手术尽可能全切肿瘤，根据手术切缘、术后增强MR和PET-CT，术后采取适型调强放疗(IMRT)(图6)。