The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma

Jimmy Yu-Wai Chan, Stanley Thian Sze Wong, William Ignace Wei

Abstract


Background:To study the incidence of microscopic tumour deposit in the neck in patients with recurrent nasopharyngeal carcinoma (NPC) and hence, the role of routine elective neck dissection during nasopharyngectomy.

Methods:Retrospective review of the pathology report of the selective neck dissection specimens in patients with recurrent NPC and clinically N0 status.

Results:Between 2000 and 2012, 38 patients presented with recurrent NPC requiring maxillary swing nasopharyngectomy and free flap reconstruction. The initial T-classification of the tumour was T1, 15.8%; T2, 52.6%; and T3, 31.6%, and the N-classification was N0, 26.3%; N1, 47.4%, N2, 15.8%; and N3, 10.5%. Concurrent chemoradiation was given in 57.9% of the subjects. All patients in the series had complete response after the initial treatment, and the mean time to develop local tumour recurrence was 22.3 months. Among these patients, only 1 (2.6%) demonstrated microscopic tumour metastasis in 1 lymph node removed during selective neck dissection.

Conclusions:Given the low incidence of microscopic tumour metastasis in patients with recurrent NPC and clinically N0 status, routine elective neck dissection is not indicated.


Keywords


Recurrent nasopharyngeal carcinoma; Maxillary swing; Elective neck dissection; Microscopic tumour deposit

Full Text:

HTML PDF Citation

References


Marks JE, Phillips JL, Menck HR. The National Cancer Data Base report on the relationship of race and national origin to the histology of nasopharyngeal carcinoma. Cancer 1998; 83(3): 582-8.

Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet 2005; 365(9476): 2041-54.

Luo J, Chia KS, Chia SE, et al. Secular trends of nasopharyngeal carcinoma incidence in Singapore, Hong Kong and Los Angeles Chinese population, 1973 – 1997. Eur J Epidemiol 2007; 22:513-21.

Chua DT, Sham JS, Wei WI, et al. The predictive value of the 1997 American Joint Committee on Cancer stage classification in determining failure patterns in nasopharyngeal carcinoma. Cancer 2001; 92:2845-55.

Agulnik M, Siu LL. State-of-the-art management of nasopharyngeal carcinoma: current and future directions. Br J Cancer 2005; 92:799-806.

Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998; 16:1310-7.

Lin JC, Jan JS, Hsu CY, et al. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 2003; 21:631-7

Wei WI, Chan YW, Ng WM, et al. Surgical salvage of persistent or recurrent nasopharyngeal carcinoma with maxillary swing approach – critical appraisal after 2 decades. Head Neck 2010; 1-8.

Sham JS, Choy D, Wei WI. Nasopharyngeal carcinoma: orderly neck node spread. Int J Radiat Oncol Biol Phys 1990; 19(4): 929 – 33.

Lee AW, Sham JS, Poon YF, Ho JH. Treatment of stage I nasopharyngeal carcinoma: analysis of the patterns of relapse and the results of withholding elective neck irradiation. Int J Radiat Oncol Biol Phys 1989; 17(6): 1183 – 90.

CA P. Nasopharynx. In: Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia: JB Lippincott; 1998.

Wei WI. Cancer of the nasopharynx: functional surgical salvage. World J Surg 2003; 27:844-8.

Ng RW, Wei WI. Elimination of palatal fistula after the maxillary swing procedure. Head Neck 2005; 27:608-12.

Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002; 53: 12-22.

Teo PM, Kwan WH, Chan AT, et al. How successful is high-dose (> or = 60 Gy) re-irradiation using mainly external beams in salvaging local failures of nasopharyngeal carcinoma? Int J Radiat Oncol Biol Phys 1998; 40:897–913.

Fee WE, Robertson JB, GoYnet DR, et al. Long-term survival after surgical resection for recurrent nasopharyngeal cancer after radiotherapy failure. Arch Otolaryngol Head Neck Surg 1991; 117:1233–6.

Fee W Jr, Moir M, Choi EC, et al. Nasopharyngectomy for recurrent nasopharyngeal cancer: a 2- to 17-year follow-up. Arch Otolaryngol Head Neck Surg 2002; 128:280–4.

To EW, Lai EC, Cheng JH, et al. Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors. Laryngoscope 2002; 112:1877–82.

Wei WI, Mok VW. The management of neck metastases in nasopharyngeal cancer.Curr Opin Otolaryngol Head Neck Surg 2007;15(2):99-102.

Chan YW, Lee VH, Chow VL, To VS, Wei WI. Extracapsular lymph node spread in recurrent nasopharyngeal carcinoma. Laryngoscope 2011;121(12):2576-80.

Chan JY, Chow VL, Wong ST, Wei WI.Surgical salvage for recurrent retropharyngeal lymph node metastasis in nasopharyngeal carcinoma.Head Neck. 2013 Mar 6. doi: 10.1002/hed.23214.

Yuen AP, Lam KY, Chan AC, Wei WI, Lam LK, Ho WK, Ho CM. Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma. Am J Surg 1999;177(1):90-2.

Yuen AP, Wei WI, Wong YM, Tang KC. Elective neck dissection versus observation in the treatment of early oral tongue carcinoma. Head Neck 1997;19(7):583-8.

Yuen AP, Ho CM, Chow TL, et al. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 2009;31(6):765-72.

Ho FC, Tham IW, Earnest A, Lee KM, Lu JJ. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a meta-analysis of clinical evidence. BMC Cancer 2012; 12: 98 – 110.

Zhang L, Zhu YX, Wang Y, Huang CP, Wu Y, Ji QH. Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma: a 10-year experience. Ann Surg Oncol 2011; 18: 233 – 8.

Chan JY, Chan RC, Chow VL, To VS, Wei WI.Efficacy of fine-needle aspiration in diagnosing cervical nodal metastasis from nasopharyngeal carcinoma after radiotherapy. Laryngoscope 2013;123(1):134-9.




DOI: http://dx.doi.org/10.15383/jnpc.4

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

eISSN: 2312-0398

Asia Press is a professional Science, Technology and Medicine publisher, who owns rapid publication, Peer-Reviewed, Open Access Journals. Asia Press aims to promote “knowledge sharing”. As you know, the main barrier for free “knowledge sharing” is the cost of publishing and transfer. In order to encourage scholars and scientists to the max, and devote whole power to realize the aim of “knowledge sharing” and the benefit of “all” mankind, Asia Press performs a permanent policy of no charge for publication and access, and always open its door for authors worldwide.

© 2013-2017 by the Asia Press. All rights reserved.