Minimally Invasive Treatment of Oligometastasis in the Liver in Recurrent Nasopharyngeal Carcinoma
Methods: A pilot study involving 4 patients with biopsy proven solitary liver metastasis from NPC. After creation of artificial ascites, cooltip RFA needle was inserted into the intra-hepatic tumour under ultrasound guidance. Procedure related complications were noted and patients were followed up regularly and indefinitely for oncological outcome.
Results: All patients had locoregionally advanced NPC at initial diagnosis and were treated with concurrent chemoradiation. Complete response was achieved in all patients. The mean time to tumour recurrence was 21.3 months. The mean size of the liver tumour was 3.5cm. Two patients had synchronous local tumour recurrence, and they underwent nasopharyngectomy and neck dissection before receiving treatment to the liver. Percutaneous RFA was performed in all patients. The mean hospital stay was 2.2 days and no procedure related complications were detected. No systemic treatment was given afterwards. The mean follow-up interval was 40.5 months. One of the patients developed progression of disease and died at 13 months after RFA, while the rest of the patients were alive and remained disease free at the last follow-up.
Conclusion: Percutaneous RFA is potentially useful as a minimally invasive procedure for patients with solitary liver metastasis after radiotherapy for NPC. Further study is required to confirm its efficacy and to define the protocol of adjuvant systemic chemotherapy to improve the treatment outcome.
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.
Lee AW, Sze WM, Au JS, et al. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2005; 61: 1107 – 16.
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: 1310–1317.
Lee AW, Tung SY, Chan AT et al. Preliminary results of a randomized study (NPC-9902 Trial) on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2006; 66: 142–151.
Chan AT, Teo PM, Ngan RK et al. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 2002; 20: 2038–2044.
Kwong DL, Sham J, Au GK et al. Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol 2004; 22: 2643–2653.
Wee J, Tan EH, Tai BC et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005; 23: 6730–6738.
Ahmad A, Stefani S. Distant metastases of nasopharyngeal carcinoma: A study of 256 male patients. J Surg Oncol 1986; 33: 194 – 7.
Wei WI, Lam KH, Shan JS. New approach to the nasopharynx: the maxillary swing approach. Head Neck 1991; 13:200-7.
Ahmad A, Stefani S. Distant metastases of nasopharyngeal carcinoma: a stud of 256 male patients. J Surg Oncol 1986; 33(3): 194 – 7.
Huang CJ, Leung SW, Lian SL, Wang CJ, Fang FM, Ho YH. Patterns of distant metastases in nasopharyngeal carcinoma. Kaohsiung J Med Sci 1996; 12(4): 229 – 34.
Chou CW, Liu JM, Wu MF, Li AF, Tie CM, Chi KH. Prolonged survival in a nasopharyngeal carcinoma patient with multiple metastases: A case report and review of the literature. Jpn J Clin Oncol 1997; 27(5): 336 – 9.
Spiros D, Ioannis B, Antonia B, Nikolaos KM, Christos D. Surgical resection of a solitary liver metastasis from nasopharyngeal carcinoma: a case report. Hepatobiliary Pancreat Dis Int 2006; 5(4): 610 – 2.
Huang J, Li Q, Zheng Y, et al. Partial hepatectomy for liver metastases from nasopharyngeal carcinoma: a comparative study and review of the literature. BMC Cancer 2014; 14: 818 – 27.
Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995; 13: 8 – 10.
Weichselbaum RR, Hellman S. Oligometastases revisited. Nat Rev Clin Oncol 2011; 8: 378 – 82.
Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol 2010; 40: 107 – 11.
Niibe Y, Chang JY. Novel insights of oligometastases and oligo-recurrence and review of the literature. Pulm Med 2012; 261096.
Nordlinger B, Van Cutsem E, Rougier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. Eur J Cancer 2007; 43: 2037 – 45.
Pan CC, Lu J, Yu JR, Chen P, et al. Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature. Exp Ther Med 2012; 4(2): 334 – 8.
Pan CC, He N, Zhao M, et al. Subdividing the M1 stage of liver metastasis for nasopharyngeal carcinoma to better predict metastatic survival. Med Oncol 2011; 28: 1349 – 55.
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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.
© 2013-2017 by the Asia Press. All rights reserved.