Salvage Treatment of Nasopharyngeal Carcinoma

비인강암종의 구제치료

  • Choi Jong-Ouck (Department of Otolaryngology-Head and Neck Surgery, Korea University, College of Medicine) ;
  • Kim Yong-Hwan (Department of Otolaryngology-Head and Neck Surgery, Korea University, College of Medicine) ;
  • Min Hun-Ki (Department of Otolaryngology-Head and Neck Surgery, Korea University, College of Medicine) ;
  • Choi Geon (Department of Otolaryngology-Head and Neck Surgery, Korea University, College of Medicine) ;
  • Kweon Hee-Weon (Department of Otolaryngology, Captial Armed Forces General Hospital)
  • 최종욱 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 김용환 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 민헌기 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 최건 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 권희원 (국군수도병원 이비인후과)
  • Published : 1996.06.01

Abstract

Nasopharyngeal carcinoma(NPC) is a disease whose primary initial treatment is radiation. Results of radiation therapy in early stage disease is promising; however, in stage IV disease, the best reported five-year survival is only about 30%. In patients with post-radiation recurrent disease, radiation controls only a small portion of patients, as well as being associated with significant radiation injury. In this paper we discuss the use of salvage treatment modalities for post-radiation recurrence. A retrospective chart review and analysis of salvage treatment results were performed for 39 patients with recurrent post-radiation NPC and positive cervical lymph nodes during the period beginning 1985 until 1995. Mean age of these patients was 52.3$\pm$10.37 years and male: female ratio was 1.8 : 1. Twenty patients were treated with salvage treatment, and ten patients were treated by salvage chemotherapy. A total of nine patients underwent surgical salvage treatment, including neck dissection(6), transnasal laser surgery and booster radiotherapy(2), and primary surgery(1). Salvage treatment were effective in reducing patients' pain in twenty patients (51.3%) and prolonging life in nine patients(23.1%); however, recurrence of disease within six months and/or residual disease by clinical or radiologic exam was noted in all patients receiving salvage radiotherapy, chemotherapy, laser surgery with radiotherapy, and primary site surgery. In the group undergoing salvage neck dissection, three patients(50%) were disease free for at least two years. Of the different modalities, radiotherapy was associated with the best quality of life while catastrophic salvage surgery resulting in insignificant prolongation of life was associated with the poorest quality of life. We conclude that salvage surgery is the optimal choice of treatment for regional recurrence such as nodal failure, however palliative salvage therapy could be preferred in other cases with recurrent post-radiation NPC.

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