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Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma

Authors

  • Ming-Yuan Chen MD, PhD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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    • The first two authors contributed equally to this article.

  • Wei-Ping Wen MD, PhD,

    1. Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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    • The first two authors contributed equally to this article.

  • Xiang Guo MD, PhD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • An-Kui Yang MD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Chao-Nan Qian MD, PhD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Yi-Jun Hua MD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Xiang-Bo Wan MD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Zhu-Ming Guo MD,

    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Tian-Ying Li MD,

    1. Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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  • Ming-Huang Hong MD

    Corresponding author
    1. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
    2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
    • Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University, 651 Dongfeng Eest Road, Guangzhou 510060, P. R. China
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  • This work was supported by the National High Technology Research and Development Program of China (863 Program): molecular classification, personalized diagnosis, and therapy of nasopharyngeal carcinoma (Grant No. 2006AA02A404).

Abstract

Objectives:

Nasopharyngectomy is the primary treatment for locally recurrent nasopharyngeal carcinoma (rNPC). However, oncological nasopharyngectomy is difficult to achieve, even using extranasal surgical approaches, with potential risks of severe functional disabilities and serious complications. This report introduces an innovative, minimally invasive, oncological, endoscopic nasopharyngectomy.

Methods:

Between October 2004 and January 2008, 37 rNPC patients received endoscopic nasopharyngectomy, with 17, 4, 14, and 2 cases of rT1N0M0, rT2aN0M0, rT2bN0M0, and rT3N0M0, respectively. Tumors in all patients were confined to the nasopharyngeal cavity, postnaris, nasal septum, superficial parapharyngeal space, or the base of the sphenoid sinus. Nasopharyngeal malignancies and adequate surgical margin (>0.5–1.0 cm) were required for continuous en bloc resection.

Results:

Among the 37 endoscopic nasopharyngectomies, 35 achieved en bloc tumor resection with negative surgical margins. In the remaining two cases, the tumors were dissected into small blocks, and one had positive surgical margins. No patient received postoperative radiotherapy and no severe complication was observed. During the 6–45 months of follow-up (median, 24 months), five patients experienced in situ residual or recurrence with 1 submaxillary lymphatic metastasis. One patient developed distant metastases and died, one died of intracranial infection, and one died of another cancer. The 2-year overall survival rate, local relapse-free survival rate, and progression-free survival rate were 84.2%, 86.3%, and 82.6%, respectively.

Conclusions:

Appropriate endoscopic nasopharyngectomy is a minimally invasive, safe, and promising surgical modality for the en bloc excision of rNPCs with encouraging short-term outcome. Long-term patient follow-up is ongoing. Laryngoscope, 119:516–522, 2009

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