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Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zou X, Feng ZK, Hua YJ, Liu YP, Xie YL, Ouyang YF, Liu YL, Wang ZQ, You R, Ding X, Yang Q, Yu ZK, Huang PY, Wang SL, Chen MY. A novel endoscopic nasopharyngectomy by low-temperature plasma radiofrequency ablation in localized recurrent nasopharyngeal carcinoma. Head Neck 2024; 46:291-299. [PMID: 37974339 DOI: 10.1002/hed.27579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/18/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Endoscopic nasopharyngectomy (ENPG) with en bloc resection has been well accepted in resectable localized recurrent nasopharyngeal carcinoma (rNPC), but it is a difficult technique to master for most otorhinolaryngology head and neck surgeons. Ablation surgery is a new and simplified method to remove tumors. We designed a novel method using low-temperature plasma radiofrequency ablation (LPRA) and evaluated the survival benefit. METHODS A total of 56 localized rNPC patients were explained in detail and retrospectively analyzed. The surgery method was ablated from the resection margin to the center of the tumor. The postmetastatic overall survival (OS), local relapse-free survival (LRFS) rate, progression-free survival (PFS) and distant metastasis-free survival (DMFS) were analyzed using the Kaplan-Meier method and compared by the log-rank test. RESULTS All surgeries were successfully performed without any severe postoperative complications or deaths. The median operation time of ablation and harvested NSFF respectively were 29 min (range, 15-100 min) and 101 min (range, 30-180 min). The average number of hospital days postoperation was 3 days (range, 2-5 days). All cases (100.0%) had radical ablation with negative resection margins. The nasopharyngeal defects were completely re-epithelialized in 54 (96.4%) patients. As of the data cutoff (September 3, 2023), the median follow-up time was 44.3 months (range, 17.1-52.7 months, 95% CI: 40.4-48.2). The 3-year OS, LRFS, PFS and DMFS of the entire cohort were 92.9% (95% CI: 0.862-0.996), 89.3% (95% CI: 0.813-0.973), 87.5% (95% CI: 0.789-0.961), and 92.9% (95% CI: 0.862-0.996), respectively. Cycles of radiotherapy were independent risk factors for OS (p = 0.003; HR, 32.041; 95% CI: 3.365-305.064), LRFS (p = 0.002; HR, 10.762; 95% CI: 2.440-47.459), PFS (p = 0.004; HR, 7.457; 95% CI: 1.925-28.877), and DMFS (p = 0.002; HR, 34.776; 95% CI: 3.806-317.799). CONCLUSION Radical endoscopic nasopharyngectomy by using low-temperature plasma radiofrequency ablation is a novel, safe and simplified method to master and disseminate for treating resectable rNPC. However, further data and longer follow-up time are needed to prove its efficacy.
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Affiliation(s)
- Xiong Zou
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zheng-Kai Feng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yi-Jun Hua
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - You-Ping Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yu-Long Xie
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yan-Feng Ouyang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yong-Long Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhi-Qiang Wang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Rui You
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xi Ding
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Qi Yang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zi-Kun Yu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Pei-Yu Huang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Shun-Lan Wang
- Department of Otorhinolaryngology, First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ming-Yuan Chen
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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3
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Tanjararak K, Tangbumrungtham N, Plumworasawat S, Roongpuvapaht B. Schwannoma Arising in Nasopharynx: A Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2022; 74:911-917. [PMID: 36452824 PMCID: PMC9702495 DOI: 10.1007/s12070-020-02000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
Schwannoma in paranasal sinus has been known as a rare tumor in this origin. This study reports on primary schwannoma arising in the nasopharynx, which is an uncommon location. A 36-year-old female presented with nasal obstruction for one month. Physical examination revealed a nasopharyngeal mass totally occluding bilateral posterior choanae and extended downward to the oropharynx. Magnetic resonance image showed heterogeneous enhancing mass at the nasopharynx extending inferiorly to the oropharynx. The tumor was excised via endoscopic combined trans-nasal/trans-oral approach under general anesthesia. The pathologic diagnosis was consistent with schwannoma. The tumor was successfully excised with en-block resection and the patient was discharged the next day after the operation, without any postoperative complications. There was no tumor recurrence at 12-months follow-up. Schwannoma primarily arising in the nasopharynx is uncommon. Minimally-invasive surgery via the endoscopic approach can be applied for tumor removal with fewer complications and reduced risk of morbidity.
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Affiliation(s)
- Kangsadarn Tanjararak
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Navarat Tangbumrungtham
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Boonsam Roongpuvapaht
- Department of Otolaryngology Head & Neck Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Road, Phayathai, Ratchathewi, Bangkok, 10400 Thailand
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Tan Q, Yang Q, Li H, Li M, Chen W, Liang Z, Yang Z, Li Y, Ning L, Zhao C, Guo X, Yang A, Shan H, Ouyang D. Short-Term Efficacy of the Transnasal-Transoral Approach to Endoscopic Nasopharyngectomy for Nasopharyngeal Adenocarcinoma. Ann Otol Rhinol Laryngol 2022:34894221120722. [PMID: 36039471 DOI: 10.1177/00034894221120722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nasopharyngeal adenocarcinomas (NPACs) are rare malignant tumors. The treatment of NPACs is usually surgery with resection of normal nasal passage tissues.We introduced an innovative double endoscopic surgery for NPACs patients and evaluated the clinical efficacy of this approach. METHODS The clinical data of 4 NPACs patients who underwent radical endoscopic nasopharyngectomy using a combined transnasal and transoral approach were analyzed to determine the efficacy of this surgery. The endpoints were en bloc resection and relief of clinical symptoms. RESULTS All surgeries were successfully performed without any severe postoperative complications or death. Postoperative MRI revealed that en bloc resection was achieved for all patients with NPACs, and they had high quality of life without postoperative complications. CONCLUSIONS The transnasal-transoral approach to endoscopic nasopharyngectomy for nasopharyngeal adenocarcinoma is safe and effective.
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Affiliation(s)
- Qingjian Tan
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Qing Yang
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Hao Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Mingtian Li
- Department of Anesthesiology & Operating Theatre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Wenkuan Chen
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zicong Liang
- Department of Anesthesiology & Operating Theatre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zhongyuan Yang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yin Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Li Ning
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Chong Zhao
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Ankui Yang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Hongbo Shan
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Dian Ouyang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
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5
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The role of nasopharyngectomy in the management of nasopharyngeal carcinoma. Curr Opin Otolaryngol Head Neck Surg 2022; 30:3-12. [PMID: 34958319 DOI: 10.1097/moo.0000000000000780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Recently, endoscopic nasopharyngectomy (ENPG) has become an effective treatment for locally recurrent nasopharyngeal carcinoma (NPC). This article reviews recent publications on ENPG and specifically addresses the surgical anatomy of the nasopharynx and discusses several important issues regarding ENPG. RECENT FINDINGS The surgical techniques for ENPG have been previously described in several studies. The latest published data revealed good outcomes of ENPG compared with intensity-modulated radiation therapy (IMRT) in recurrent NPC. In addition, ENPG avoids severe reirradiation side effects. This review highlights the surgical anatomy of ENPG, which is important in preventing possible serious complications. SUMMARY ENPG is a good option for managing recurrent NPC. Careful preoperative evaluation and a full understanding of the surgical anatomy help in preventing damage to nearby critical neurovascular structure. Long-term follow-up is still needed to evaluate its eventual morbidity and efficacy.
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Sun X, Liu Q, Yu H, Wang H, Zhao W, Gu Y, Li H, Zhao K, Song X, Wang D, Miranda JCF, Snyderman CH. Transinfratemporal Fossa Transposition of the Temporalis Muscle Flap for Skull Base Reconstruction after Endoscopic Expanded Nasopharyngectomy: Anatomical Study and Clinical Application. Skull Base Surg 2021; 83:159-166. [PMID: 35433181 DOI: 10.1055/s-0040-1718764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 08/19/2020] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Temporalis muscle flap (TMF) is widely used in traditional skull base surgery, but its application in endoscopic skull base surgery remains rarely reported. We aimed to investigate the surgical anatomy and clinical application of TMF for reconstruction of skull base defects after expanded endoscopic nasopharyngectomy.
Methods Nine fresh cadaver heads (18 sides) were used for endoscopic dissection at the University of Pittsburgh School of Medicine in the United States. TMF was harvested using a traditional open approach and then transposed into the maxillary sinus and nasal cavity through the infratemporal fossa using an endoscopic transnasal transmaxillary approach. TMF length was then measured. Moreover, TMF was used for the reconstruction of skull base defects of six patients with recurrent nasopharyngeal carcinoma after expanded endoscopic nasopharyngectomy.
Results The length of TMF harvested from the temporal line to the tip of the coronoid process of the mandible was 11.8 ± 0.9 cm. The widest part of the flap was 9.0 ± 0.4 cm. When TMF was dislocated from the coronoid process of the mandible, approximately another 2 cm of reach could be obtained. When the superficial layer of the temporalis muscle was split from the deep layer, the pedicle length could be extended 1.9 ± 0.2 cm. TMF could cover skull base defects in the anterior skull base, sellar, and clivus regions.
Conclusion TMF can be used to reconstruct skull base defects after endoscopic expanded nasopharyngectomy and can effectively prevent the occurrence of serious complications in patients with recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Weidong Zhao
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Yurong Gu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Houyong Li
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Keqing Zhao
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Xiaole Song
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | | | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2020; 29:86-92. [PMID: 33278136 DOI: 10.1097/moo.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Persistent or recurrent disease in the neck lymphatics is an unusual pattern of failure in nasopharyngeal carcinoma (NPC) after definitive radiotherapy or chemoradiotherapy. The purpose of this review is to critically synthesize the current knowledge regarding salvage treatment of this unique form of failure in NPC. RECENT FINDINGS Surgery in the form of radical neck dissection has been established as the standard salvage treatment with 5-year regional control of 60--86%. Recent shift in paradigm has resulted in the use of modified or selective neck dissection as salvage surgery in some centers. Risk factors for poor survival outcome include recurrent nodal disease, number of involved lymph nodes, extracapsular extension, high lymph node ratio, and positive resection margin. There are no well controlled studies on the role of additional radiotherapy or chemotherapy to improve local control or survival after salvage neck dissection in this group of patients with regional failure. SUMMARY There is limited literature regarding the extent of surgical dissection in treating nodal persistent or recurrent disease. Prospective studies are also needed to determine whether adjuvant therapy improves treatment outcomes.
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Li G, Wang J, Tang H, Han R, Zhao Y, Wang X, Zhou H. Comparing endoscopic surgeries with open surgeries in terms of effectiveness and safety in salvaging residual or recurrent nasopharyngeal cancer: Systematic review and meta-analysis. Head Neck 2020; 42:3415-3426. [PMID: 33463833 DOI: 10.1002/hed.26397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/01/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
Consensus has yet to be reached on the optimal operation for patients with residual or recurrent nasopharyngeal carcinoma (NPC). To compare effectiveness and safety of open surgery and endoscopic surgery for patients with residual or recurrent NPC. Pubmed, Embase, and Cochrane were searched for relevant publications from January 1, 2000 to May 1, 2017. Included studies reported specific residual or local recurrent nasopharyngeal cancer survival data. Proportional meta-analysis was performed on both outcomes with a random-effects model, and the 95% confidential intervals were calculated by Stata 12.0 software. For patients with different tumor classification, a downward trend of 2-year overall survival (OS) was observed for both surgical populations. Endoscopic surgeries achieved bigger rates than open surgeries in patients with recurrent tumor (rT) 1, rT2, and rT3 (93% vs 87%, 77% vs 63%, 67% vs 53%). As for patients with rT4, 2-year OS was similar (35% vs 35%).In addition, the former is less severe complications, lower local recurrence rates (27% vs 32%). Our study found that, compared to open surgery, endoscopic surgery was a safer and more effective treatment modality in managing patients with recurrent or residual NPC.
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Affiliation(s)
- Gang Li
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianqi Wang
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haocheng Tang
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ri Han
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunteng Zhao
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianwen Wang
- Department of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huijun Zhou
- Department of Public Administration Business School, University of Shanghai for Science and Technology, Shanghai, China
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9
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Tsang RK, Wei WI. Salvage surgery for nasopharyngeal cancer. World J Otorhinolaryngol Head Neck Surg 2015; 1:34-43. [PMID: 29204538 PMCID: PMC5698510 DOI: 10.1016/j.wjorl.2015.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 12/04/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence. The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC. Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC. Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment. Traditional form of retreatment was to employ a second course of radiation. The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal. Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications. Surgical salvage, on the other hand, could spare the patients from complications of re-treatment. Due to the difficult access of the nasopharynx, various surgical approaches had been devised for nasopharyngectomy. The maxillary swing approach had the largest published experience with over 300 cases from various centers. In the recent decade, the endoscopic approach with or without robotic assistance had gained popularity for resecting small, centrally located recurrences. This minimally invasive approach further reduced the morbidity for treating locally recurrent NPC. Nodal recurrences had been a rare entity after the introduction of modern radiotherapy technique and concurrent chemotherapy. Treatment of nodal failure with second radiation has dismal results. Surgical removal of the lymph node harboring the recurrence should be in the form of a formal radical neck dissection. In cases of extensive nodal recurrence where microscopic disease may be present after a formal neck dissection, additional radiotherapy can be delivered with after-loading brachytherapy. Surgical treatment played a definitive role in salvage of loco-regional failures of nasopharyngeal carcinoma.
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Affiliation(s)
- Raymond K Tsang
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - William I Wei
- Li ShuPui ENT Head & Neck Surgery Centre, Hong Kong Sanatorium & Hospital, Hong Kong
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Volumetric Analysis of Nasopharyngectomy via Endoscopic Endonasal, Maxillary Transposition, and Lateral Temporal-Subtemporal Approaches. J Craniofac Surg 2015; 26:2136-41. [PMID: 26468798 DOI: 10.1097/scs.0000000000002153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This project develops a computer model that allows volumetric analysis of the exposure afforded by an endonasal-endoscopic approach, maxillary transposition, and lateral temporal-subtemporal approaches during a nasopharyngectomy. The model will demonstrate idiosyncracies of these approaches, including sacrifice of normal tissues, ease of instrumentation, and gate of entry. SUBJECTS AND METHODS Computed tomographic scans of an anatomic specimen were used to create computer simulations of the endoscopic endonasal, maxillary transposition, and lateral temporal-subtemporal approaches for T1and T4 nasopharyngeal carcinoma; therefore, allowing assessment of their surgical corridor using Intuition, a software that allows a semiautomated computerized segmented volumetric analysis. RESULTS The smallest volumes of tissue mobilization or removal were observed during the endoscopic-endonasal nasopharyngectomy. The volumes of tissue mobilization for the maxillary transposition approach were higher than those of lateral temporal-subtemporal approaches. CONCLUSIONS This model adds to our understanding of select surgical corridors to the nasopharynx. It suggests that an endoscopic-endonasal approach requires less manipulation or resection of smaller volumes of normal tissue to expose a nasopharyngeal tumor than the lateral temporal-subtemporal and maxillary transposition approaches. It also, however, requires instrumentation through a smaller entry gate implying greater difficulty. Nonetheless, these factors should not be construed as superiority of one approach over the other. Factors that are important in the choosing of the surgical approach, such as surgeon's training and experience, invasion of neurovascular structures and method of reconstruction are not considered in this model.
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12
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Gao Z, Chi FL. Anatomy Relationship around Internal Carotid Artery in the Endoscopic Surgery of Nasopharynx: A Study Based on Computed Tomography Angiography. J Neurol Surg B Skull Base 2015. [PMID: 26225298 DOI: 10.1055/s-0034-1395488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective Anatomic knowledge is needed to avoid injury to internal carotid artery (ICA) during the endoscopic surgery around nasopharynx and its surrounding space. Design We prospectively studied the computed tomography angiography (CTA) data of 28 patients with image processing software. Special attention was given to ICA and various landmarks around nasopharynx. Results The anatomic relationship between ICA and different landmarks around nasopharynx was clearly presented in three-dimension. The fossa of Rosenmuller is the nearest point of the nasopharyngeal cavity to ICA. The opening of the Vidian canal in the middle cranial fossa could be either above, below, or at the level of the horizontal segment of petrous ICA. The pharyngeal trunk of the ascending pharyngeal artery can also be clearly identified in most reconstructed CTA images. Multiple anatomic relationships were also quantified. Conclusions Reconstructed CTA can provide key anatomic information for a safe and accurate endoscopic dissection around nasopharynx.
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Affiliation(s)
- Zhen Gao
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Fang-Lu Chi
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China
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13
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Chan JYW, Wong STS, Wei WI. The role of Epstein-Barr virus-encoded microRNA BART7 status of resection margins in the prediction of local recurrence after salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma. Cancer 2015; 121:2358-66. [PMID: 25955785 DOI: 10.1002/cncr.29380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Local recurrence is the major cause of treatment failure in patients who undergo surgical salvage of recurrent nasopharyngeal carcinoma (NPC) after radiotherapy. The authors investigated the role of Epstein-Barr virus (EBV)-encoded Bam HI-A rightward transcript 7 microRNA (BART7) status in resection margins in the identification of a subgroup of patients who may benefit from adjuvant reradiation after surgery. METHODS One hundred two consecutive patients who had histologically clear resection margins after undergoing nasopharyngectomy for recurrent NPC were studied. The status of EBV microRNA BART7 in resection margins was investigated and correlated with the pattern of subsequent disease recurrence. RESULTS After a median follow-up of 64 months, 20 patients (19.6%) developed local recurrence after surgery despite histologically uninvolved margins. The risk of local recurrence in patients with histologically close (<5 mm) and clear (≥5 mm) margins was 31.6% and 12.5%, respectively. In patients with clear histologic margins, those with margins that were positive for EBV microRNA BART7 has a significantly higher chance of developing local tumor recurrence (P = .016) than those with negative molecular margins. The difference was not significant when the histologic clearance at the resection margins was <5 mm. CONCLUSIONS Tissue EBV microRNA BART7 is useful for identifying a subgroup of patients with histologically clear margins who are at increased risk of subsequent local tumor recurrence. Postoperative adjuvant treatment is warranted for these patients.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
| | - Stanley Thian Sze Wong
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
| | - William Ignace Wei
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
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Peng H, Wang SJ, Yang X, Lin J, Guo H, Liu M. Modified radical neck dissection for residual neck disease after radiotherapy of nasopharyngeal carcinoma. Auris Nasus Larynx 2014; 41:485-90. [PMID: 24925704 DOI: 10.1016/j.anl.2014.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/02/2014] [Accepted: 05/03/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Although radical neck dissection is proposed as a standard salvage procedure for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck, modified radical neck dissection may be appropriate for select patients. This study was designed to evaluate the efficacy of individualized neck dissections based on preoperative imaging studies and intraoperative exploration for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck. METHODS The study included 42 consecutive patients who failed radiotherapy or chemo-radiotherapy for nasopharyngeal carcinoma of the neck and underwent a total of 46 radical neck dissections or modified radical neck dissections. Selection of the proper type of neck dissection was based on preoperative imaging studies and intraoperative exploration. The patients' clinical features, pathologic characteristics, complications, and treatment outcome were estimated and analyzed. RESULTS Radical neck dissection and modified radical neck dissection were performed on 19 and 27 necks, respectively. Thirty-three necks (71.7%) had multiple node metastases. Nineteen necks (41.3%) had node metastases at two or more levels. The overall morbidity rate was 11.9%. The 5-year neck control rate (NCR) was 79.1% for 46 necks. The 5-year overall survival and disease free survival for 42 patients were 58.0% and 44.0%, respectively. No statistically significant differences were found in comparing OS, DFS, NCR between the MRND and RND groups. CONCLUSIONS Individualized neck dissection based on preoperative imaging studies and intraoperative exploration is appropriate for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.
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Affiliation(s)
- Hanwei Peng
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China.
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, 2233 Post St, 3rd Floor, San Francisco, CA 94115, United States
| | - Xihong Yang
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China
| | - Jianying Lin
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China
| | - Haipeng Guo
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China
| | - Muyuan Liu
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou City, Guangdong Province 515031, China
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15
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Monteiro E, Witterick I. Endoscopic nasopharyngectomy: Patient selection and surgical execution. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.otot.2014.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Chan JYW, To VSH, Chow VLY, Wong STS, Wei WI. Multivariate analysis of prognostic factors for salvage nasopharyngectomy via the maxillary swing approach. Head Neck 2014; 36:1013-7. [PMID: 23784801 DOI: 10.1002/hed.23403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the prognostic factors for salvage nasopharyngectomy. METHODS A retrospective review was conducted on maxillary swing nasopharyngectomy performed between 1998 and 2010. Univariate and multivariate analyses identified prognostic factors affecting actuarial local tumor control and overall survival. RESULTS The median follow-up duration was 52 months. Among the 268 patients, 79.1% had clear resection margins. The 5-year actuarial local tumor control and overall survival was 74% and 62.1%, respectively. On multivariate analysis, tumor size, resection margin status, and gross tumor in the sphenoid sinus were independent prognostic factors for local tumor control. For overall survival, resection margin status, synchronous cervical nodal recurrence, and cavernous sinus invasion had a negative influence on overall survival after surgery. CONCLUSION Extent of nasopharyngectomy should be tailored to the individual tumor to achieve clear resection margins. Cavernous sinus invasion is associated with poor survival outcome, and detailed counseling and meticulous surgical planning is crucial in such circumstances.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, Special Administrative Regions of the, People's Republic of China
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Arango BA, Castrellon AB, Perez CA, Raez LE, Santos ES. Nasopharyngeal carcinoma: alternative treatment options after disease progression. Expert Rev Anticancer Ther 2014; 10:377-86. [DOI: 10.1586/era.10.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Kekatpure VD, Rajan GP, Patel D, Trivedi NP, Arun P, Iyer S, Kuriakose MA. Morbidity profile and functional outcome of modified facial translocation approaches for skull base tumors. Skull Base 2012; 21:255-60. [PMID: 22470269 DOI: 10.1055/s-0031-1280680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complication observed was nasal crusting in 16 patients. Grade 2 trismus and exposure of mini plate was seen in three patients. Two patients developed necrosis of translocated bone. Three patients developed palatal fistula before modification of palatal incision. Facial translocation provides a satisfactory access for adequate clearance of skull base tumors with satisfactory aesthetic and functional results. With modifications of the surgical technique and implementation of new surgical tools, the morbidity of facial translocation approaches will continue to decrease.
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Chan JYW, Wei WI. Critical appraisal of maxillary swing approach for nasopharyngeal carcinoma. Expert Opin Ther Targets 2012; 16 Suppl 1:S111-7. [DOI: 10.1517/14728222.2011.637920] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Ong YK, Solares CA, Lee S, Snyderman CH, Fernandez-Miranda J, Gardner PA. Endoscopic nasopharyngectomy and its role in managing locally recurrent nasopharyngeal carcinoma. Otolaryngol Clin North Am 2012; 44:1141-54. [PMID: 21978898 DOI: 10.1016/j.otc.2011.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Local recurrence after primary radiation of nasopharyngeal carcinoma (NPC) remains an important cause of morbidity and mortality. Salvage treatment using reirradiation or surgery has been shown to improve survival over nontreatment. Surgery is traditionally performed using an open approach. Advances in endoscopic approaches for resection of paranasal sinus tumors have been extended to NPC. This article reviews the treatment options, in particular the role of endoscopic nasopharyngectomy in the management of recurrent NPC. The endoscopic anatomy, surgical principles, and published results on endoscopic nasopharyngectomy are presented. Short-term outcomes for early-stage recurrences are promising but long-term follow-up is needed.
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Affiliation(s)
- Yew Kwang Ong
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, 1E Kent Ridge Road, Singapore 119228.
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Chan JYW, Chow VLY, Tsang R, Wei WI. Nasopharyngectomy for locally advanced recurrent nasopharyngeal carcinoma: Exploring the limits. Head Neck 2011; 34:923-8. [DOI: 10.1002/hed.21855] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 11/10/2022] Open
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Abstract
Although radiotherapy has been generally accepted as the treatment of choice for nasopharyngeal carcinoma (NPC), NPC at the primary site is not always controlled by this therapy. We performed surgical treatment to eradicate such residual tumor through a transmandibular, transpterygoid approach, on four patients with local residual NPC after curative radiotherapy. Two patients survived with no evidence of disease for more than 6 years. The other two patients died of multiple metastases to the liver or bone at 4 years and at 6 months after treatment. However, the nasopharynx remained free of disease in these two patients. Although the number of patients in the present series is small, surgical treatment of local persistent tumor after radiotherapy was beneficial. The indication for this technique is tumor in the nasopharynx extending to the parapharyngeal space, not invading intracranially. The transmandibular, transpterygoid approach offers a wide operative field with minimal postoperative morbidity, making it possible to manage the internal carotid artery easily.
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23
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Bian X, Chen H, Liao L. A retrospective study of salvage surgery for recurrent nasopharyngeal carcinoma. Int J Clin Oncol 2011; 17:212-7. [DOI: 10.1007/s10147-011-0276-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 06/10/2011] [Indexed: 11/30/2022]
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Dallan I, Castelnuovo P, Montevecchi F, Battaglia P, Cerchiai N, Seccia V, Vicini C. Combined transoral transnasal robotic-assisted nasopharyngectomy: a cadaveric feasibility study. Eur Arch Otorhinolaryngol 2011; 269:235-9. [DOI: 10.1007/s00405-011-1550-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
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Residual cervical lymphadenopathy after definitive treatment of nasopharyngeal carcinoma: fine needle aspiration cytology, computed tomography and histopathological findings. The Journal of Laryngology & Otology 2010; 125:70-7. [DOI: 10.1017/s0022215110001933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem.Methods:We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results.Results:The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease.Conclusion:In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.
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Suárez C, Rodrigo JP, Rinaldo A, Langendijk JA, Shaha AR, Ferlito A. Current treatment options for recurrent nasopharyngeal cancer. Eur Arch Otorhinolaryngol 2010; 267:1811-24. [PMID: 20865269 PMCID: PMC2966947 DOI: 10.1007/s00405-010-1385-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/27/2010] [Indexed: 11/28/2022]
Abstract
Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1–T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation.
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Affiliation(s)
- Carlos Suárez
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
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27
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Wen YH, Wen WP, Chen HX, Li J, Zeng YH, Xu G. Endoscopic nasopharyngectomy for salvage in nasopharyngeal carcinoma: a novel anatomic orientation. Laryngoscope 2010; 120:1298-302. [PMID: 20564602 DOI: 10.1002/lary.20958] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngectomy for residual/recurrent nasopharyngeal carcinoma (NPC) using an endoscopic technique is less invasive than traditional methods. Our objective was to identify the important anatomic landmarks so that the endoscopic surgeon can avoid injury to the internal carotid artery and perform a nasopharyngectomy safely. STUDY DESIGN Anatomical study. METHODS Transnasal endoscopic dissection was carried out on three fresh adult cadaver specimens (six sides) after arterial latex injection. Measurements were made in 50 adult skulls (100 sides), detailing the distances between orienting critical landmarks and the internal carotid canal (external aperture). RESULTS Adequate exposure for endoscopic nasopharyngectomy is available by removing portions of the inferior turbinate, nasal septum, and medial pterygoid plate. Anatomy of the operative field (endoscopic view) is described. Orientating topical landmarks include: posterior portions of the inferior turbinate and nasal septum, fossa of Rosenmuller, and the torus tubarius. The deep landmarks include: medial pterygoid plate-posterior margin at the skull base, eustachian tube isthmus, foramen lacerum, and the longus capitis. All topical and deep landmarks were identified from the endoscopic point of view and their distances to the internal carotid canal (external aperture) were measured. CONCLUSIONS This anatomic study provides novel orienting landmarks for endoscopic nasopharyngectomy. Surgeons can efficiently and safely deal with residual and/or recurrent NPC endoscopically.
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Affiliation(s)
- Yi-Hui Wen
- Department of Otolaryngology, First Affiliated Hospital, and Otolaryngology Institute, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
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Liu TR, Chen FJ, Qian CN, Guo X, Zeng MS, Guo ZM, He JH, Cao JY, Yang AK, Zhang GP. Primary salivary gland type carcinoma of the nasopharynx: therapeutic outcomes and prognostic factors. Head Neck 2010; 32:435-44. [PMID: 19760795 DOI: 10.1002/hed.21203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary salivary gland type nasopharyngeal carcinoma (SNPC) is a rare malignancy with diverse clinical behavior and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Furthermore, controversy exists as to the treatment policy of SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors of SNPC. METHODS The medical records of 67 patients with SNPC at 1 institution between 1977 and 2005 were reviewed. Patient records were analyzed for management approaches, outcomes, and prognostic factors. RESULTS SNPC is a rare malignancy accounting for only 0.29% of nasopharyngeal malignancies, and the lymphatic metastases and distant metastases rates were 28.4% and 23.9%, respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 41.1% and 57.1%, respectively; no significant differences were found in DFS or OS between different histological subtypes. A significant difference was found in OS between surgical treatment and nonsurgical treatment in T1-T2 patients with well-differentiated tumors. Multivariate analyses indicated that lymph node metastases, stage, and distant metastases were independent factors for DFS, whereas cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS. CONCLUSIONS SNPC is a malignancy with generally favorable prognosis. In T1-T2 patients with well-differentiated tumors, SNPC should be treated by combined surgical operation and radiotherapy. Cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS.
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Affiliation(s)
- Tian-Run Liu
- Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong, China
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29
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Liu H, Xia Y, Cui N. Impact of diabetes mellitus on treatment outcomes in patients with nasopharyngeal cancer. Med Oncol 2010; 23:341-6. [PMID: 17018891 DOI: 10.1385/mo:23:3:341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 11/30/1999] [Accepted: 01/31/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE To determine the influence of diabetes mellitus on stages and long-term outcomes among patients with nasopharyngeal cancer. MATERIAL AND METHODS The study summarized 37 patients who were diagnosed as having diabetes mellitus and nasopharyngeal cancer and treated by radiotherapy between January 1999 and December 1999. With a median follow-up of 34.6 mo, we analyzed differences in RFS, MFS, DFS, and OS between the diabetes and the non-diabetes group. RESULTS 37 patients were involved in our study. According to the Chinese Fuzhou staging system for NPC, which was modified in 1992, 2 patients belong to stage I, 9 stage II, 17 stage III, and 6 stage IV. The 4-yr RFS of diabetes group and non-diabetes group was 52.1% vs 68.2%, the 4-yr MFS was 73.0% vs 72.0%, the 4-yr DFS was 35.1% vs 65.1%, and the OS was 67.6% vs 75.7%. The Wilcoxon (Gehan) test showed there was no significant difference between the two groups of RFS, MFS, and OS, while the diabetes group had a worse DFS than non-diabetes group (Wilcoxon p = 0.0047). CONCLUSIONS Patients with diabetes had a worse DFS than non-diabetes, but statistic tests did not show significant differences in RFS, MFS, and OS; further studies should be continue to find out the results in the future.
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Affiliation(s)
- Hui Liu
- Department of Radiotherapy, The Affiliated Tumor Hospital of Sun-Yet-Sen University, Guangzhou, China
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30
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Chen MY, Wen WP, Guo X, Yang AK, Qian CN, Hua YJ, Wan XB, Guo ZM, Li TY, Hong MH. Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma. Laryngoscope 2009; 119:516-22. [PMID: 19235750 DOI: 10.1002/lary.20133] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Ming-Yuan Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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31
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Xia L, Zeng Z, Guo Z, Guo G, Zhang B, Qiu H, Zhou F. Neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma after radiotherapy: effect and choice. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s10330-008-0158-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rivera S, Keryer C, Busson P, Maingon P. Les carcinomes du nasopharynx : de la biologie à la clinique. Cancer Radiother 2005; 9:55-68. [PMID: 15804621 DOI: 10.1016/j.canrad.2004.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2004] [Indexed: 11/19/2022]
Abstract
Nasopharyngeal carcinomas (NPC) are very different from other head and neck cancers because of their specific multifactorial etiology and their geographic distribution. Epstein-Barr Virus (EBV) is implicated in oncogenesis of NPC in association with genetic alterations such as inactivation of the p16/Ink4, p19/ARF, RASSF1 or Blu genes. Tumoral tissues include a very abundant characteristic lymphoid infiltrate. Inflammatory cytokines are produced by both malignant and infiltrating cells. There is no efficient immune response against the tumor. On the opposite, infiltrating lymphocytes might play a role in tumor development. Serological methods and detection of circulating viral DNA are expected to become useful for early detection of relapse and on a longer term for primary screening. NPC are often diagnosed at a late stage because patients may remain asymptomatic for a long time. Computed tomography (CT scan) and magnetic resonance imaging (MRI) are complementary for the initial evaluation. Positron emission tomography (PET) is efficient for the evaluation of treatment efficiency and detection of relapses. Treatment is based on radiotherapy and chemotherapy. Their optimal use needs to be evaluated by phase III trials but positive results have been obtained by concomitant association of radiotherapy and chemotherapy. Targeted therapies are being studied with strategies based on disruption of viral latency, use of replicative adenoviruses or anti-tumor vaccination.
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Affiliation(s)
- S Rivera
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21079 Dijon cedex, France.
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Terlikiewicz J, Makarewicz R, Lebioda A, Kabacińska R, Biedka M. An analysis of outcomes, after re-irradiation by HDR (high-dose-rate) brachytherapy, among patients with locally recurrent nasopharyngeal carcinoma (NPC). Rep Pract Oncol Radiother 2005. [DOI: 10.1016/s1507-1367(05)71092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Suárez C, Llorente JL, Muñoz C, García LA, Rodrigo JP. Facial Translocation Approach in the Management of Central Skull Base and Infratemporal Tumors. Laryngoscope 2004; 114:1047-51. [PMID: 15179211 DOI: 10.1097/00005537-200406000-00017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objectives were to systematize the indications of various types of facial translocation and to present a technical modification to avoid some sequelae of this approach. STUDY DESIGN Retrospective analysis was made of patients treated with different types of facial translocation approach to resect nasopharyngeal, infratemporal, and sinonasal tumors. METHODS Thirty-nine patients underwent facial translocation approaches for neoplasms originally involving the nasopharynx (27) infratemporal fossa (7), and nasal cavity (5). Of the 21 malignant tumors, 2 were stage T2, 5 were stage T3, and 14 were stage T4. From the entire series of patients, 10 received a unilateral medial translocation, 3 a bilateral medial translocation, 25 a standard facial translocation, and 1 an extended medial facial translocation. RESULTS Fifteen patients (38%) developed some kind of complication, such as wound infection (nine cases) and osteomyelitis and cerebrospinal fluid leak (five cases each). Two patients died as a result of postoperative complications (5.2%). Overall 5-year survival for malignant tumors was 43%. Neither the histological appearance of the tumor nor the T stage influenced the survival of patients. Survival of patients with intracranial involvement was significantly decreased compared with patients with involvement of other areas (P =.0003). CONCLUSION The facial translocation approach offers an excellent exposure in tumors with large degree of involvement of the nasopharynx, infratemporal fossa, nasal cavity, and maxillary sinus. More limited osteotomies are indicated in smaller tumors. The use of midfacial degloving minimizes the number of sequelae of these approaches.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, and the Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain.
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Hall CEJ, Harris R, A'Hern R, Archer DJ, Rhys-Evans P, Henk JM, Harrington KJ, Nutting CM. Le Fort I osteotomy and low-dose rate Ir192 brachytherapy for treatment of recurrent nasopharyngeal tumours. Radiother Oncol 2003; 66:41-8. [PMID: 12559519 DOI: 10.1016/s0167-8140(02)00309-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Treatment of recurrent nasopharyngeal carcinoma is a difficult clinical problem. External beam re-irradiation is associated with a long-term cure in a proportion of cases but this may be associated with severe radiation injury. METHODS Eighteen patients with post-nasal space tumours were treated between 1986 and 2001 with surgical excision and nasopharyngeal brachytherapy via a Le Fort I osteotomy approach. Low-dose rate (LDR) and high-dose rate (HDR) brachytherapy was used. Data was prospectively collected. Local control and overall survival were measured. Acute and late complications were assessed using the RTOG system. RESULTS The overall survival was 67% at 2 years and 33.5% at 5 years. The corresponding local control rates were 42 and 31.5%, respectively. The T stage at relapse was a significant prognostic factor for local control (P=0.004) but not overall survival. Acute toxicity was mild. RTOG grade >/=3 late complications occurred in 40% of patients treated with the HDR, and 0% treated with LDR. CONCLUSIONS The results of the Le Fort osteotomy, tumour debulking and post-operative brachytherapy gives local control rates similar to those achieved with wide-field re-irradiation. Complication rates are acceptable and are lower than that reported with other methods of radiation therapy. The surgical technique was well tolerated. HDR brachytherapy with this technique had a high complication rate. This approach is a viable option in the treatment of recurrent nasopharyngeal tumours.
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Affiliation(s)
- Charles E J Hall
- Head and Neck Unit, Royal Marsden Hospital and Institute of Cancer Research, 203 Fulham Road, London SW3 6JJ, UK
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Law SCK, Lam WK, Ng MF, Au SK, Mak WT, Lau WH. Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy: an effective means of local salvage. Int J Radiat Oncol Biol Phys 2002; 54:1095-113. [PMID: 12419437 DOI: 10.1016/s0360-3016(02)03009-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the role of intracavitary mold brachytherapy in salvaging local failure of nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS The outcomes of 118 consecutive NPC patients with local failure treated with mold brachytherapy between 1989 and 1996 were retrospectively reviewed. Eleven patients received additional external radiotherapy. RESULTS All molds were tailor-made, and the whole procedure was performed under local anesthesia. Pharyngeal recess dissection was routinely performed to allow direct contact of the radioactive source with the pharyngeal recess, a common site of local failure. Initially, the molds were preloaded with 192Ir wires, but since 1992, the sources have been manually afterloaded; the mold has also been redesigned for better conformity, ease of insertion, and radiation safety. Using brachytherapy alone, 50-55 Gy was given for recurrence in 4-7 days; for persistence, 40 Gy was administered. The overall complete remission rate was 97%. The rates of 5-year local control, relapse-free survival, disease-specific survival, overall survival, and major complication were 85%, 68.3%, 74.8%, 61.3%, and 46.9%, respectively. Major complications included nasopharyngeal necrosis with headache, necrosis of cervical vertebrae with atlantoaxial instability, temporal lobe necrosis, and palsy of the cranial nerves. The afterloaded mold was as effective as the preloaded version, but with fewer complications. CONCLUSIONS Intracavitary mold brachytherapy was effective in salvaging NPC with early-stage local persistence or first recurrence.
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Affiliation(s)
- Stephen C K Law
- Department of Clinical Oncology, Block R, 30 Gascoigne Road, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
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Abstract
Nasopharyngeal carcinoma (NPC) is the most common epithelial tumor of the nasopharynx. Radiation therapy is the mainstay of treatment while surgery or chemotherapy is used in selected patients. NPC usually regresses after 3 months of radiation therapy. Nonetheless, a residual mass may be present following treatment and this does not necessarily indicate viable tumor. Imaging studies are often used in conjunction with clinical examination following treatment. While computed tomography (CT) is widely used due to its greater availability, less expensive, and less time consuming, MR imaging is now becoming the preferred modality. MR imaging is more capable than CT for identifying mature scarring, tumor recurrence and postradiation complications. However, MR imaging cannot reliably demonstrate mucosal recurrence or differentiate tumor recurrence from postradiation tissue changes. Familiarity with the imaging findings of various posttreatment changes, tumor recurrence and postradiation complications is essential for management of NPC. Comparison with previous images or imaging-guided biopsy facilitates definitive diagnosis.
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Affiliation(s)
- Shu Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, 222 Mai-Chin Road, Keelung, Taiwan.
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To EWH, Lai ECH, Cheng JHH, Pang PCW, Williams MD, Teo PML. Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors. Laryngoscope 2002; 112:1877-82. [PMID: 12368634 DOI: 10.1097/00005537-200210000-00033] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngectomy is a well-established treatment option for recurrent nasopharyngeal carcinoma. Over a period of 4 years and 3 months, in a total of 43 patients, 45 nasopharyngectomies were performed. Thirty-one patients with follow-up ranging from 12 to 58 months were studied. Twenty-two patients (58%) survived; of these, 18 patients (82%) remained disease free. All patients who developed repeat recurrence or died (n = 12) had a high recurrent T-stage tumor, skull base involvement, multiple recurrences, positive surgical margins, or concurrent neck node metastasis. These factors are poor prognostic parameters and might mitigate the indications for aggressive salvage surgery. However, low recurrent T-stage tumor without neck metastasis carries a good prognosis. Modern minimally invasive surgery carries minimal morbidity. STUDY DESIGN A retrospective study was made to determine prognostic indicators in patients treated with salvage surgery for recurrent nasopharyngeal carcinoma. METHODS Medical records were analyzed for all patients who had received nasopharyngectomy for recurrent nasopharyngeal carcinoma from March 1997 to June 2001. They were followed up from March 1997 to January 2002. Recurrent T stage, nodal metastasis, surgical approach, surgical margins, and pathological nodal status, together with surgical mortality, morbidity, and the delivery of postoperative irradiation, were compared with survival. RESULTS In all, 43 patients underwent 45 nasopharyngectomies over a period of 4 years and 3 months. Patients with less than 1 year of follow-up were excluded. Four patients with residual disease, who represent a more favorable group, and five patients with planned debulking, nasopharyngectomy, and postoperative stereotactic irradiation were also excluded. The study group comprised 25 men and 6 women (ratio of 4:1) with age ranging from 26 to 69 years (mean age, 49.5 y). In 28 patients (90.3%), the recurrence of nasopharyngeal carcinoma was their first recurrence; in 3 patients (9.7%), the recurrences were second recurrences. Twenty-two patients (71%) survived, achieving a mean survival of 28.5 months. Nine patients died with a mean interval of 7.8 months (range, 1-14 mo). Of the nine patients who died, six (67%) had T3 or T4 tumor, four (44.4%) had concurrent recurrent neck disease, and five (55.5%) had positive surgical margins. Two patients died of perioperative meningitis. Fifteen (83.3%) of the 18 disease-free survivors had a low recurrent T-stage tumor. Mean intervals for development of repeat recurrence or distant metastasis were 16 and 7.9 months, respectively. CONCLUSIONS High recurrent T stage, skull base involvement, repeated recurrence before surgery, nodal metastasis, and positive surgical margins carry a poor prognosis. This is particularly evident with high T stage and concurrent nodal metastasis. However, patients with low T stage have a survival advantage and benefit most from surgical treatment.
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Affiliation(s)
- Edward W H To
- Department of Surgery, The Chinese University of Hong Kong Prince of Wales Hospital, Hong Kong.
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Noël G, Dessard-Diana B, Vignot S, Mazeron JJ. [Treatment of nasopharyngeal cancer: literature review]. Cancer Radiother 2002; 6:59-84. [PMID: 12035485 DOI: 10.1016/s1278-3218(02)00150-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The conventional radiotherapy and the associated treatments improved the prognostic of nasopharyngeal cancer. A better selection of the patients who must have a more aggressive treatment also probably contributed to this improvement. Even if a relation could be found between the locoregional relapse rate and the distant relapse rate, these two events remain often independent. It results from it that the improvement of local control rate necessarily does not result in a better control of the disease. The patients with a locally advanced tumor, with or not an invasion of the base of the skull and/or neurological symptoms, must have an aggressive locally treatment. This probably includes the increase in dose delivered to the tumor via a more conformational radiotherapy, a brachytherapy, radiotherapy in stereotaxic conditions or other techniques. Dose within the tumor must be at least 70 Gy and the prophylactic nodal dose, at least 50 Gy. CT scan and MRI are essential for delineating the volumes of interest. The protocols of hyperfractionated radiotherapy did not give convincing results. Association with chemotherapy allowed, on the other hand, an improvement of the prognostic locally advanced cancers. Neoadjuvant or adjuvant chemotherapy was largely used to attempt to limit the risks of systemic dissemination, but an improvement of results was not clearly demonstrated. An improvement of the rates of survival and control of the disease, on the other hand, was observed in a certain number of studies with the chemoradiotherapy. In the event of locoregional relapse, an aggressive attitude can allow the control of the disease in the absence of systemic dissemination. Salvage treatments are, however, disappointing for when distant relapse occurs which suggests a difference in chemosensitivity between primary tumor and metastasis.
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Affiliation(s)
- G Noël
- Centre de protonthérapie d'Orsay, BP 65, 91402 Orsay, France.
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Abstract
Nasopharyngeal carcinoma (NPC), although rare in Europe and North America, is not uncommon in parts of Asia such as southern China and Hong Kong. Consequently, very few oncologists in the Western world have extensive experience in treating this neoplasm. Treatment using external beam therapy and/or brachytherapy evolved greatly during the 20th century and is still evolving, particularly with the use of adjunctive chemotherapy regimes. Diagnosis of NPC has also improved with the availability of CT and MRI. This worldwide review is divided into historical, transitional and modern eras, with the latter concerning 1971-2000. Currently, the most controversial aspects of NPC are recommendations for treatment of recurrent disease and the role of chemotherapy in the overall framework of treatment. Comparison of results from different centres is not possible without an understanding of the various staging systems that are, and have been, used; a comparison is given in this review. In the future, early diagnosis, adequate radiation dose to the primary with boost to bulky disease, and regular follow-up with biopsy of any suspicious residual or recurrent disease, are likely to become key issues to improve outcome. Also, apart from direct/indirect nasopharyngoscopy, the role of follow-up CT needs to be studied for early detection of residual or recurrent disease. More clinical trials on chemo-radiation are also required, in order to study optimum doses and agents.
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Affiliation(s)
- R F Mould
- Department of Radiation Oncology, Allan Blair Cancer Centre, 4101 Dewdney Avenue, Regina, Saskatchewan, S4T 7T1 Canada
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To EWH, Yuen EHY, Tsang WM, Lai ECH, Wong GKC, Sun DTF, Chan DTM, Lam JMK, Ahuja A, Poon WS. The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open transfacial approach. Br J Radiol 2002; 75:345-50. [PMID: 12000693 DOI: 10.1259/bjr.75.892.750345] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this paper is to study the efficacy of applying stereotactic navigation guidance to nasopharyngectomy via a minimally invasive transnasal approach as compared with the conventional open transfacial approaches. The nasopharynx is the centre of the anterior skull base, which is remote from the surface of the facial skeleton. It is well known that there are several surgical approaches for access to resect tumours from the nasopharynx. However, the open techniques have been associated with much morbidity and only provide access to, and identification of, the ipsilateral internal carotid artery that forms the lateral boundary and resection limit of the nasopharynx. The coupling of stereotactic navigation guidance and a minimally invasive transnasal approach for nasopharyngectomy allows the surgeon to identify and protect the internal carotid artery bilaterally at the nasopharynx. This technique reduces operating time and morbidity to a minimum and yet is oncologically sound for resecting nasopharyngeal lesions. We compare 15 patients who underwent the stereotactic navigation guidance approach with 20 patients who received a conventional open transfacial approach.
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Affiliation(s)
- E W H To
- Division of Head and Neck-Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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To EW, Teo PM, Ku PK, Pang PC. Nasopharyngectomy for recurrent nasopharyngeal carcinoma: an innovative transnasal approach through a mid-face deglove incision with stereotactic navigation guidance. Br J Oral Maxillofac Surg 2001; 39:55-62. [PMID: 11178858 DOI: 10.1054/bjom.2000.0479] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traditional approaches to nasopharyngectomy for the treatment of recurrent nasopharyngeal carcinoma carry considerable complications. This paper presents an innovative transnasal approach with stereotactic navigation guidance through a mid-face deglove incision which has been done for 15 patients with minimal morbidity. All patients had resumed their oral diet within a week, and were discharged within 10 days. The intraoral wound had healed within a week. The only complications were a mild degree of saddling of the nasal dorsum in one patient and temporary facial numbness that resolved within six weeks in three. Tumour had been resected with clear margins in 12/15, in the other three being stuck to the carotid artery.
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Affiliation(s)
- E W To
- Division of Head and Neck-Plastic & Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Shu CH, Cheng H, Lirng JF, Chang FC, Chao Y, Chi KH, Yen SH. Salvage surgery for recurrent nasopharyngeal carcinoma. Laryngoscope 2000; 110:1483-8. [PMID: 10983947 DOI: 10.1097/00005537-200009000-00014] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site. STUDY DESIGN A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy. METHODS The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranial-intracranial (EC-IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins. RESULTS Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients. CONCLUSIONS In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC-IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.
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Affiliation(s)
- C H Shu
- Department of Otolaryngology, Veterans General Hospital, Taipei and National Yang-Ming University School of Medicine, Taiwan
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Syed AM, Puthawala AA, Damore SJ, Cherlow JM, Austin PA, Sposto R, Ramsinghani NS. Brachytherapy for primary and recurrent nasopharyngeal carcinoma: 20 years' experience at Long Beach Memorial. Int J Radiat Oncol Biol Phys 2000; 47:1311-21. [PMID: 10889385 DOI: 10.1016/s0360-3016(00)00520-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE We evaluated treatment outcomes of patients with mostly locally advanced primary and recurrent cancer of the nasopharynx managed with interstitial and intraluminal brachytherapy. METHODS AND MATERIALS This is a retrospective analysis of 56 patients with cancer arising from the nasopharynx treated with interstitial and intracavitary afterloading brachytherapy from 1978 to 1997. Patients were divided into three treatment groups: 15 patients with primary cancer (Group 1), 34 patients with recurrent or persistent disease (Group 2), and 7 patients with cancer in the nasopharynx who had history of previous definitive radiation therapy to the nasopharynx for head and neck cancer (Group 3). Fifty-three percent of patients in Group 1 had 1992 AJCC Stage IV disease, and 49% of patients in Groups 2 and 3 had extensive disease (defined as T3, T4, or parapharyngeal extension). Group 1 received megavoltage radiation to 50-60 Gy followed by a boost to the primary site and neck (in cases of persistent neck disease) with a combination of interstitial and intracavitary brachytherapy (mean dose 33-37 Gy). Five patients received chemotherapy, and 6 patients received hyperthermia. Groups 2 and 3 patients were treated with brachytherapy implants (mean dose 50-58 Gy) without external beam radiation. Twenty-five patients received chemotherapy either before or during radiation, and 21 patients received hyperthermia. RESULTS The overall survival at 2, 5, and 10 years for patients in Group 1 was 79%, 61%, and 61%, respectively, and for patients in Groups 2 and 3 combined was 48%, 30%, and 20%, respectively. Cause-specific survival at 2, 5, and 10 years was 87%, 74%, and 74%, respectively, for patients in Group 1; and 82%, 60%, and 60%, respectively, for patients in Groups 2 and 3. Local control at 2, 5, and 10 years was 93%, 93%, and 77%, respectively, for patients in Group 1; and 81%, 59%, and 49%, respectively, for patients in Groups 2 and 3. Control in the neck at 2, 5, and 10 years was achieved in 93%, 93%, and 93% of patients, respectively, in Group 1; and 88%, 81%, and 81%, respectively, for patients in Groups 2 and 3. Disease-free survival was 87%, 74%, and 62%, respectively, for patients in Group 1, and 56%, 41%, and 34%, respectively, for patients in Groups 2 and 3. There were 4 peri-operative deaths. One death (2%) was attributable to the development of late complications. Forty-five percent of patients experienced some form of late complications. CONCLUSION Interstitial afterloading brachytherapy can provide effective treatment for nasopharyngeal cancers, especially for locally persistent/recurrent and locally extensive lesions.
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Affiliation(s)
- A M Syed
- Department of Radiation Oncology, Long Beach Memorial Medical Center, CA 90806, USA
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Abstract
BACKGROUND The incidence of recurrent nasopharyngeal carcinoma (NPC) after primary radiotherapy is considerable. The result of re-irradiation to the recurrent tumor is not satisfactory. METHODS Thirty-one patients who received nasopharyngectomy for treatment of their recurrent nasopharyngeal carcinoma (NPC) (rT1 to rT3) at the Prince of Wales Hospital during the period 1986 to 1997 were reviewed retrospectively. Eleven patients had nasopharyngectomy performed by the transoropalatal approach, 9 patients by the maxillary swing approach, and 11 patients by the mandibular approach. RESULTS Most recurrences (29 of 31) were rT1 and rT2 tumors. No hospital mortality occurred. The common complications of nasopharyngectomy were palatal defect (17 of 31), trismus (15 of 31), otitis media with effusion (20 of 31), dysphagia (12 of 31), and nasal regurgitation (8 of 31). Nine surgical specimens had microscopic invasion of the resection margins. The 5-year actuarial overall survival, actuarial disease-free survival, and tumor control were 47%, 42%, and 43%, respectively. The administration of postoperative radiotherapy significantly enhanced survival and tumor control after nasopharyngectomy. CONCLUSIONS Nasopharyngectomy supplemented by postoperative radiotherapy achieved significant survival and tumor control with acceptable complications in selected recurrent NPC. It appears to be a better salvage treatment than re-irradiation alone for selected recurrent NPC.
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Affiliation(s)
- W W King
- Division of Head and Neck-Plastic & Reconstructive Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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46
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Surgical options for continuing treatment of recurrent nasopharyngeal carcinoma. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200004000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Recurrent primary nasopharyngeal carcinoma after radiotherapy exhibits wide local extension [Uttley D, Moore A, Archer DJ. J Neurosurg 1989;71:705-10]. This wide exposure of the nasopharynx and its vicinity is essential for an oncological radical resection to be carried out. The resection should embrace the tumor with an adequate mucosal margin including the cartilaginous portion of the Eustachian tube. Paranasopharyngeal tissues should be included in the resection whenever indicated. The anterolateral approach to the nasopharynx and the paranasopharyngeal space provides adequate exposure required for an oncological resection. Morbidity associated with the operation is low and this is recommended for resection of most recurrent primary nasopharyngeal carcinoma after radiotherapy.
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Affiliation(s)
- W I Wei
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Takeshita H, Furukawa M, Fujieda S, Shoujaku H, Ookura T, Sakaguchi M, Ito H, Mineta H, Harada T, Matsuura H, Saito H. Epidemiological research into nasopharyngeal carcinoma in the Chubu region of Japan. Auris Nasus Larynx 1999; 26:277-86. [PMID: 10419035 DOI: 10.1016/s0385-8146(98)00080-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although patient death due to nasopharyngeal carcinoma (NPC) is increasing, few epidemiological analyses of NPC in Japan have been conducted since Sawaki's report in 1979. To determine the current incidence of NPC in Japan we examined NPC case in the Chubu area from 1986 to 1995. The leaders and reporting representatives of all otorhinolaryngological groups in the area were asked for their support of this epidemiological research. A total of 607 cases (445 male and 162 female NPC patients) were analyzed epidemiologically, histologically, serologically and clinically in this study. The incidence of NPC gradually increased with age. The mean age of the patients was 54.1 years. The age-standardized annual incidence in the Chubu region was 0.28 per 10(5) persons per year. The incidence in prefectures bordering Japan Sea (0.36) was significantly higher than that of prefectures facing the Pacific Ocean (0.21, P<0.05). On the basis of World Health Organization (WHO) histological criteria, 12%) of the cases were classified as WHO I, 54% as WHO II and 34% as WHO III. As for tumor origin, in 58% of the cases it originated posterosuperiorly, in 32% laterally and in 1% inferiorly. Tumor staging showed 4% to belong to stage I, 9% to stage II, 15% to stage III and 72% to stage IV. The positive rates of serum titers of the antibodies to Epstein Barr virus
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Affiliation(s)
- H Takeshita
- Department of Otolaryngology, School of Medicine, Kanazawa University, Ishikawa, Japan
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Abstract
Management of cervical nodal metastasis from nasopharyngeal carcinoma (NPC) begins with a thorough assessment of the patient to determine extent of the disease process at the primary site, regionally and systematically. Detailed knowledge of the anatomy of the head and neck will facilitate an accurate diagnosis and subsequent staging of each individual patient. The use of the appropriate diagnostic tools such as imaging, fine-needle aspiration studies, and serology direct the clinician to the appropriate management scheme. This article attempts to cull information from various clinicians who treat the majority of NPC patients, and to raise the issue of the need for more innovative approaches.
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Affiliation(s)
- J J Brown
- Department of Otolaryngology- Head and Neck Surgery, Charles R. Drew University of Science and Medicine, Los Angeles, California, USA
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50
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Hwang JM, Fu KK, Phillips TL. Results and prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1998; 41:1099-111. [PMID: 9719121 DOI: 10.1016/s0360-3016(98)00164-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To review the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. METHODS AND MATERIALS We reviewed the records of 74 patients with locally recurrent nasopharyngeal carcinoma treated at the University of California, San Francisco between 1957 and 1995. The histologic types included squamous cell carcinoma in 6 (8.1%), nonkeratinizing carcinoma in 48 (64.9%), and undifferentiated carcinoma in 20 (27%) cases. The site of recurrence was in the primary in 46 (62.2%), in the neck nodes in 20 (27%), and in both sites in 8 (10.8%) patients. The recurrent disease was Stage I in 10 (13.5%), Stage II in 16 (21.6%), Stage III in 20 (27%), and Stage IV in 28 (37.9%) patients. Thirty-seven (50%) patients developed recurrence within 2 years and 58 (78.4%) within 5 years after initial treatment. Radiotherapeutic techniques used in the retreatment of primary recurrence consisted of external beam radiotherapy (EBRT), intracavitary brachytherapy, heavy-charged particle beam, and gamma knife, alone or in combination. Reirradiation doses ranged from 18 to 108 Gy, with a median dose of 60 Gy. Treatment of recurrent neck nodes consisted of radical neck dissection (RND) +/- intraoperative radiotherapy (IORT), or EBRT +/- hyperthermia, or chemotherapy +/- hyperthermia. Chemotherapy was used in 22 (30%) patients. Median follow-up was 20 months (range: 2 to 308 months). RESULTS The 3-, 5-, and 10-year actuarial overall survival following retreatment were 49, 37, 18%, respectively. Thirty-six patients (49%) were free of further local-regional recurrence after retreatment. The 3-, 5-, and 10-year local-regional progression-free rates were 52, 40, and 38%, respectively. On univariate analysis, histologic type (p < 0.0001), interval to recurrence (p = 0.034), and treatment modality for early-stage disease (p = 0.01) were significant prognostic factors for overall survival, with age being marginally significant (p = 0.053). For local-regional progression-free rate, only histology was significant (p = 0.035). On multivariate analysis, age (p = 0.026), histology (p = 0.015), and interval to recurrence (p = 0.030) were significant for overall survival, and only histology (p = 0.002) and presence of complications (p = 0.016) were significant for local-regional progression-free rate. Of the 64 reirradiated patients, late complications were documented in 29 (45%) patients. The late complications were permanent in 21 (33%) and severe in 15 (23%) patients. CONCLUSION Retreatment using radiotherapy alone or in combination with other treatment modalities can achieve long-term local-regional control and survival in a substantial proportion of patients with locally recurrent nasopharyngeal carcinoma. Age, histology, and interval to recurrence were independent prognostic factors for overall survival, but only histology and presence of complications were significant for local-regional progression-free rate.
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Affiliation(s)
- J M Hwang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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