Embargoed until May 11, 2001
Contact: Kenneth S. Satterfield760-776-8502 (5/11-5/16) 703- 519-1563[email protected]
Neck Dissection Proves Effective in TreatingCancer Recurrence of the Nasopharynx
Study shows that surgery in an "inaccessible location"
may be a viable treatment option for a deadly cancer
Palm Desert, CA -- Recurrence of cancer in the nasopharynx (the part of the pharynx that lies above the soft palate) has usually been treated with a second course of radiation. Additionally, the disease is known to be Epstein-Barr virus related and, unlike other epithelial tumors from other parts of the upper aerodigestive tract, the mainstay treatment of this disorder has been radiotherapy. Previous studies report that long-term survival after a second course of radiation was less than 30 percent and was associated with a 26 percent incidence of complications, including two percent therapy-related death.
Until recently, surgery was considered impossible due to the inaccessible location of the nasopharynx. While there are no optimum treatment options for this metastatic disease, neck dissection is an excellent choice for regional recurrence of nasaopharynx cancer after radiation therapy when the primary site is controlled. This study examined the feasibility of surgical resection for nasopharynx cancer and documented long-term survival results.
The authors of the study, Nasopharyngectomy for Recurrent Nasopharyngeal Cancer: 2 - 17 Year Follow-up, are Willard E. Fee, Jr., MD, Melinda S. Moir, MD, and Don Goffinet, MD, all from Stanford University, Palo Alto, CA, and Eun Chang Choi, MD, currently at Yonsei University, South Korea. Their paper was presented May 14, 2001, at the spring meeting of the American Head and Neck Society, held in Palm Desert, CA.
Methodology: From May, 1984, to March, 1999, 44 patients at Stanford University Medical Center underwent nasopharyngectomy for recurrent nasopharyngeal carcinoma. A retrospective chart review was performed by surgeons unassociated with the surgery who paid particular attention to any and all complications associated with (but not necessarily due to) the surgical procedure. Follow-up was obtained from patient medical records, either at Stanford or from referring physicians.
The surgical approach was variable depending upon the tumor location but included an intraoral, transpalatal, and a sublabial, transmaxillary approach, isolation of the internal carotid artery and cranial nerves 9, 10, and 12 to the skull base, and modified (sparing cranial nerve 11) or radical neck dissection as the clinical condition dictated. Since this tumor mimics juvenile angiofibroma in its location, the surgical approaches are similar with the exception of the need for both isolating the internal carotid artery and performing a neck dissection.
Results: Seven patients were excluded from the final analysis leaving 37. Patients were followed for a minimum of 2 to 17 years (mean 5.4 years, median 5.2 years) or until death.
The remaining group of 37 patients consisted of 24 men and 13 women with an average age at the time of operation of 49 years (range, 28 - 72 years). Patients were restaged based on the preoperative evaluation using the AJC Cancer Staging Manual. Twenty-two patients were staged T1, 5 patients T2, 7 patients T3, and 3 patients T4. The percent of patients who are living free of disease by T-stage is: T1 =73 percent, T2= 40 percent, T3=14 percent, and 0 percent of patients with T4 disease. In those patients who developed postoperative recurrences, the mean time for diagnosis of recurrent disease was eight months, and to death, 19 months.
In all patients, primary treatment with radiation had failed to control the neoplasm. The average dose delivered to the nasopharynx was 68 Gy (range 60 - 75 Gy). The mean time to recurrence after irradiation was 28.6 months (range, two - 108 months). Six patients failed a second course of external beam radiation prior to surgical treatment; five of the six are free of disease more than five years after surgery
Survival rates were:
All patients (n=37) > 5 yrs (n=33)
Living with disease 8 percent 3 percentDead of disease 32 percent 36 percentDead of other cause 8 percent 9 percentNo evidence of disease 51 percent 52 percent
The actuarial 5-year survival was 60 percent which is better than previous published surgery or radiation therapy treated patients.
Conclusions: The results of this study are better than most published reports of re-irradiation for rT1 and rT2 lesions. More recent radiation studies utilizing radiosurgery or implants suggest promising early results. A randomized prospective study comparing surgery with re-irradiation is warranted.
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