SURGICAL RESECTION OF PULMONARY METASTASES FROM NASOPHARYNGEAL CARCINOMA

Background: Nasopharyngeal carcinoma (NPC), unlike other head and neck cancers, is known for its propensity for distant metastases. Chemothe rapy remains the mainstay of treatment because of this and the chemose nsitivity of the tumour, but longterm control is rare. The surgical ma nagement of pulmonary metastases of other extrathoracic malignancies p rompted this review of surgical management of patients with NPC. Metho ds: Thirteen thoracotomies were performed in 12 patients with pulmonar y metastases as the first and only site of relapse of nasopharyngeal c arcinoma. Postoperative chemotherapy was given in four patients, radio therapy to the mediastinum in one patient and both chemotherapy and ra diotherapy in two patients. The survival pattern of this group of 12 p atients was compared with a historical control group consisting of 65 patients without surgical resection. Results: Lymph node involvement w as documented in four patients during operation. Four patients relapse d after surgical resection, two of them were from the group of three p atients with lymph node involvement. The site of subsequent relapse wa s the lung for three patients and the skeletal system for the fourth. The 2 year actuarial survival of the surgically resected group compare d favourably with the historical control group (80% and 24.1%, respect ively; P = 0.0002 by Mantel-Cox test). Conclusions: Surgical resection of pulmonary metastases from NPC seems to be a promising approach tho ugh the effect of case selection cannot be excluded and further studie s are indicated. The importance of exploration and dissection of media stinal nodes in the surgical management of pulmonary metastases from N PC was demonstrated.