Factors affecting the overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site - Experience with 60 cases

Objective: To analyze the factors affecting overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary sire alter a full course of radiotherapy. Design: Retrospective analysis of 60 consecutive patients treated by surgic al resection of the recurrent tumors, with a mean follow-up of 43.1 months (range, 19-96 months). Setting: Academic tertiary referral center. Results: The overall survival and locoregional relapse-free survival were 5 6% and 60% at 2 years, respectively, and 30% and 40% at 5 years. Twenty-nin e (81%) of 36 patients died with uncontrolled local disease. The T stage of the recurrent tumors appeared robe an, important prognostic factor. Age, s ex, pathologic findings, and disease free interval (time between previous r adiotherapy and local recurrence) were not significant prognosis-affecting factors by the log-rank test. Multivariate analysis showed that patients wi th recurrent tumors of undifferentiated carcinoma, sarcoma, or small cell c arcinoma had unfavorable prognoses. Uncontrolled local disease and the emer gence of distant metastasis predicted grave results as well. Postoperative irradiation showed some benefit to patients, but the difference was not sta tistically significant. Conclusions: The T stage of the recurrence tvas the prominent prognosis-aff ecting factor in patients with recurrent nasopharyngeal carcinoma who recei ved salvage surgery. Patients with local recurrence should be carefully sel ected for the salvage surgery. The recommend this surgery for patients with rT1, rT2, or limited rT3 lesions. The results of surgical resection in ter ms of local control and overall survival were slightly better than those of high-dose reirradiation, with fewer late complications.