Top

BMC Cancer

Published in:

Open Access 01-12-2024 | Radiotherapy | Research

Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma

Authors: Yuebing Chen, Yiping Huang, Xiaoqiang Chen, Zhiwei Chen, Xiane Peng, Shaojun Lin, Cheng Lin, Jingfeng Zong

Published in: BMC Cancer | Issue 1/2024

Abstract

Background

To compare the clinical characteristics and prognoses of patients with isolated regional lymph node recurrent nasopharyngeal carcinoma (irrNPC) who underwent surgery or re-irradiation treatment.

Methods

We retrospectively reviewed 124 irrNPC patients who underwent initial radiotherapy between January 2010 and December 2020. The staging of regional lymph node recurrence was as follows: 75.8% for rN1, 14.5% for rN2, and 9.7% for rN3. Fifty-five patients underwent regional lymph node surgery (Surgery group), and sixty-nine patients received salvage radiotherapy with or without chemotherapy (Re-irradiation group). The survival rate was compared using Kaplan‒Meier analysis and evaluated by the log-rank test. Cox proportional hazard models were used to analyze prognostic factors.

Results

The median follow-up time was 70 months, the 5-year overall survival (OS) was 74%, and the median survival time was 60.8 months. There were no significant differences in 5-year OS (75.6% vs. 72.4%, P = 0.973), regional recurrence-free survival (RRFS, 62.7% vs. 71.1%, P = 0.330) or distant metastasis-free survival (DMFS, 4.2% vs.78.7%, P = 0.677) between the Surgery group and Re-irradiation group. Multivariate analysis revealed age at recurrence, radiologic extra-nodal extension (rENE) status, and recurrent lymph node (rN) classification as independent prognostic factors for OS. The rENE status was an independent prognostic factor for DMFS. Subgroup analysis of the Surgery group revealed that the rN3 classification was an adverse prognostic factor for OS. Age at recurrence ≥ 50 years, GTV-N dose, and induction chemotherapy were found to be independent prognostic factors for OS, RRFS, and DMFS, respectively, in the Re-irradiation group.

Conclusions

For NPC patients with isolated regional lymph node recurrence after initial radiotherapy, those who underwent surgery had survival prognosis similar to those who underwent re-radiotherapy with or without chemotherapy. A prospective study is needed to validate these findings.

Available only for authorised users

Chen Y-P, Chan ATC, Le Q-T, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet. 2019;394(10192):64–80.PubMed

Lee AWM, Ng WT, Chan JYW, Corry J, Makitie A, Mendenhall WM, Rinaldo A, Rodrigo JP, Saba NF, Strojan P, et al. Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat Rev. 2019;79:101890.PubMed

Yeung DCM, Yeung Z, Wong EWY, Vlantis AC, Chan JYK. Neck lymph node status on survival of regionally recurrent or persistent nasopharyngeal carcinoma. Sci Rep. 2020;10(1):5622.PubMed

Wang SY, Lou JL, Chen J, Zhang SZ, Guo L. Salvage surgery for neck residue or recurrence of nasopharyngeal carcinoma after primary radiotherapy: options of surgical methods and regions. World J Surg Oncol. 2016;14:89.PubMed

Xiao X-T, Wu Y-S, Chen Y-P, Liu X, Guo R, Tang L-L, Ma J, Li W-F. Patterns and prognosis of regional recurrence in nasopharyngeal carcinoma after intensity-modulated radiotherapy. Cancer Med. 2023;12(2):1399–408.PubMed

Lang J, Hu C, Lu T, Pan J, Lin T. Chinese expert consensus on diagnosis and treatment of nasopharyngeal carcinoma: evidence from current practice and future perspectives. Cancer Manag Res. 2019;11:6365–76.PubMed

Tang LL, Chen YP, Chen CB, Chen MY, Chen NY, Chen XZ, Du XJ, Fang WF, Feng M, Gao J, et al. The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma. Cancer Commun (Lond). 2021;41(11):1195–227.PubMed

Liu X, Wu B, Huang J, Qin Y, Zhang Z, Shi L, Hong X, Ding Q, Peng G, Yang K. Tumor factors associated with in-field failure for nasopharyngeal carcinoma after intensity-modulated radiotherapy. Head Neck. 2022;44(4):876–88.PubMed

Guo Q, Zheng Y, Lin J, Xu Y, Hu C, Zong J, Lu T, Xu H, Chen B, Liang Q, et al. Modified reduced-volume intensity-modulated radiation therapy in non-metastatic nasopharyngeal carcinoma: A prospective observation series. Radiother Oncol. 2021;156:251–7.PubMed

10.

Hu Y, Lu T, Huang SH, Lin S, Chen Y, Fang Y, Zhou H, Chen Y, Zong J, Zhang Y, et al. High-grade radiologic extra-nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma. Head Neck. 2019;41(9):3317–27.PubMed

11.

Liu Y-P, Li H, You R, Li J-B, Liu X-K, Yang A-K, Guo X, Song M, Zhang Q, Guo Z-M, et al. Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection. Laryngoscope. 2019;129(2):387–95.PubMed

12.

Zong J-F, Liang Q-D, Lu Q-J, Liu Y-H, Xu H-C, Chen B-J, Guo Q-J, Xu Y, Hu C-R, Pan J-J, et al. Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma. BMC Cancer. 2021;21(1):1274.PubMed

13.

Lin S, Pan J, Han L, Zhang X, Liao X, Lu JJ. Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys. 2009;75(4):1071–8.PubMed

14.

Hu Y-J, Lu T-Z, Guo Q-J, Zhang L, Xiao Y-P, Lin S-J, Zhou H, Zheng D-C, Ding S-R, Liu L-Z, et al. The role of radiologic extranodal extension in predicting prognosis and chemotherapy benefit for T1–2 N1 nasopharyngeal carcinoma: A multicenter retrospective study. Radiother Oncol. 2023;178:109436.PubMed

15.

Ng WT, Soong YL, Ahn YC, AlHussain H, Choi HCW, Corry J, Grégoire V, Harrington KJ, Hu CS, Jensen K, et al. International recommendations on reirradiation by intensity modulated radiation therapy for locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2021;110(3):682–95.PubMed

16.

Poh SS, Soong YL, Sommat K, Lim CM, Fong KW, Tan TW, Chua ML, Wang FQ, Hu J, Wee JT. Retreatment in locally recurrent nasopharyngeal carcinoma: current status and perspectives. Cancer Commun (London, England). 2021;41(5):361–70.

17.

Karakurt Eryılmaz M, Kadıyoran C. Prognostic significance of radiologic extranodal extension in nasopharyngeal cancer. Otolaryngol Head Neck Surg. 2022;166(2):321–6.PubMed

18.

Tsai T-Y, Chou Y-C, Lu Y-A, Kang C-J, Huang S-F, Liao C-T, Chang K-P. The prognostic value of radiologic extranodal extension in nasopharyngeal carcinoma: Systematic review and meta-analysis. Oral Oncol. 2021;122:105518.PubMed

19.

Lu T, Hu Y, Xiao Y, Guo Q, Huang SH, O’Sullivan B, Fang Y, Zong J, Chen Y, Lin S, et al. Prognostic value of radiologic extranodal extension and its potential role in future N classification for nasopharyngeal carcinoma. Oral Oncol. 2019;99:104438.PubMed

20.

Lo W-C, Wang C-P, Ko J-Y, Lou P-J, Yang T-L, Wang C-W, Hu Y-L, Chen T-C. Salvage treatment for isolated regional failure of nasopharyngeal carcinoma after primary radiotherapy. Ann Surg Oncol. 2012;19(3):1001–8.PubMed

21.

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(5):485–90.PubMed

22.

Tsang RKY, Chung JCK, Ng YW, To VSH, Ho ACW, Chan JYW, Ho WK, Wei WI. Efficacy of neck dissection for locoregional failures versus isolated nodal failures in nasopharyngeal carcinoma. Head Neck. 2012;34(5):638–42.PubMed

23.

Li X, Lin C, Yan J, Chen Q, Sun X, Liu S, Guo S, Liu L, Xie H, Tang Q, et al. Establishment of a prognostic scoring model for regional recurrent nasopharyngeal carcinoma after neck dissection. Cancer Biol Med. 2020;17(1):227–36.PubMed

24.

Wei WI, Ho WK, Cheng AC, Wu X, Li GK, Nicholls J, Yuen PW, Sham JS. Management of extensive cervical nodal metastasis in nasopharyngeal carcinoma after radiotherapy: a clinicopathological study. Arch Otolaryngol Head Neck Surg. 2001;127(12):1457–62.PubMed

25.

Tsang RK, Ng W-T. Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer. Curr Opin Otolaryngol Head Neck Surg. 2021;29(2):86–92.PubMed

26.

Lou J, Wang S, Guo L, Zhao J, Wang K, Ge M. Salvage surgery for neck recurrence or residue of nasopharyngeal carcinoma after primary radiotherapy. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014;49(4):300–4.PubMed

27.

Qiu S, Lin S, Tham IWK, Pan J, Lu J, Lu JJ. Intensity-modulated radiation therapy in the salvage of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2012;83(2):676–83.PubMed

28.

Sham JS, Choy D. Nasopharyngeal carcinoma: treatment of neck node recurrence by radiotherapy. Australas Radiol. 1991;35(4):370–3.PubMed

29.

Chua DTT, Wei WI, Sham JST, Cheng ACK, Au G. Treatment outcome for synchronous locoregional failures of nasopharyngeal carcinoma. Head Neck. 2003;25(7):585–94.PubMed

Title: Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma
Authors: Yuebing Chen
Yiping Huang
Xiaoqiang Chen
Zhiwei Chen
Xiane Peng
Shaojun Lin
Cheng Lin
Jingfeng Zong
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Radiotherapy
Cytostatic Therapy
Neck Dissection
Published in: BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-024-12259-w

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Correction: Impact of preoperative antiviral therapy on the prognosis of hepatitis B virus-related hepatocellular carcinoma

Association of lipid-lowering drug targets with risk of cutaneous melanoma: a mendelian randomization study

Enrichment of colibactin-associated mutational signatures in unexplained colorectal polyposis patients

Assessing colposcopy competencies in medically underserved communities: a multi-center study in China

Exercise accelerates recruitment of CD8+ T cell to promotes anti-tumor immunity in lung cancer via epinephrine

Correction: Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma

Keynote webinar | Spotlight on antibody–drug conjugates in cancer