Nasopharyngeal carcinoma relapsed two years after radiotherapy

After the first course of radical radiotherapy for nasopharyngeal carcinoma, the recurrence is divided into simple nasopharyngeal recurrence, simple neck metastasis recurrence or recurrence of both. The recurrence rate is about 20% to 40%, and most recurrences occur within 2 to 3 years after radiotherapy. So, what should we do after recurrence? Recurrence must be confirmed by nasopharyngeal neoplasms or neck lymph node biopsy, or neck lymph node puncture, and cannot be confirmed by CT or MRI examination alone. CT or MRI is only to understand the scope of recurrence and facilitate the design of irradiation field. For the imaging diagnosis of nasopharyngeal carcinoma, MRI is superior to CT in many aspects, so MRI examination should be chosen as much as possible.

If the recurrence is only in the nasopharynx and/or skull base, radiotherapy is only used to irradiate the nasopharynx and/or skull base, and the neck is not given preventive irradiation. Try to set up small fields and multiple fields, and try to irradiate from different parts and angles than the first course of radiotherapy to avoid excessive damage. Nasopharyngeal intensity modulated radiotherapy technology can meet the above requirements very well. It can minimize the dose of surrounding normal tissues while ensuring the dose of the target area, that is, to exchange the minimum damage for the maximum effect.

For recurrence of cervical metastases, surgical treatment should be the first choice. Depending on the size of the lymph nodes, it can be divided into local resection and regional neck dissection. Then, based on the pathological findings during or after surgery, whether postoperative radiotherapy should be considered.

Endoscopic minimally invasive surgery for recurrent or residual nasopharyngeal carcinoma is a salvage surgery for patients without metastasis to the neck or other parts of the body. For example, endoscopic minimally invasive surgery utilizes the natural passages of the human nasal cavity to reach the nasopharynx under the guidance of special endoscopic surgical equipment, and removes the recurrent or residual lesions in the nasopharynx while ensuring a sufficient safety margin. Postoperatively, small doses of radiotherapy can be supplemented preventively, thus avoiding to the greatest extent the side effects of repeated radiotherapy on the head and neck, such as neck stiffness, masseter muscle rigidity, difficulty opening the mouth to eat, salivary gland fibrosis, stubborn dry mouth, and stubborn secretory otitis media, significantly improving the quality of life of patients.

It is recommended that nasopharyngeal carcinoma patients adhere to regular check-ups after the first radiotherapy treatment. For early recurrence or residual disease after radiotherapy, try to choose active treatment methods to achieve the treatment goal.