Long-term survival after surgical resection for recurrent nasopharyngeal cancer after radiotherapy failure.

Results are reported of transpalatal, transcervical, and transmaxillary resection in 15 patients with recurrent nasopharyngeal cancer after failure of primary radiotherapy. Seven patients treated for cure have been followed up for more than 3 years (mean, 55 months; range, 40 to 82 months), with three (43%) remaining free of disease. Two patients are living with local disease (59 and 40 months postoperatively), while two have died of their local and regional recurrence (40 and 17 months postoperatively). Two additional patients underwent nasopharyngectomy for palliation. One of these patients died of uncontrolled disease 12 months postoperatively; the other remains alive with disease 70 months after resection. Six patients have been followed up for less than 3 years (mean, 22.3 months; range, 16 to 32 months). Of this group, one (17%) is without evidence of disease, four are living with local disease (13, 16, 17, and 27 months postoperatively), and one has died of disease (13 months postoperatively). Recurrence (10 of 13 patients) has occurred an average of 8 months after surgery (range, 4 to 17 months). Complications include transient marginal mandibular nerve weakness (one), permanent cranial nerve paralysis (two), nasopharyngitis and/or osteomyelitis of the cervical vertebrae or base of skull requiring intravenous antibiotics (two), aspiration pneumonia (two), prolonged nasogastric tube feeding (two), and intraoperative thyroid storm (one). No cerbrospinal fluid leaks or perioperative deaths occurred. The long-term cure rate and disease-free interval of transpalatal nasopharyngectomy lead us to believe that this technique is probably only slightly better than reirradiation in the appropriately selected patient.