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Cancer Treat Rev. 2019 Sep;79:101890. doi: 10.1016/j.ctrv.2019.101890. Epub 2019 Aug 21.

Management of locally recurrent nasopharyngeal carcinoma.

Author information

Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China.
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong. Electronic address:
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia.
Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States.
University of Udine School of Medicine, Udine, Italy.
Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain; Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
Department of Medical Oncology, Antwerp University Hospital, Belgium.
Department of Radiation Oncology, University of California, San Francisco, United States.
Coordinator of the International Head and Neck Scientific Group, Padua, Italy.


As a consequence of the current excellent loco-regional control rates attained using the generally accepted treatment paradigms involving intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC), only 10-20% of patients will suffer from local and/or nodal recurrence after primary treatment. Early detection of recurrence is important as localized recurrent disease is still potentially salvageable, but this treatment often incurs a high risk of major toxicities. Due to the possibility of radio-resistance of tumors which persist or recur despite adequate prior irradiation and the limited tolerance of adjacent normal tissues to sustain further additional treatment, the management of local failures remains one of the greatest challenges in this disease. Both surgical approaches for radical resection and specialized re-irradiation modalities have been explored. Unfortunately, available data are based on retrospective studies, and the majority of them are based on a small number of patients or relatively short follow-up. In this article, we will review the different salvage treatment options and associated prognostic factors for each of them. We will also propose a treatment algorithm based on the latest available evidence and discuss the future directions of treatment for locally recurrent NPC.


Nasopharyngeal carcinoma; Nasopharyngectomy; Prognostic factor; Radiotherapy; Recurrent

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