title: Factors affecting the overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site: experience with 60 cases.
abstract: OBJECTIVE
  To analyze the factors affecting overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site after a full course of radiotherapy.
  
  
  METHODS
  Retrospective analysis of 60 consecutive patients treated by surgical resection of the recurrent tumors, with a mean follow-up of 43.1 months (range, 19-96 months).
  
  
  METHODS
  Academic tertiary referral center.
  
  
  RESULTS
  The overall survival and locoregional relapse-free survival were 56% and 60% at 2 years, respectively, and 30% and 40% at 5 years. Twenty-nine (81%) of 36 patients died with uncontrolled local disease. The T stage of the recurrent tumors appeared to be an important prognostic factor. Age, sex, pathologic findings, and disease-free interval (time between previous radiotherapy and local recurrence) were not significant prognosis-affecting factors by the log-rank test. Multivariate analysis showed that patients with recurrent tumors of undifferentiated carcinoma, sarcoma, or small cell carcinoma had unfavorable prognoses. Uncontrolled local disease and the emergence of distant metastasis predicted grave results as well. Postoperative irradiation showed some benefit to patients, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  The T stage of the recurrence was the prominent prognosis-affecting factor in patients with recurrent nasopharyngeal carcinoma who received salvage surgery. Patients with local recurrence should be carefully selected for the salvage surgery. We recommend this surgery for patients with rT1, rT2, or limited rT3 lesions. The results of surgical resection in terms of local control and overall survival were slightly better than those of high-dose reirradiation, with fewer late complications.
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital, 7 Chung-Shan S Road, Taipei, Taiwan. mmhsu@ha.mc.ntu.edu.tw
authors.forename: M M
authors.initials: MM
authors.lastname: Hsu
authors.forename: R L
authors.initials: RL
authors.lastname: Hong
authors.forename: L L
authors.initials: LL
authors.lastname: Ting
authors.forename: J Y
authors.initials: JY
authors.lastname: Ko
authors.forename: T S
authors.initials: TS
authors.lastname: Sheen
authors.forename: P J
authors.initials: PJ
authors.lastname: Lou
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate