title: Recurrent nasopharyngeal carcinoma: surgical salvage vs. additional chemoradiation.
abstract: OBJECTIVE
  The primary treatment modality of nasopharyngeal carcinoma (NPC) is radiation or chemoradiation. With the application of conformal radiation and appropriate chemotherapeutic agents, there was marked improvement in the outcome. Despite this, a small number of patients still develop residual or recurrent disease either in the neck or at the primary site. In recent years there are many developments in the disciplines of surgery, radiation and medical oncology which are applicable for the management of residual or recurrent NPC. It is timely to review the applicability and efficacy of the various therapeutic options.
  
  
  RESULTS
  The theme of the literature review included the management of these recurrent or residual diseases in the neck or nasopharynx with open or endoscopic or robot-assisted surgical approaches. The application of radiation techniques such as intensity modulated radiotherapy, stereotactic radiation and brachytherapy was also included. The use of chemotherapy and targeted agents is also reviewed.
  
  
  CONCLUSIONS
  In general, the size, extent and location of the residual or recurrent NPC together with the biological behaviour of the tumour determine the optimal therapy. The surgical and clinical oncological expertise applied optimally will give the best outcome.
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, PR China. hrmswwi@hkucc.hku.hk
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
authors.forename: Dora L W
authors.initials: DL
authors.lastname: Kwong
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D018572:Disease-Free Survival; D016503:Drug Delivery Systems; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016634:Radiosurgery; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012086:Reoperation / Q000379:methods; D012371:Robotics; D016879:Salvage Therapy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome