title: Salvage treatment for isolated regional failure of nasopharyngeal carcinoma after primary radiotherapy.
abstract: BACKGROUND
  Isolated regional failure of nasopharyngeal carcinoma (NPC) after primary treatment is traditionally treated with radical neck dissection (RND). The roles of modified radical neck dissection (MRND) and postoperative radiotherapy after salvage surgery currently remain unclear.
  
  
  METHODS
  Medical records from our facility of all NPC patients with isolated regional failure after complete primary radiotherapy and receipt of radical surgery as a part of salvage treatment between January 1985 and December 2004 were retrospectively reviewed.
  
  
  RESULTS
  Forty-five patients were enrolled onto the study. On univariate analyses, the 5-year regional-free, disease-free, and overall survival rates were 67.7%, 47.8%, and 65.7% for patients who underwent salvage surgery alone and were 66.0%, 34.7%, and 61.3% for patients who received salvage surgery plus postoperative radiotherapy (P = 0.74, P = 0.39 and P = 0.7, respectively). The 5-year regional-free, disease-free, and overall survival rates were 87.4%, 53.5%, and 87.1% for patients undergoing RND and were 54.3%, 34.2%, and 50.5% for patients undergoing MRND (P = 0.01, P = 0.02 and P = 0.05, respectively). On multivariate analyses, recurrent N3 disease was the only adverse prognostic factor for disease-free and overall survival (P = 0.05 and P = 0.03, respectively).
  
  
  CONCLUSIONS
  RND or MRND alone may be the superior treatment for NPC patients with isolated regional failure after primary radiotherapy. Compared to MRND, radical neck dissection could provide better regional control. Postoperative radiotherapy seems to have no benefit on disease-free or overall survival. Distant metastasis is the major cause of death in these patients.
authors.affiliation: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Wu-Chia
authors.initials: WC
authors.lastname: Lo
authors.forename: Cheng-Ping
authors.initials: CP
authors.lastname: Wang
authors.forename: Jeng-Yuh
authors.initials: JY
authors.lastname: Ko
authors.forename: Pei-Jen
authors.initials: PJ
authors.lastname: Lou
authors.forename: Tsung-Lin
authors.initials: TL
authors.lastname: Yang
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Wang
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Hu
authors.forename: Tseng-Cheng
authors.initials: TC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D016879:Salvage Therapy; D015996:Survival Rate