Chang Kai-Ping, Hao Sheng-Po, Tsang Ngan-Ming, Ueng Shir-Hwa
Department of Otolaryngology-Head and Neck Surgery, Chang Gung Cancer Center, Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital and Chang Gung University, Taiwan, Republic of China.
Otolaryngol Head Neck Surg. 2004 Oct;131(4):497-502. doi: 10.1016/j.otohns.2004.02.049.
To evaluate the result of salvage surgery for patients with primary recurrence of nasopharyngeal carcinoma (NPC) after radiation therapy.
Prospective cohort at a tertiary referral center.
Thirty-eight consecutive patients with primary recurrence of NPC after radiation failure underwent salvage surgery for curative intention via the facial translocation approach from July 1993 to December 2002. The follow-up time ranged from 2 to 88 months. Twelve patients with intracranial and skull base invasion needed a combined neurosurgical approach. Eight patients had additional postoperative radiation therapy.
The actuarial 3-year survival and local control rate was 60% and 72.8%, respectively. Ten (83.3%) of 12 patients with intracranial and skull base invasion achieved local control. There was no surgical mortality, and the morbidity rate was only 13.2%.
The results of this study reveal better outcome of salvage surgery than that of most published literature of reirradiation for recurrent NPC. With the adequate exposure provided by the facial translocation approach, an integrated concept of skull base surgery, and the collaboration of neurosurgeons, we can extend our surgical indications of salvage surgery and resect many advanced lesions with acceptable mortality and morbidity.
评估鼻咽癌（NPC）放疗后原发灶复发患者挽救性手术的结果。
在一家三级转诊中心进行的前瞻性队列研究。
1993年7月至2002年12月，38例放疗失败后鼻咽癌原发灶复发的患者通过面移位入路接受了旨在治愈的挽救性手术。随访时间为2至88个月。12例有颅内和颅底侵犯的患者需要联合神经外科手术入路。8例患者术后接受了额外的放疗。
3年精算生存率和局部控制率分别为60%和72.8%。12例有颅内和颅底侵犯的患者中有10例（83.3%）实现了局部控制。无手术死亡，发病率仅为13.2%。
本研究结果显示，挽救性手术的结果优于大多数已发表的复发性鼻咽癌再程放疗的文献报道。通过面移位入路提供的充分暴露、颅底手术的综合概念以及神经外科医生的协作，我们可以扩大挽救性手术的手术适应证，并切除许多晚期病变，且死亡率和发病率可接受。
