Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands,
Curr Treat Options Oncol. 2013 Dec;14(4):475-91. doi: 10.1007/s11864-013-0261-5.
Local residual disease occurs in 7-13 % after primary treatment for nasopharyngeal carcinoma (NPC). To prevent tumor progression and/or distant metastasis, treatment is indicated. Biopsy is the "gold standard" for diagnosing residual disease. Because late histological regression frequently is seen after primary treatment for NPC, biopsy should be performed when imaging or endoscopy is suspicious at 10 weeks. Different modalities can be used in the treatment of local residual disease. Interestingly, the treatment of residual disease has better outcomes than treatment of recurrent disease. For early-stage disease (rT1-2), treatment results and survival rates are very good and comparable to patients who had a complete response after the first treatment. Surgery (endoscopic or open), brachytherapy (interstitial or intracavitary), external or stereotactic beam radiotherapy, or photodynamic therapy all have very good and comparable response rates. Choice should depend on the extension of disease, feasibility of the treatment, and doctor's and patient's preferences and experience, as well as the risks of the adverse events. For the more extended tumors, choice of treatment is more difficult, because complete response rates are poorer and severe side effects are not uncommon. The results of external beam reirradiation and stereotactic radiotherapy are better than brachytherapy for T3-4 tumors. Photodynamic therapy resulted in good palliative responses in a few patients with extensive disease. Also, chemotherapeutics or the Epstein-Barr virus targeted therapies can be used when curative intent treatment is not feasible anymore. However, their advantage in isolated local failure has not been well described yet. Because residual disease often is a problem in countries with a high incidence of NPC and limited radiotherapeutic and surgical facilities, it should be understood that most of the above mentioned therapeutic modalities (radiotherapy and surgery) will not be readily available. More research with controlled, randomized trials are needed to find realistic treatment options for residual disease.
局部残留疾病在鼻咽癌（NPC）初次治疗后发生率为 7-13%。为了预防肿瘤进展和/或远处转移，需要进行治疗。活检是诊断残留疾病的“金标准”。由于 NPC 初次治疗后常出现晚期组织学消退，因此在影像学或内镜检查可疑时应在 10 周时进行活检。局部残留疾病的治疗可采用不同的方法。有趣的是，残留疾病的治疗效果优于复发性疾病的治疗效果。对于早期疾病（rT1-2），治疗结果和生存率非常好，与初次治疗后完全缓解的患者相当。手术（内镜或开放）、近距离放疗（间质或腔内）、外照射或立体定向放射治疗、光动力治疗的缓解率都非常好且相当。选择应取决于疾病的范围、治疗的可行性、医生和患者的偏好和经验，以及不良反应的风险。对于更广泛的肿瘤，治疗选择更为困难，因为完全缓解率较低，且严重副作用并不罕见。对于 T3-4 肿瘤，外照射再放疗和立体定向放疗的结果优于近距离放疗。光动力治疗在少数广泛疾病患者中产生了良好的姑息缓解效果。此外，当无法进行治愈性治疗时，还可以使用化疗药物或针对 EBV 的靶向治疗。然而，它们在孤立性局部失败中的优势尚未得到很好的描述。由于残留疾病通常是鼻咽癌发病率高且放射治疗和手术设施有限的国家的一个问题，因此应理解，上述大多数治疗方法（放疗和手术）都不易获得。需要进行更多具有对照、随机试验的研究，以找到残留疾病的现实治疗选择。
