Salvage neck dissection for cervical recurrence of nasopharyngeal carcinoma.

OBJECTIVE

To evaluate the effectiveness of salvage neck dissection as part of a multidisciplinary treatment approach in persistent or recurrent metastatic nasopharyngeal carcinoma, after failure of initial radiotherapy at the regional site.

DESIGN

A retrospective study of 31 patients treated during a 14-year period from March 1981 through May 1995, with a maximum follow-up of 152 months. Factors evaluated include patients' sex, age, and initial stage of tumor, mobility and number of nodal recurrences, surgical and pathological findings, and postoperative irradiation.

SETTING

Academic tertiary referral center.

PATIENTS

Twenty-six men and 5 women were studied; one patient had neck dissection to both sides of the neck on separate occasions, for a total of 32 operations. All patients had pathologically proved nasopharyngeal carcinoma and had been previously treated at the primary site and both sides of the neck with definitive radiotherapy.

INTERVENTION

Patients underwent a radical, modified radical, or level I-sparing radical neck dissection.

MAIN OUTCOME MEASURE

Surgical morbidity, time to recurrence at the regional site, and survival time.

RESULTS

Clinically, there was a disease predilection of 81% at levels II and V. Surgical morbidity was minimal. Regional control was achieved in 20 (65%) of the patients, and the overall 5-year survival was 67%. Tumor involvement of the posterior triangle musculature and spinal accessory nerve was associated with failure to control neck disease. Extracapsular nodal extension correlated with a poor survival outcome.

CONCLUSION

Control of regional disease by salvage neck dissection when radiotherapy has failed is both safe and effective in properly selected patients.