It is well established that radiation therapy is the first choice for the treatment of nasopharyngeal carcinoma, and its 5-year survival rate is between 32% and 56%. For the treatment of residual or recurrent lesions in the local area or neck after radical radiation therapy, surgery can be chosen.
I. Surgical modality: Treatment of primary nasopharyngeal lesions (all need pathological confirmation after recurrence).
Treatment of cervical lymph nodes (clinically palpable enlarged lymph nodes).
Indications for surgery: ① no control or recurrence in the nasopharynx or neck after radiation therapy; ② no fixed lymph nodes in the neck or fixed but no carotid artery involvement; ③ no skull base bone destruction and no cranial nerve invasion; ④ no distant metastases throughout the body; ⑤ no contraindication to surgery with general anesthesia.
The best time to perform rescue surgery is after the failure of the first radiation therapy. The lesions of those who relapse after two or more courses of radiation therapy are more extensive, with heavy trauma to the local and soft tissues of the neck, often accompanied by osteonecrosis. Surgery is difficult to perform.
②Nasopharynx should be selected according to the location and scope of the lesion, so as to eradicate the tumor with the smallest possible surgery.
If the lymph nodes in the neck do not subside within 3 months after the end of radiation therapy, they should be surgically removed; local lymph node dissection is feasible for a single enlarged lymph node, and radical cervical lymph node dissection is required for multiple enlarged lymph nodes; ④ Whether or not radiation therapy is needed again after the relief surgery should be decided by the radiotherapist depending on the specific situation. The survival rate of 3 years and 5 years after surgery is better than that of re-radiation therapy.