After the first course of radical radiotherapy for nasopharyngeal cancer, there are recurrence of nasopharyngeal cancer alone, recurrence of metastases in the neck alone or recurrence of both, and the recurrence rate is about 20-40%. Whether it is recurrence or not must be confirmed by nasopharyngeal neoplasm or neck lymph node biopsy or neck lymph node puncture, not by CT or MRI alone, which is only to understand the scope of recurrence and facilitate the design of irradiation field. For the imaging diagnosis of nasopharyngeal cancer, MRI is superior to CT in many aspects, so MRI should be chosen as much as possible.
If it is only nasopharyngeal or/and skull base recurrence, radiotherapy will only irradiate nasopharynx or/and skull base, and the neck will not be irradiated prophylactically, try to set up small fields and multiple fields, and try to irradiate from different parts and different angles from the first course of radiotherapy to avoid excessive damage. The nasopharyngeal intensity-modulated radiotherapy technique can meet the above requirements well. It can achieve the guaranteed dose to the target area while minimizing the dose to the surrounding normal tissues, which is to exchange the minimum damage for the maximum efficacy.
Surgical treatment should be preferred for recurrence of neck metastases. According to the size of the lymph nodes, they are divided into local excision and regional neck clearance. Then, according to the intraoperative or postoperative pathology seen, whether to perform postoperative radiotherapy is considered.