Most of nasopharyngeal cancers are low-differentiated squamous carcinomas, with high malignancy, easily invade the adjacent tissues of nasopharynx, prone to cervical lymph node metastasis, so it is not easy to remove them cleanly during surgery; the nasopharynx is located in the middle of the skull, the site is hidden, and it is close to important organs, nerves and blood vessels. Therefore, the effect of nasopharyngeal cancer surgery alone is not good.
Since 95% of nasopharyngeal carcinoma is low-differentiated squamous carcinoma, it has high sensitivity to radiation, and radiotherapy can easily include the primary lesions of nasopharyngeal carcinoma and cervical lymph node drainage area in the irradiation field area.
The overall five-year survival rate after radiotherapy can be more than 50%. In addition, the summary of the treatment of recurrence of nasopharyngeal carcinoma also shows that re-radiation therapy still has some therapeutic value. Therefore, radiotherapy is the first choice, followed by chemotherapy or surgery.
In principle, combined facial and cervical fields are used, including nasopharyngeal cavity, skull base parapharyngeal space and upper cervical lymph nodes, and neck irradiation includes cervical tangential field and cervical vertical lateral field.
In recent years, the use of central irradiation techniques such as low dissolution point lead block makes the 5-year survival rate and local control rate of patients higher than conventional radiotherapy, which is first made of polymer plastic mask to fix the mold, positioned under the simulator, and determine the target area of radiotherapy according to the positioning film.
2.Surgery For residual or locally recurrent foci after radiotherapy, selective surgery is still an effective means, and its indications: (1) residual nasopharyngeal primary foci 3 months after radical radiotherapy, with limited lesions.
(2) Residual cervical lymph nodes or local recurrence after radical radiotherapy.
Chemotherapy is not highly effective in nasopharyngeal cancer, but concurrent radiotherapy can be used to enhance the sensitivity of radiotherapy, and the effective drugs include cisplatin, 5-fluorouracil, paclitaxel and cyclophosphamide.