Familial Nasopharyngeal Carcinoma 6

Surgery for Recurrent Nasopharyngeal Carcinoma 20William Ignace WeiCONTENTS20.1 Introduction 25320.2 Surgical Anatomy 25420.2.1 Surgical Anatomyof the Nasopharynx 25420.2.2 Surgical Anatomy of the Neck 25520.3 Management of Neck Recurrencein Nasopharyngeal Carcinoma 25520.3.1 Recurrence in the NeckAfter Radiotherapy 25520.3.2 Diagnosis of Neck Recurrence 25620.3.3 Surgical Salvage Procedures 25620.3.4 Pathological Basis of Surgical Salvage 25720.3.5 Salvage of Extensive Neck Recurrence 25820.4 Management of Recurrent Carcinomain the Nasopharynx 25920.4.1 Local Recurrence of NasopharyngealCarcinoma 25920.4.2 Brachytherapy 25920.4.3 Nasopharyngectomy 26120.5 Summary 263References 264William Ignace Wei, MS FRCS, FRCSE, FRACS (Hon), FACS,FHKAM (Surg) (ORL)Queen Mary Hospital, The University of Hong Kong, Pok FuLam Road, Hong Kong SAR, P.R. China20.1IntroductionThe utilization of conformal radiation therapy andcombined chemoradiation therapy has substantiallyimproved the outcome of nasopharyngeal carcinoma(NPC) after treatment. However, local and/or regionalrecurrences remain a major concern of treatmentfailure. Therapeutic modalities are usually limited,and the outcome of nasopharyngeal cancer patientswho experience local and/or regional recurrences isusually suboptimal.Surgery plays a relatively limited role in the initialmanagement of nasopharyngeal cancer; however, it isan important treatment option for patients who experiencerecurrence after definitive radiation therapy orchemoradiation therapy. Isolated recurrence in thecervical without evidence of distant metastasis or localrecurrence in the nasopharynx can usually be successfullymanaged by surgery. For local recur rence in oraround the nasopharynx, salvage treatment using reirradiationis a valid option. However, as most patientswith recurrent NPC are previously treated with definitivedose of irradiation to the nasopharynx and itssurrounding structures, high incidence of significantcomplications could result from the second course ofirradiation. Alternative salvage measures have beenintroduced, in the treatment of recurrent disease inthe nasopharynx this include the introduction ofbrachytherapy source into the tumor or surgical resectionof the pathology. These treatment options areapplicable especially when the residual or recurrenttumor is of limited size and is localized in thenasopharynx.The aim of this chapter is to address the anatomicaland pathological basis as well as the procedures ofsurgical management for the recurrent NPC in theneck or nasopharynx. As a thorough understanding ofthe surgical anatomy is crucial for the proper surgical