Familial Nasopharyngeal Carcinoma 6

264 W. I. WeiFig. 20.21. The mucoperiosteum over the hard palate is liftedas a flap (arrow heads) after the division of the greater palatinevessel (arrow). Then the osteotomy between the two incisors(dotted line) will not be in the same plane as incision of thesoft tissuecourse of radiation therapy may be associated withsignificant treatment-induced complications.Surgical salvage is a valid treatment option fornasopharyngeal cancer patients who experiencelocal/regional recurrences. Radical neck dissectionis a commonly utilized modality for patients withmore limited neck recurrence, and radical neck dissectionwith after-loading brachytherapy can beconsidered for patients with more extensive disease,especially when surgical margins are dubious. A66% of disease control and 37% of overall survivalrates can be expected after surgical salvage for isolatedneck recurrences in NPC. For local recurrencein the nasopharynx, treatment associated mortalityafter nasopharyngectomy is low, and the 5-yearactuarial local control and disease-free survivalrates after salvage nasopharyngectomy were 65 and54%, respectively.ReferencesChen MK, Lai JC, Chang CC, Liu MT (2007) Minimally invasiveendoscopic nasopharyngectomy in the treatment of recurrentT1 – 2a nasopharyngeal carcinoma. Laryngoscope117:894–896Choy D, Sham JS, Wei WI, Ho CM, Wu PM (1993) Transpalatalinsertion of radioactive gold grain for the treatment ofpersistent and recurrent nasopharyngeal carcinoma. IntJ Radiat Oncol Biol Phys 25:505–512Chua DT, Sham JS, Wei WI, et al (2001) The predictive value ofthe 1997 American Joint Committee on Cancer stage classificationin determining failure patterns in nasopharyngealcarcinoma. Cancer 92:2854–2855Fee WE Jr, Moir MS, Choi EC, Goffinet D (2002) Nasopharyngectomyfor recurrent nasopharyngeal cancer: a 2- to 17-yearfollow-up. Arch Otolaryngol Head Neck Surg 128: 280–284Fee WE Jr, Roberson JB Jr, Goffinet DR (1991) Long-term survivalafter surgical resection for recurrent nasopharyngealcancer after radiotherapy failure. Arch Otolaryngol HeadNeck Surg 117:1233–1236Fisch U (1983) The infratemporal fossa approach for nasopharyngealtumors. Laryngoscope 93:36–44Harrison LB, Weissber JB (1987) A technique for interstitialnasopharyngeal brachytherapy. Int J Radiat Oncol BiolPhys 13:451–453Hung SC, Lui LT, Lynn TC (1985) Nasopharyngeal cancer:study III. A review of 1206 patients treated with combinedmodalities. Int J Radiat Oncol Biol Phys 11:1789–1793Kam MK, Chau RM, Suen J, et al (2003) Intensity-modulatedradiotherapy in nasopharyngeal carcinoma: dosimetricadvantage over conventional plane and feasibility of doseescalation. Int J Radiat Oncol Biol Phys 56:145–157Kwong DL, Wei WI, Cheng AC, Choy DT, Lo AT, Wu PM, ShamJS (2001) Long term results of radioactive gold grainimplantation for the treatment of persistent and recurrentnasopharyngeal carcinoma. Cancer 91:1105–1113Lee AW, Foo W, Law SC, et al (1997) Nasopharyngeal carcinoma:presenting symptoms and duration before diagnosis.Hong Kong Med J 3:355–361Lee AW, Lau WH, Tung SY, et al (2005) Preliminary results of arandomized study on therapeutic gain by concurrent chemotherapyfor regionally-advanced nasopharyngeal carcinoma:NPC-9901 Trial by the Hong Kong NasopharyngealCancer Study Group. J Clin Oncol 23:6966–6975Lee AW, Law SC, Foo W, Poon YF, Cheung FK, Chan DK, TungSY, Thaw M, Ho JH (1993) Retrospective analysis of patientswith nasopharyngeal carcinoma treated during 1976–1985:survival after local recurrence. Int J Radiat Oncol Biol Phys26:773–782Lee AW, Sham JS, Poon YF, Ho JH (1989) Treatment of stageI nasopharyngeal carcinoma: analysis of the patternsof relapse and the results of withholding elective neckirradiation. Int J Radiat Oncol Biol Phys 17:1183–1190Law SC, Lam WK, Ng MF, Au SK, Mak WT, Lau WH (2002)Reirradiation of nasopharyngeal carcinoma with intracavitarymold brachytherapy: an effective means of localsalvage. Int J Radiat Oncol Biol Phys 54:1095–1113Lui MT, Hsieh CY, Chang TH, et al (2003) Prognostic factorsaffecting the outcome of nasopharyngeal carcinoma. JpnJ Clin Oncol 33:501–508Morton RP, Liavaag PG, McLean M, Freeman JL (1996)Transcervico-mandibulo-palatal approach for surgical salvageof recurrent nasopharyngeal cancer. Head Neck18:352–358Ng RW, Wei WI (2005) Elimination of palatal fistula after themaxillary swing procedure. Head Neck 27:608–612Ng RW, Wei WI (2006) Quality of life of patients with recurrentnasopharyngeal carcinoma treated with nasopharyngectomyusing the maxillary swing approach. Arch OtolaryngolHead Neck Surg 132:309–316Palazzi M, Guzzo M, Bossi P, et al (2004) Regionally advancednasopharyngeal carcinoma: long term outcome after sequentialcheomtherpy and radiotherapy. Tumori 90:60–65