Retreatment in locally recurrent nasopharyngeal carcinoma: Current status and perspectives

Nasopharyngeal carcinoma (NPC) arises from the epithelial cells that cover and line the nasopharynx. While it is considered a rare cancer globally, it is commonly observed in South China and a few other ethnically distinct racial groups. Due to its propensity to spread early through the submucosal tissue and the highly infiltrative nature of this disease, NPC spreads easily through areas of lesser resistance within the pharyngobasilar fascia with a tendency for neural infiltration [1–3]. Radiation therapy (RT) is the most suitable modality for primary curative treatment and can be complemented with either induction, concurrent, or adjuvant chemotherapy in the more advanced cases. The overall predominant cause of treatment failure is distant metastases. However, on average, 10% to 20% of NPC patients present with local recurrence after primary curative treatment. The 5-year local failure-free rate decreases depending on the initial stage of the primary tumor. For T1 disease, this can range from 88% to 100%, whereas for T4 disease, this can drop to 55% to 86% [4–8]. For patients with first local failure, the majority of them have only local recurrence without distant metastases [9]. Recurrent disease is defined as a biopsy-proven disease that recurs after a period of remission following completion of initial treatment, occurring more than 3 months post-treatment [10]. Thus, the prospect of offering salvage treatment to these patients is to achieve control of local disease in order to have a chance of cure, as well as allevi-