A curative-intent endoscopic surgery for postradiation nasopharyngeal necrosis in patients with nasopharyngeal carcinoma

Cancer Communications

Ming-Yuan Chen¹  Shun-Lan Wang¹  Hai-Qiang Mai¹  Yu-Long Xie¹  Yi-Nuan Zhang¹  Yan-Ling Liu²  Meng-Xia Zhang³  Ling Guo⁴  Mei Lin⁴  Rou Jiang⁴  You-Ping Liu⁴  Rui You⁴  Ru-Hai Zou⁵  Pei-Yu Huang⁵  Ming-Huang Hong⁵  Xiong Zou⁵  Chao-Nan Qian⁵  Qi Yang⁵ 

[1] Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China;Department of Otorhinolaryngology, First Hospital Affiliated of Guangzhou University of Traditional Chinese Medicine, Guangzhou, P.R. China;Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China;Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China;State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China

关键词: Nasopharyngeal carcinoma;    Postradiation;    Necrosis;    Endoscopy;    Necrectomy;    Flap;    Reconstruction;    Re-epithelialization;   

DOI  :  10.1186/s40880-018-0338-4

学科分类：肿瘤学

来源: Springer

【 摘 要 】

Postradiation nasopharyngeal necrosis (PRNN) is a severe complication after radiotherapy in patients with nasopharyngeal carcinoma (NPC), which can severely affect the quality of life and threaten the patient’s life. Only 13.4%–28.6% of patients can be cured by traditional repeated endoscopic debridement. Here, we introduced an innovative curative-intent endoscopic surgery for PRNN patients and evaluated its clinical efficacy. Clinical data of 72 PRNN patients who underwent radical endoscopic necrectomy, followed by reconstruction using a posterior pedicle nasal septum and floor mucoperiosteum flap were analyzed to determine the efficacy of this surgery. The endpoints were complete re-epithelialization of the nasopharyngeal defect, relief of headache, and overall survival (OS). All surgeries were successfully performed without any severe postoperative complications or death. The median value of numeric rating scales of pain decreased from 8 before surgery to 0 after surgery (P < 0.001). Fifty-one patients (70.8%) achieved complete re-epithelialization of the nasopharyngeal defect. The number of cycles of radiotherapy (odds ratio [OR], 7.254; 95% confidence interval [CI] 1.035–50.821; P = 0.046), postoperative pathological result (OR, 34.087; 95% CI 3.168–366.746; P = 0.004), and survival status of flap (OR, 261.179; 95% CI 17.176–3971.599; P < 0.001) were independent risk factors of re-epithelialization of the nasopharyngeal defects. Postoperative pathological result (hazard ratio [HR], 5.018; 95% CI 1.970–12.782; P = 0.001) was an independent prognostic factor for OS. The 2-year OS rate of the entire cohort was 77.9%. Curative-intent endoscopic necrectomy followed by construction using the posterior pedicle nasal septum and floor mucoperiosteum flap is a novel, safe, and effective treatment of PRNN in patients with NPC.

【 授权许可】

CC BY