Critical Appraisal of Maxillary Swing Approach for Recurrent Nasopharyngeal Carcinoma

Background: The aim of the current study was to report our results of salvage nasopharyngectomy using the maxillary swing approach for persistent or recurrent nasopharyngeal carcinoma after primary treatment. Methods: Between 1989 and 2011, nasopharyngectomies were performed in 312 patients. Data were composed of retrospective review of records of the first 72 patients followed by a prospective collection of data for the remaining patients. Results: Among our patients, 41 (13.1%) had persistent tumors and 271 (86.9%) had recurrent disease. Resection with clear margins was achieved in 248 (79.5%) patients. All patients survived the operations. The median follow-up duration was 34 months. The overall 5-year actuarial local tumor control was 74% and the overall 5-year disease free survival was 56% (rT1: 78; rT2: 62; and rT3: 48%, respectively). On multivariate analysis, tumor size, resection margin status, and gross tumor in sphenoid sinus were independent prognostic factor for local tumor control. For overall survival, resection margin status, synchronous cervical nodal recurrence, and cavernous sinus invasion were shown to have a negative influence on overall survival after surgery. Conclusions: Maxillary swing nasopharyngectomy is an effective salvage procedure for small, persistent or recurrent tumor in the nasopharynx after primary therapy.