Endoscopic Endonasal Nasopharyngectomy and Its Use in Rt3 and Rt4 Recurrent Nasopharyngeal Carcinoma

Background: Endoscopic endonasal nasopharyngectomy (EEN) has been extensively used for rT1 and rT2 recurrent nasopharyngeal carcinoma (rNPC); however, limited literature exists about its use in recurrent T3 (rT3) and T4 (rT4) rNPC. We have performed a systematic review of the literature and reported preliminary data regarding the efficacy and safety of its use in rT3 and rT4 rNPC.

Study Design: Systematic review.

Methods: A systematic PubMed search adherent to PRISMA guidelines included relevant clinical studies reporting the use of the endoscopic endonasal nasopharyngectomy (EEN) for salvage surgery of rT3 and rT4 nasopharyngeal carcinoma (rNPC) in adult humans from 1974 onward. Available data regarding clinical outcomes were abstracted and preliminary results are reported.

Results: Sixteen of 400 articles were eligible for a detailed review of which the majority (n = 11) were retrospective studies. They report on a total of 238 rT3 and rT4 rNPC patients undergoing salvage EEN. Only one study included patients with only rT3 and rT4 disease. A total of 193 rT3 patients were reported in all studies. Six of the 9 studies specifying the extension of rT3 disease included only patients with rT3 disease confined to the sphenoid sinus; 11 studies included individual rT3 survival data. OS is most frequently reported as 2-year OS resulting in a combined 74.1% 2-year OS. DFS was most frequently reported as a 2-year DFS resulting in a combined 2-year DFS of 67.9%. As for rT4, a total of 45 patients were reported in five studies. Four studies included individual rT4 survival data. OS was most frequently reported as 2-year OS by three studies, resulting in a combined 48.5% 2-year OS. DFS was most frequently reported by two studies, as a 2-year DFS resulting in a combined 2-year DFS of 42.9%. No studies specified the extension of rT4 disease. The mean follow-up for all studies was 26.1 (SD: 9.9) months. Of the nine studies reporting complications, the most common was secretory otitis media. Apart from the presence of distant metastasis, and comorbidities contraindicating anesthesia, the most common reasons for exclusion from surgical management were ICA involvement, intracranial intradural extension of disease, and neck metastasis.

Summary: Among these two groups of patients, EEN was mostly used for rT3 rNPC. OS and DFS are higher in rT3 than in rT4 rNPC; however, it must be taken into account that the majority of rT3 patients included have exclusive involvement of the sphenoid sinus as this might greatly improve outcomes given the extent of resection necessary. Overall, limitations of the literature reviewed include lack of rT3 and rT4 subgroup analysis of survival, recurrence and complications, and limited individual patient data. Although the majority of these studies include the use of EEN on rT3 and rT4 rNPC, there is still a need to evaluate its use uniquely on rT3 and rT4 patients.