-Surgery may be of use in managing involved neck nodes. It has absolutely no place in the treatment of the primary tumour.

-"Successful" can be defined in many ways. Improved quality of life and extended survival may be considered at least partially successful, even if a total cure isn't achieved. Even though surgery as a salvage therapy for relapsed NPC may not be totally curative, some people seem to have had encouraging short-term results: Arch Otolaryngol Head Neck Surg. 2002 Oct;128(10):1196-7.

Nasopharyngectomy after failure of 2 courses of radiation therapy.

Ibrahim HZ, Moir MS, Fee WW.

Department of Otolaryngology & Bronchoesophagology, Rush-Presbyterian-Sain Luke's Medical Center, Chicago, IL 60602, USA. ibrahimh...@hotmail.com

BACKGROUND: Recurrence of nasopharyngeal carcinoma after initial therapy has been reported to range between 18% and 54%. As an alternative to surgical salvage, patients with recurrent nasopharyngeal carcinoma are offered a second course of radiation therapy. If this second course fails, patients may be candidates for surgical resection. OBJECTIVE: To identify the effectiveness and morbidity of surgical resection of recurrent nasopharyngeal carcinoma in patients who have received 2 cycles of external beam radiation. DESIGN AND SETTING: Retrospective survey of 6 patients in a university-based practice who underwent resection of recurrent nasopharyngeal carcinoma after 2 courses of radiation therapy. PATIENTS: Our study group comprised 4 women and 2 men aged between 35 and 67 years. All patients underwent 2 courses of radiation with a mean total dose of 11 500 rad (115 Gy) (range, 9500-13 200 rad [95-132 Gy]) delivered to the nasopharynx prior to resection. The mean duration between the second course of radiation and resection is 21 months (range, 8-52 months). The mean follow-up period is 7.2 years (range, 4.2-11.5 years). INTERVENTION: Nasopharyngectomy after failure of 2 courses of radiation therapy. MAIN OUTCOME MEASURES: Postoperative clinical outcome and morbidity. RESULTS: Five years after resection, 1 patient died of disease. The remaining 5 patients (83%) are alive with no evidence of disease. Osteomyelitis is the most common complication, affecting 5 patients. Three of the 5 patients with osteomyelitis required operative debridement of the nasopharynx and split-thickness skin grafting. Other complications include oronasal fistula
(2 patients), chronic otitis media (2 patients), and nasopharyngeal stenosis
(1 patient). CONCLUSION: Although poor wound healing is evident, the overall
5-year survival of 83% is encouraging.