International recommendations on postoperative management for potentially resectable locally recurrent nasopharyngeal carcinoma Review
| Authors: | Li, J. S.; Blanchard, P.; Wong, C. H. L.; Ahn, Y. C.; Bonomo, P.; Bresson, D.; Caudell, J.; Chen, M. Y.; Chow, V. L. Y.; Chua, M. L. K.; Corry, J.; Dupin, C.; Giralt, J.; Hu, C. S.; Kwong, D. L. W.; Le, Q. T.; Lee, A. W. M.; Lee, N. Y.; Li, Y. Z.; Lim, C. M.; Lin, J. C.; Mendenhall, W. M.; Moya-Plana, A.; O'Sullivan, B.; Ozyar, E.; Pan, J. J.; Qiu, Q. H.; Sher, D. J.; Snyderman, C. H.; Tao, Y. G.; Tsang, R. K.; Wang, X. S.; Wu, P. A.; Yom, S. S.; Ng, W. T. |
| Review Title: | International recommendations on postoperative management for potentially resectable locally recurrent nasopharyngeal carcinoma |
| Abstract: | Locally recurrent nasopharyngeal carcinoma (NPC) presents substantial challenges in clinical management. Although postoperative re-irradiation (re-RT) has been acknowledged as a potential treatment option, standardized guidelines and consensus regarding the use of re-RT in this context are lacking. This article provides a comprehensive review and summary of international recommendations on postoperative management for potentially resectable locally recurrent NPC, with a special focus on postoperative re-RT. A thorough search was conducted to identify relevant studies on postoperative re-RT for locally recurrent NPC. Controversial issues, including resectability criteria, margin assessment, indications for postoperative re-RT, and the optimal dose and method of re-RT, were addressed through a Delphi consensus process. The consensus recommendations emphasize the need for a clearer and broader definition of resectability, highlighting the importance of achieving clear surgical margins, preferably through an en bloc approach with frozen section margin assessment. Furthermore, these guidelines suggest considering re-RT for patients with positive or close margins. Optimal postoperative re-RT doses typically range around 60 Gy, and hyperfractionation has shown promise in reducing toxicity. These guidelines aim to assist clinicians in making evidence-based decisions and improving patient outcomes in the management of potentially resectable locally recurrent NPC. By addressing key areas of controversy and providing recommendations on resectability, margin assessment, and re-RT parameters, these guidelines serve as a valuable resource for clinical experts involved in the treatment of locally recurrent NPC. © 2024 The Authors |
| Keywords: | controlled study; human tissue; treatment outcome; cancer surgery; overall survival; review; cancer recurrence; intensity modulated radiation therapy; cisplatin; systemic therapy; gemcitabine; cancer radiotherapy; disease free survival; postoperative care; recurrence risk; follow up; consensus; progression free survival; neoplasm recurrence, local; radiotherapy dosage; radiotherapy; evidence based practice; practice guideline; radiation injury; necrosis; clinical management; cetuximab; docetaxel; postoperative complication; feasibility study; systematic review; tumor recurrence; endoscopic surgery; practice guidelines as topic; surgery; consensus development; nasopharynx carcinoma; delphi study; delphi technique; feedback system; postoperative hemorrhage; stereotactic body radiation therapy; decision making; frozen section; nasopharyngeal carcinoma; nasopharynx tumor; nasopharyngeal neoplasms; frozen sections; meta analysis; en bloc resection; surgical margin; clinical target volume; clinical outcome; reirradiation; pharyngectomy; sphenoid sinus; procedures; re-irradiation; internal carotid artery; open surgery; open access; parapharyngeal space; hypofractionated radiotherapy; humans; human; blood vessel graft; hyperfractionation; margins of excision; toripalimab; irradiation dose; broad definitions; evidence- based decisions; irradiation parameters |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 120 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-12-01 |
| Start Page: | 1294 |
| End Page: | 1306 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2024.07.2143 |
| PUBMED: | 39009321 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
