1
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Li JS, Blanchard P, Wong CHL, Ahn YC, Bonomo P, Bresson D, Caudell J, Chen MY, Chow VLY, Chua MLK, Corry J, Dupin C, Giralt J, Hu CS, Kwong DLW, Le QT, Lee AWM, Lee NY, Li YZ, Lim CM, Lin JC, Mendenhall WM, Moya-Plana A, O'Sullivan B, Ozyar E, Pan JJ, Qiu QH, Sher DJ, Snyderman CH, Tao YG, Tsang RK, Wang XS, Wu PA, Yom SS, Ng WT. International Recommendations on Postoperative Management for Potentially Resectable Locally Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02954-7. [PMID: 39009321 DOI: 10.1016/j.ijrobp.2024.07.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/25/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
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.
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Affiliation(s)
- Ji-Shi Li
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Charlene H L Wong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Damien Bresson
- Department of Neurosurgery, Hôpital Foch, Suresnes, France
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Velda L Y Chow
- Division of Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Melvin L K Chua
- Department of Head and Neck and Thoracic Radiation Oncology; Precision Radiotherapeutics Oncology Programme, Division of Medical Sciences, National Cancer Centre Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - June Corry
- Division of Radiation Oncology, GenesisCare Radiation Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Charles Dupin
- Department of Radiation Oncology, Bordeaux University Hospital, Bordeaux, France
| | - Jordi Giralt
- Department of Radiation Oncology, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Chao-Su Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Dora L W Kwong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Anne W M Lee
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York
| | - You-Zhong Li
- The Second Xiangya Hospital of Central South University, Department of Otorhinolaryngology, Head and Neck Surgery, Changsha, China
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | | | - A Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - Brian O'Sullivan
- Department of Radiation Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Enis Ozyar
- Acibadem MAA University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey
| | - Jian-Ji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Qian-Hui Qiu
- Department of Otolaryngology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh
| | - Yun-Gan Tao
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Raymond K Tsang
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Xiao-Shen Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ping-An Wu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Wai Tong Ng
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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2
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Cui X, Chen Y, Zhao L, Ding X. Extracellular vesicles derived from paclitaxel-sensitive nasopharyngeal carcinoma cells deliver miR-183-5p and impart paclitaxel sensitivity through a mechanism involving P-gp. Cell Biol Toxicol 2023; 39:2953-2970. [PMID: 37296288 DOI: 10.1007/s10565-023-09812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Paclitaxel treatment has been applied for late-stage nasopharyngeal carcinoma (NPC), but therapy failure usually occurs due to paclitaxel resistance. Besides, microRNAs (miRs) delivered by extracellular vesicles (EVs) have been demonstrated as promising biomarkers affecting cancer development. Our work clarified the role of bioinformatically predicted miR-183-5p, which could be delivered by EVs, in the paclitaxel resistance of NPC. Downstream targets of miR-183-5p were predicted in publicly available databases, followed by GO enrichment analysis. A confirmatory dual-luciferase reporter assay determined the targeting relationship between miR-183-5p and P-glycoprotein (P-gp). The shuttling of extracellular miR-183-5p was identified by immunofluorescence. EVs transferred miR-183-5p from paclitaxel-sensitive NPC cells to paclitaxel-resistant NPC cells. Furthermore, overexpression of miR-183-5p and under-expression of P-gp occurred in clinical samples and cells of NPC. High expression of miR-183-5p corresponded to better survival of paclitaxel-treated patients. The effects of manipulated expression of miR-183-5p on NPC cell activities, tumor growth, and paclitaxel resistance were investigated in vitro and in vivo. Its effect was achieved through negatively regulating drug transporters P-gp. Ectopically expressed miR-183-5p enhanced the cancer-suppressive effects of paclitaxel by targeting P-gp, corresponding to diminished cell viability and tumor growth. Taken together, this work goes to elucidate the mechanical actions of miR-183-5p delivered by EVs and its significant contribution towards paclitaxel sensitivity to NPC. 1. This study provides mechanistic insight into the role of miR-183-5p-containing EVs in NPC. 2. The intercellular transportation of miR-183-5p is mediated by EVs in NPC. 3. Overexpressing miR-183-5p facilitates the anti-tumor effects of paclitaxel in NPC. 4. miR-183-5p suppresses paclitaxel resistance of NPC cells by inhibiting P-gp.
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Affiliation(s)
- Xiangguo Cui
- Department of Otorhinolaryngology Head and Neck, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang, 110000, China
| | - Yu Chen
- Department of Otorhinolaryngology Head and Neck, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang, 110000, China
| | - Lanqing Zhao
- Department of Sleep Medical Center, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Xiaoxu Ding
- Department of Otorhinolaryngology Head and Neck, Shengjing Hospital of China Medical University, Liaoning Province, Shenyang, 110000, China.
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3
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Tsang RK, Chan WCP, Holsinger FC, Chung JCK, Chow VLY, Chan JYW, Ho WK, Wei WI. Long-term results of robotic-assisted nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 2022; 44:1940-1947. [PMID: 35642444 DOI: 10.1002/hed.27115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We have previously reported our early experience in robotic-assisted nasopharyngectomy. The current case series is a report of our experience in 33 robotic-assisted nasopharyngectomy. METHODS Prospective series of patients who underwent robotic-assisted nasopharyngectomy for local recurrent nasopharyngeal carcinoma from January 2010 to March 2019. RESULTS Thirty-one patients underwent robotic-assisted nasopharyngectomy with two additional second procedure for positive margin. Median age is 55 years (29-85). Twenty-five patients had rT1 disease and six patients had tumor invaded sphenoid floor (rT3). Median operative time was 227 min and median blood loss was 200 ml. The median follow-up period for all patients were 38 months. Four patients had local recurrence. Five-year local control rate, overall survival, and disease-free survival are 85.1%, 55.7%, and 69.1%, respectively. CONCLUSION Robotic-assisted nasopharyngectomy for recurrent nasopharyngectomy was showed to have a high local control rate. The operating time was comparable to open surgery.
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Affiliation(s)
- Raymond K Tsang
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Division of Head and Neck Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Floyd Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | | | - Velda L Y Chow
- Division of Head and Neck Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jimmy Y W Chan
- Division of Head and Neck Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai-Kuen Ho
- Department of ENT, Queen Mary Hospital, Hong Kong, China
| | - William I Wei
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China
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4
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See A, Chu C, Kiong KL, Teo C, Tan HK, Wong EWY, Chan JYK, Tsang RKY, Chan J, Chang KP, Chien CY, Hao SP, Chen M, Lim CM. Surgical salvage of recurrent nasopharyngeal cancer- a multi-institutional review. Oral Oncol 2021; 122:105556. [PMID: 34688054 DOI: 10.1016/j.oraloncology.2021.105556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Anna See
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Clarisse Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Kimberley L Kiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Constance Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Hiang Khoon Tan
- Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Eddy W Y Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, NT East, Hong Kong
| | - Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, NT East, Hong Kong
| | - Raymond K Y Tsang
- Division of Otolaryngology, Department of Surgery, University of Hong Kong, Hong Kong
| | - Jimmy Chan
- Division of Otolaryngology, Department of Surgery, University of Hong Kong, Hong Kong
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Po Hao
- Department of Otolaryngology-Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mingyuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chwee Ming Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.
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5
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Li L, London NR, Prevedello DM, Carrau RL. An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension. J Neurol Surg B Skull Base 2021; 83:e537-e544. [DOI: 10.1055/s-0041-1735557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/25/2021] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of lesions with a posterolateral invasion. As a secondary goal, the study intends to propose a classification system of endoscopic endonasal nasopharyngectomy determined by the depth of posterolateral invasion.
Methods Eight cadaveric specimens (16 sides) underwent progressive nasopharyngectomy using an endoscopic endonasal approach. Resection of the torus tubarius, Eustachian tube (ET), medial pterygoid plate and muscle, lateral nasal wall, and lateral pterygoid plate and muscle were sequentially performed to expose the fossa of Rosenmüller, petroclival region, parapharyngeal space (PPS), and jugular foramen, respectively.
Results Technical feasibility of endonasal nasopharyngectomy toward a posterolateral direction was validated in all 16 sides. Nasopharyngectomy was classified into four types as follows: (1) type 1: resection restricted to the posterior or superior nasopharynx; (2) type 2: resection includes the torus tubarius which is suitable for lesions extended into the petroclival region; (3) type 3: resection includes the distal cartilaginous ET, medial pterygoid plate, and muscle, often required for lesions extending laterally into the PPS; And (4) type 4: resection includes the lateral nasal wall, pterygoid plates and muscles, and all the cartilaginous ET. This extensive resection is required for lesions involving the carotid artery or extending to the jugular foramen region.
Conclusion Selected lesions with posterolateral invasion into the PPS or jugular foramen is amenable to a resection via expanded endonasal approach. Classification of nasopharyngectomy based on tumor depth of posterolateral invasion helps to plan a surgical approach.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology—Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
| | - Nyall R. London
- Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Daniel M. Prevedello
- Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
- Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
| | - Ricardo L. Carrau
- Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
- Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
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6
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Sun X, Liu Q, Yu H, Wang H, Zhao W, Gu Y, Li H, Zhao K, Song X, Wang D, Miranda JCF, Snyderman CH. Transinfratemporal Fossa Transposition of the Temporalis Muscle Flap for Skull Base Reconstruction after Endoscopic Expanded Nasopharyngectomy: Anatomical Study and Clinical Application. Skull Base Surg 2021; 83:159-166. [PMID: 35433181 DOI: 10.1055/s-0040-1718764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 08/19/2020] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Temporalis muscle flap (TMF) is widely used in traditional skull base surgery, but its application in endoscopic skull base surgery remains rarely reported. We aimed to investigate the surgical anatomy and clinical application of TMF for reconstruction of skull base defects after expanded endoscopic nasopharyngectomy.
Methods Nine fresh cadaver heads (18 sides) were used for endoscopic dissection at the University of Pittsburgh School of Medicine in the United States. TMF was harvested using a traditional open approach and then transposed into the maxillary sinus and nasal cavity through the infratemporal fossa using an endoscopic transnasal transmaxillary approach. TMF length was then measured. Moreover, TMF was used for the reconstruction of skull base defects of six patients with recurrent nasopharyngeal carcinoma after expanded endoscopic nasopharyngectomy.
Results The length of TMF harvested from the temporal line to the tip of the coronoid process of the mandible was 11.8 ± 0.9 cm. The widest part of the flap was 9.0 ± 0.4 cm. When TMF was dislocated from the coronoid process of the mandible, approximately another 2 cm of reach could be obtained. When the superficial layer of the temporalis muscle was split from the deep layer, the pedicle length could be extended 1.9 ± 0.2 cm. TMF could cover skull base defects in the anterior skull base, sellar, and clivus regions.
Conclusion TMF can be used to reconstruct skull base defects after endoscopic expanded nasopharyngectomy and can effectively prevent the occurrence of serious complications in patients with recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Huan Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Weidong Zhao
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Yurong Gu
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Houyong Li
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Keqing Zhao
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Xiaole Song
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
| | | | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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7
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Analysis of Surgical Approaches to Skull Base Tumors Involving the Pterygopalatine and Infratemporal Fossa. J Craniofac Surg 2019; 30:589-595. [DOI: 10.1097/scs.0000000000005108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Roger V, Patron V, Moreau S, Kanagalingam J, Babin E, Hitier M. Extended endonasal approach versus maxillary swing approach to the parapharyngeal space. Head Neck 2018; 40:1120-1130. [PMID: 29385316 DOI: 10.1002/hed.25092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 09/24/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The nasopharyngeal and parapharyngeal spaces are difficult for surgeons to access. Of the various external routes described, the maxillary swing has emerged as the gold standard because of its simplicity. However, its morbidity has led to the development of less invasive techniques. The purpose of our study was to compare the surgical anatomy of the maxillary swing with that of the endoscopic endonasal approach. METHODS Each procedure was performed on 10 anatomic specimens. The exposure and the limits obtained were evaluated. A CT scan analysis was performed. RESULTS The endoscopic endonasal approach extended the limits, offering wider exposure. The endoscopic endonasal approach made possible better visualization of deep structures and precise dissection of the parapharyngeal spaces. However, the maxillary swing provided better access to the oropharynx and could be completed 3 times faster. CONCLUSION The endoscopic endonasal approach provides excellent exposure, a wide dissection range, and precise definition of anatomic structures, making it an alternative of choice rather than the maxillary swing approach.
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Affiliation(s)
- Vivien Roger
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
| | - Vincent Patron
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France
| | - Sylvain Moreau
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
| | - Jeeve Kanagalingam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Emmanuel Babin
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France
| | - Martin Hitier
- Department of Otolaryngology - Head and Neck Surgery, CHU de Caen, Caen, France.,Department of Anatomy, UNICAEN, Caen, France
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9
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Chan JYW, Wei WI. Three‐dimensional endoscopy for endoscopic salvage nasopharyngectomy: Preliminary report of experience. Laryngoscope 2017; 128:1386-1391. [DOI: 10.1002/lary.26993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical CentreQueen Mary HospitalHong Kong SAR People's Republic of China
| | - William Ignace Wei
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical CentreQueen Mary HospitalHong Kong SAR People's Republic of China
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10
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Chan JYW, Wong STS, Wei WI. Stage II recurrent nasopharyngeal carcinoma: Prognostic significance of retropharyngeal nodal metastasis, parapharyngeal invasion, and carotid encasement. Head Neck 2017; 40:103-110. [PMID: 29083514 DOI: 10.1002/hed.24976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/19/2017] [Accepted: 09/03/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
| | - Stanley Thian Sze Wong
- Division of Head and Neck Surgery, Department of Surgery; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
| | - William Ignace Wei
- Division of Head and Neck Surgery, Department of Surgery; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
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11
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Gao W, Li ZH, Chen S, Chan JYW, Yin M, Zhang MJ, Wong TS. Epstein-Barr virus encoded microRNA BART7 regulates radiation sensitivity of nasopharyngeal carcinoma. Oncotarget 2017; 8:20297-20308. [PMID: 28423621 PMCID: PMC5386763 DOI: 10.18632/oncotarget.15526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 01/10/2017] [Indexed: 12/18/2022] Open
Abstract
Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) is very sensitive to radiotherapy. To date, the underlying mechanism remains poorly understood. Here, we demonstrated that expression of EBV-encoded microRNA BART7 (ebv-miR-BART7) increases responsiveness of NPC to radiation treatment by targeting GFPT1/TGFβ1 signaling. GFPT1 is the the key rate-limiting enzyme of the hexosamine signaling pathway and governs TGFβ1 production. TGFβ1, a pleotropic cytokine with the potency to trigger self-renewal and damage-repair machinery in somatic cells. TGFβ1 can protect zebrafish embryo from the lethal effects of radiation treatment. In silico analysis showed that ebv-miR-BART7 could target GFPT1 transcript. Correlation analysis on primary NPC tissues suggested that ebv-miR-BART7 and GFPT1 have negative expression correlation. Expression of GFPT1 and TGFβ1 were inducible by radiation in NPC cell with ebv-miR-BART7 expression. Further, suppressing endogenous GFPT1 expression inhibited TGFβ1 which subsequently increased the responsiveness of NPC to radiation treatment. Taken together, our results demonstrated that ebv-miR-BART7 controls TGFβ1 production by targeting GFPT1. Detection of ebv-miR-BART7 may provide useful indicator for monitoring NPC progression and predict therapeutic outcomes.
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Affiliation(s)
- Wei Gao
- Department of Surgery, The University of Hong Kong, Hong Kong SAR.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Guangdong Province, China
| | - Zeng-Hong Li
- Department of Otolaryngology, The First People's Hospital of Foshan, Guangdong Province, China
| | - Siqi Chen
- Department of Surgery, The University of Hong Kong, Hong Kong SAR.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Guangdong Province, China
| | - Jimmy Yu-Wai Chan
- Department of Surgery, The University of Hong Kong, Hong Kong SAR.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Guangdong Province, China
| | - Min Yin
- Department of Otorhinolaryngology Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min-Juan Zhang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Guangdong Province, China
| | - Thian-Sze Wong
- Department of Surgery, The University of Hong Kong, Hong Kong SAR.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, Guangdong Province, China
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12
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Vogt P, Mett T, Broelsch G, Radtke C, Gellrich NC, Krauss J, Samii M, Ipaktchi R. Interdisciplinary reconstruction of oncological resections at the skull base, scalp and facial region. Surg Oncol 2017; 26:318-323. [DOI: 10.1016/j.suronc.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/10/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
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13
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Choi NY, Kim HJ, Baek CH. Surgical management of extensive osteoradionecrosis in nasopharyngeal carcinoma patients with the maxillary swing approach and free muscular flaps. Clin Otolaryngol 2017; 42:1100-1104. [PMID: 28306199 DOI: 10.1111/coa.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/01/2022]
Affiliation(s)
- N Y Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - H J Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - C H Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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14
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Gao W, Li JZ, Chen S, Chu C, Chan JY, Wong T. BEX3 contributes to cisplatin chemoresistance in nasopharyngeal carcinoma. Cancer Med 2017; 6:439-451. [PMID: 28083995 PMCID: PMC5313644 DOI: 10.1002/cam4.982] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) can develop cisplatin‐resistant phenotype. Research has revealed that enriched in cancer stem cell population is involved in developing cisplatin‐resistant phenotype. CD271 is a candidate stem cell maker in head and neck cancers. The CD receptor does not possess any enzymatic property. Signal transduction function of CD271 is mediated by the cellular receptor‐associated protein. Our data showed that Brain‐expressed X‐linked 3 (BEX3), a CD271 receptor‐associated protein, was overexpressed in NPC. BEX3 overexpression was a unique event in cancer developed in the head and neck regions, especially NPC. BEX3 expression was inducible by cisplatin in NPC. In cisplatin‐resistant NPC xenograft, treatment with nontoxic level of cisplatin led to a remarkable increase in BEX3 level. High BEX3 expression was accompanied with high octamer‐binding transcription factor 4 (OCT4) expression in cisplatin‐resistant NPC. To confirm the inducing role of BEX3 on OCT4 expression, we knockdown BEX3 using siRNA and compared the expression of OCT4 with mock transfectants. Suppressing BEX3 transcripts led to a significant reduction in OCT4. In addition, targeting BEX3 using shRNA could increase the sensitivity of NPC cells to cisplatin. In summary, our results indicated a unique functional role of BEX3 in mediating the sensitivity of NPC cells to cisplatin. Targeting or blocking BEX3 activity might be useful in reversing the cisplatin‐resistant phenotype in NPC.
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Affiliation(s)
- Wei Gao
- Department of SurgeryThe University of Hong KongHong Kong SARChina
| | - John Zeng‐Hong Li
- Department of SurgeryThe University of Hong KongHong Kong SARChina
- Department of OtolaryngologyThe First People's Hospital of FoshanGuangdong ProvinceChina
| | - Si‐Qi Chen
- Department of SurgeryThe University of Hong KongHong Kong SARChina
| | - Chiao‐Yun Chu
- Department of SurgeryThe University of Hong KongHong Kong SARChina
| | | | - Thian‐Sze Wong
- Department of SurgeryThe University of Hong KongHong Kong SARChina
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15
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Gao W, Lam JWK, Li JZH, Chen SQ, Tsang RKY, Chan JYW, Wong TS. MicroRNA-138-5p controls sensitivity of nasopharyngeal carcinoma to radiation by targeting EIF4EBP1. Oncol Rep 2017; 37:913-920. [PMID: 28075468 DOI: 10.3892/or.2017.5354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/26/2016] [Indexed: 11/06/2022] Open
Abstract
Radiation therapy is the standard treatment for primary nasopharyngeal carcinoma (NPC). MicroRNA regulates cancer responsiveness to radiation therapy by controlling the genes involved in radiation responses. Recent studies suggested that downregulation of microRNA-138-5p was clinically significant in NPC. Here, we evaluated the effect of miR-138-5p on radiosensitivity of NPC cells and explored the underlying mechanisms by identifying its target gene that impacted sensitivity to radiation. Our results revealed that overexpression of miR-138-5p reduced the ability to form colonies, inhibited proliferation, and enhanced radiation-induced DNA damage and autophagy in NPC cells upon radiation treatment. By integrating predicted targets with the transcripts downregulated by miR-138-5p, EIF4EBP1 was identified to be a target gene of miR-138-5p. Results from luciferase reporter assay demonstrated that miR-138-5p downregulated the expression of EIF4EBP1 by binding to the 3'-UTR. Silence of EIF4EBP1 enhanced radiosensitivity of NPC cells as evidenced by reduced ability to form colonies after radiation exposure. In summary, our results indicated that miR-138-5p enhanced radiosensitivity of NPC cells by targeting EIF4EBP1. Further studies are warranted to investigate the potential use of miR-138-5p in the clinical management and treatment prediction of NPC patients.
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Affiliation(s)
- Wei Gao
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Jacky Wei Kei Lam
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - John Zeng-Hong Li
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Si-Qi Chen
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | | | - Jimmy Yu-Wai Chan
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Thian-Sze Wong
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, P.R. China
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16
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Vlantis AC, Lee DL, Wong EW, Chow SM, Ng SK, Chan JY. Endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma: a case series, literature review, and pooled analysis. Int Forum Allergy Rhinol 2016; 7:425-432. [DOI: 10.1002/alr.21881] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/01/2016] [Accepted: 10/19/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Alexander C. Vlantis
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
| | - Dennis L.Y. Lee
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
- Department of Otorhinolaryngology; Head and Neck Surgery; United Christian Hospital, Kowloon East Cluster; Hong Kong
| | - Eddy W.Y. Wong
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
| | - Samuel M.W. Chow
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
| | - Siu K. Ng
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
| | - Jason Y.K. Chan
- Department of Otorhinolaryngology; Head and Neck Surgery; Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong
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Simon F, Vacher C, Herman P, Verillaud B. Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study. Laryngoscope 2016; 126:1562-6. [DOI: 10.1002/lary.25870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/28/2022]
Affiliation(s)
- François Simon
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
| | - Christian Vacher
- Department of Maxillofacial Surgery; AP-HP, Beaujon Hospital, Paris Diderot University; Paris France
| | - Philippe Herman
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology; AP-HP, Lariboisière Hospital, Paris Diderot University; Paris France
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18
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Chan JYW, Tsang RKY, Wong STS, Wei WI. Indocyanine green fluorescence mapping of sentinel lymph node in patients with recurrent nasopharyngeal carcinoma after previous radiotherapy. Head Neck 2015; 37:E169-73. [DOI: 10.1002/hed.24052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jimmy Yu Wai Chan
- Department of Surgery, Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; People's Republic of China
| | - Raymond King Yin Tsang
- Department of Surgery, Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; People's Republic of China
| | - Stanley Thian Sze Wong
- Department of Surgery, Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; People's Republic of China
| | - William Ignace Wei
- Department of Surgery, Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; People's Republic of China
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19
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Masuda M, Fukushima J, Fujimura A, Uryu H. Combined transcervical and orbitozygomatic approach for the removal of a nasopharyngeal adenocarcinoma. Auris Nasus Larynx 2015; 43:192-6. [PMID: 26165630 DOI: 10.1016/j.anl.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/24/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In some cases, the exposure and safeguarding of the internal carotid artery (ICA) are not easy by the maxillary swing approach that is used as a mainstay for the removal of nasopharyngeal tumors. To address this issue, we have developed a new combined transcervical and orbitozygomatic approach. METHODS A nasopharyngeal adenocarcinoma arose in a 52-year-old patient and occupied the right middle skull base extending to the ICA. We first identified and dissected the ICA from the posterolateral part of the tumor using a transcervical approach. Then, the tumor was approached and removed by an orbitozygomatic technique with hemifacial dismasking. The surgical defect was filled using a temporal muscle flap, which was divided into two parts according to the blood supply from either the anterior or the posterior deep temporal artery. RESULTS The postoperative course was uneventful and favorable cosmetic results were obtained. The patient has been free of carcinoma for more than 40 months after the surgery. CONCLUSION Our new combined approach might be a good option for selected patients with nasopharyngeal tumors.
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Affiliation(s)
- Muneyuki Masuda
- Department of Head and Neck Surgery, National Kyushu Cancer Center, 3-1-1, Notame, Minamiku, Fukuoka 811-1395, Japan.
| | - Junichi Fukushima
- Department of Otorhinolaryngology and Head and Neck Surgery, Japanese Fukuoka Red Cross Hospital, 3-1-1, Okusu, Minamiku, Fukuoka 815-8555, Japan
| | - Akiko Fujimura
- Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
| | - Hideoki Uryu
- Department of Otorhinolaryngology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan
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20
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Chan JYW, Wei WI. Impact of resection margin status on outcome after salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 2015; 38 Suppl 1:E594-9. [PMID: 25783024 DOI: 10.1002/hed.24046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to present the postoperative local tumor control and survival with regard to the different resection margin statuses during salvage nasopharyngectomy. METHODS We conducted a whole-organ study of nasopharyngectomy specimens. RESULTS Between 2005 and 2010, 126 patients underwent maxillary swing nasopharyngectomy. The T classification of the recurrent tumor was: T1, 23.8%; T2, 41.3%; T3, 28.6%; and T4, 6.3%. The chance of clear, close, and involved resection margins at nasopharyngectomy was 44.4%, 31.0%, and 24.6%, respectively. At follow-up, the corresponding risk of local tumor recurrence after surgery was 10.7%, 38.5%, and 67.7%, respectively. The local tumor control was significantly worse in patients with involved margins compared with those with close margins (p = .01), which was, in turn, significantly worse than those with clear margins (p = .04). CONCLUSION The primary objective of salvage nasopharyngectomy is to achieve clear resection margins. Close and involved margins result in significantly inferior local tumor control and overall survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E594-E599, 2016.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Department of Surgery, Division of Head and Neck Surgery, Center for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region of the People's Republic of China
| | - William Ignace Wei
- Department of Surgery, Division of Head and Neck Surgery, Center for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region of the People's Republic of China
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21
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Chan JYW, Wong STS, Wei WI. The role of Epstein-Barr virus-encoded microRNA BART7 status of resection margins in the prediction of local recurrence after salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma. Cancer 2015; 121:2358-66. [PMID: 25955785 DOI: 10.1002/cncr.29380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Local recurrence is the major cause of treatment failure in patients who undergo surgical salvage of recurrent nasopharyngeal carcinoma (NPC) after radiotherapy. The authors investigated the role of Epstein-Barr virus (EBV)-encoded Bam HI-A rightward transcript 7 microRNA (BART7) status in resection margins in the identification of a subgroup of patients who may benefit from adjuvant reradiation after surgery. METHODS One hundred two consecutive patients who had histologically clear resection margins after undergoing nasopharyngectomy for recurrent NPC were studied. The status of EBV microRNA BART7 in resection margins was investigated and correlated with the pattern of subsequent disease recurrence. RESULTS After a median follow-up of 64 months, 20 patients (19.6%) developed local recurrence after surgery despite histologically uninvolved margins. The risk of local recurrence in patients with histologically close (<5 mm) and clear (≥5 mm) margins was 31.6% and 12.5%, respectively. In patients with clear histologic margins, those with margins that were positive for EBV microRNA BART7 has a significantly higher chance of developing local tumor recurrence (P = .016) than those with negative molecular margins. The difference was not significant when the histologic clearance at the resection margins was <5 mm. CONCLUSIONS Tissue EBV microRNA BART7 is useful for identifying a subgroup of patients with histologically clear margins who are at increased risk of subsequent local tumor recurrence. Postoperative adjuvant treatment is warranted for these patients.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
| | - Stanley Thian Sze Wong
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
| | - William Ignace Wei
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hon Kong SAR, China
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22
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23
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Qiu S, Lu J, Zheng W, Xu L, Lin S, Huang C, Xu Y, Huang L, Pan J. Advantages of intensity modulated radiotherapy in recurrent T1-2 nasopharyngeal carcinoma: a retrospective study. BMC Cancer 2014; 14:797. [PMID: 25366703 PMCID: PMC4233080 DOI: 10.1186/1471-2407-14-797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent T1-2 Nasopharyngeal Carcinoma (rT1-2) may be salvaged by 3D – CRT (3D-Conformal Radiotherapy), IMRT (Intensity Modulated Radiotherapy), Brachytherapy (BT), BT with external radiotherapy. The purpose of this study is to address the efficacy and toxicity profile of aforementioned four modalities for rT1-2 NPC. Methods 168 patients, median age 48 years (range 16–75 years) proven rT1-2 NPC were diagnosed and treated with four different irradiation modalities (3D-CRT, IMRT, BT, BT with external radiotherapy). Median time to recurrence was 30 months (range 1–180 months). The median follow-up time was 28 months (range, 4–135 months). Results 161 patients completed a median dose of 6445 cGy (ranging 30 to 87 Gy). Seven patients prematurely terminated their treatment due to acute side-effects and received 30–49 Gy. The 1- and 3-year local regional recurrent free survival (LRRFS), distant free survival (DFS), and overall survival (OS) rates were 82.03% vs. 82.03% vs. 82.58%, 51.33% vs. 51.33% vs. 53.41, respectively. Gender and recurrence T-classification were the two significant adverse prognostic factors for LRRFS, DFS, and OS rates. Grade 3 or 4 toxicities were tolerable. Conclusion 3D-CRT, IMRT, BT, BT with external radiotherapy are feasible and efficacious for rT1-2 NPC. In toxicity 3D-CRT/IMRT group is lower than BT group. IMRT is superior for rT1-2 NPC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
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Chan JYW, Tsang RKY, Wei WI. Morbidities after maxillary swing nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 2014; 37:487-92. [DOI: 10.1002/hed.23633] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/25/2013] [Accepted: 02/17/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jimmy Yu Wai Chan
- Department of Surgery; Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
| | - Raymond King Yin Tsang
- Department of Surgery; Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
| | - William Ignace Wei
- Department of Surgery; Division of Head and Neck Surgery; Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital; Hong Kong SAR China
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25
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Xu T, Tang J, Gu M, Liu L, Wei W, Yang H. Recurrent nasopharyngeal carcinoma: a clinical dilemma and challenge. ACTA ACUST UNITED AC 2013; 20:e406-19. [PMID: 24155638 DOI: 10.3747/co.20.1456] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recurrent nasopharyngeal carcinoma, which represents a small proportion of head-and-neck cancers, has a unique set of patho-clinical characteristics. The management of recurrent nasopharyngeal carcinoma remains a challenging clinical problem. Traditional treatments offer limited local control and survival benefits; more seriously, they frequently induce severe late complications. Recently, novel treatment techniques and strategies-including precision radiotherapy, endoscopic surgery or transoral robotic resection, third-generation chemotherapy regimens, and targeted therapies and immunotherapy-have provided new hope for patients with recurrent nasopharyngeal carcinoma. Some of these patients can potentially be cured with modern treatments. However, a lack of adequate evidence makes it difficult for clinicians to apply these powerful techniques and strategies. Individualized management guidelines, full evaluation of quality of life in these patients, and a further understanding of the mechanisms underlying recurrence are future directions for research into recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- Tao Xu
- Department of Radiation Oncology, First People's Hospital of Foshan Affiliated to Sun Yat-Sen University, Foshan, PR China. ; Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
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Chan JYW. Surgical management of recurrent nasopharyngeal carcinoma. Oral Oncol 2013; 50:913-7. [PMID: 24021797 DOI: 10.1016/j.oraloncology.2013.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Nasopharyngeal carcinoma is a unique tumour which is endemic in Southern China including Hong Kong. While the treatment results for primary cancer has been encouraging, management of persistent or recurrent tumours has been challenging. Compared to other surgical approaches, the maxillary swing operation provides spacious access to the bilateral nasopharynx and the ipsilateral parapharyngeal space, allowing resection of tumours with wide margins. In this article, we will present our results in the surgical management of recurrent nasopharyngeal carcinoma. MATERIALS AND METHODS Retrospective review. RESULTS Over the years, we have performed salvage maxillary swing nasopharyngectomy for 312 patients. Microscopic negative resection margins were achieved in the majority (79.5%) of the patients. The overall local recurrence rate after surgery was 13.1%, the risk of which was significantly higher in patients with previous positive resection margins. The overall 5-year actuarial local tumour control and overall survival was 74% and 62%, respectively, which was significantly higher in patients with clear resection. For small tumours located in the posterior wall, minimally invasive approach can be used, which included the endoscopic resection, or more recently, the transoral robotic (TORS) assisted approach. CONCLUSION The result of surgical salvage of recurrent nasopharyngeal carcinoma is promising. Every effort should be made to ensure microscopic clearance of disease as well as to minimize the potential complications of surgery that may adversely affect the subsequent quality of life.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region.
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27
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Castelnuovo P, Nicolai P, Turri-Zanoni M, Battaglia P, Bolzoni Villaret A, Gallo S, Bignami M, Dallan I. Endoscopic Endonasal Nasopharyngectomy in Selected Cancers. Otolaryngol Head Neck Surg 2013; 149:424-30. [DOI: 10.1177/0194599813493073] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs). Study Design Case series with chart review. Setting Patients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers. Subjects and Methods NER was tailored to the NPT extension and classified as follows: type 1 NER, resection of the posterior nasopharyngeal wall; type 2 NER, resection superiorly extended to the sphenoid; type 3 NER, trans-pterygoid approach to the postero-lateral nasopharynx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal-petrous-cavernous segments of the internal carotid artery. Results Thirty-six consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs were enrolled. The lesions were staged as follows: stage I, 16 (44.4%); stage II, 3 (8.4%); stage III, 15 (41.6%); and stage IVA, 2 (5.6%). Type 1 NER was performed in 6 cases, type 2 NER in 12, type 3 NER in 16, and bilateral-extended type 3 NER in 2. No perioperative mortality or major complications were observed. Postoperatively, 11 patients received intensity-modulated radiotherapy, with or without chemotherapy. Follow-up ranged from 2 to 173 months (mean: 38 months). Five years overall, disease-specific, and disease-free survivals were 75.1% ± 9.13%, 80.9% ± 7.79%, and 58.1% ± 14.8%, respectively. Conclusion NER is a feasible and minimally invasive surgical approach for the management of selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional procedures. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of the technique.
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Affiliation(s)
- Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | | | - Stefania Gallo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Iacopo Dallan
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
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28
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Tsang RK, Mohr C. Lateral palatal flap approach to the nasopharynx and parapharyngeal space for transoral robotic surgery: a cadaveric study. J Robot Surg 2013; 7:119-23. [PMID: 23704859 PMCID: PMC3657084 DOI: 10.1007/s11701-012-0351-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/07/2012] [Indexed: 10/28/2022]
Abstract
The da Vinci surgical robot has been used for minimally invasive surgery of the head and neck region including resection of tumors in the nasopharynx. Access to and vision of the nasopharynx with the robot are difficult. A pure transoral approach and midline palatal split approach have been described. The disadvantage of these approaches is the limited lateral access to the parapharyngeal space. The objective of this study was to investigate the feasibility of accessing the nasopharynx and parapharyngeal space with a lateral palatal flap. Two complete nasopharyngectomies with resection of the parapharyngeal space and exposure of the internal carotid artery and branches of the mandibular nerves were performed on two fresh cadavers with the da Vinci surgical robot. The set up of the robot, the surgical procedure of elevating the lateral palatal flap, and robotic resection of the nasopharynx and parapharyngeal space are described.
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Affiliation(s)
- Raymond K. Tsang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Hong Kong, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong, SAR, China
| | - Catherine Mohr
- Medical Research, Intuitive Surgical Inc., Sunnyvale, CA USA
- Stanford University School of Medicine, Palo Alto, CA USA
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Chan JYW, Wong STS, Wei WI. Whole-organ histopathological study of recurrent nasopharyngeal carcinoma. Laryngoscope 2013; 124:446-50. [PMID: 23712855 DOI: 10.1002/lary.24218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Jimmy Y W Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
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Chan JYW, Wong ST. The role of plasma Epstein‐Barr virus DNA in the management of recurrent nasopharyngeal carcinoma. Laryngoscope 2013; 124:126-30. [DOI: 10.1002/lary.24193] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Jimmy Yu Wai Chan
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong China
| | - Stanley Thian‐Sze Wong
- Division of Head and Neck Surgery, Department of SurgeryUniversity of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary HospitalHong Kong China
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Tsang RKY, Ho WK, Wei WI, Chan JYW. Transoral robotic assisted nasopharyngectomy via a lateral palatal flap approach. Laryngoscope 2013; 123:2180-3. [PMID: 23553323 DOI: 10.1002/lary.24089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/04/2013] [Accepted: 02/12/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Raymond K. Y. Tsang
- Department of Surgery, Queen Mary Hospital; The University of Hong Kong; Hong Kong SAR; China
| | - Wai-Kuen Ho
- Department of Surgery, Queen Mary Hospital; The University of Hong Kong; Hong Kong SAR; China
| | - William I. Wei
- Department of Surgery, Queen Mary Hospital; The University of Hong Kong; Hong Kong SAR; China
| | - Jimmy Y. W. Chan
- Department of Surgery, Queen Mary Hospital; The University of Hong Kong; Hong Kong SAR; China
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