Impact of Clinical Surveillance on Outcomes of Locally Recurrent Nasopharyngeal Carcinoma

Background: Local recurrence of nasopharyngeal carcinoma (NPC) occurs in 10%-20% of patients, with salvage potential in early recurrences. Yet, clear surveillance protocols are lacking. We compare survival outcomes and suitability for salvage in symptomatic and incidentally detected locally recurrent NPC.

Methods: Locally recurrent NPC patients, initially diagnosed at the National Cancer Center Singapore between October 2003 and November 2009, were identified. Demographics, symptoms, detection modalities, and survival outcomes were analyzed.

Results: Eighty-two patients were studied. Median follow up and time to local recurrence was 5.51 and 2.19 years; 45.1% were symptomatic; 65.9% were diagnosed incidentally; 62.2% were offered salvage treatment. Symptomatic patients (vs. asymptomatic) had lower 5-year overall-survival (39.1% vs. 74.5%, p = 0.011). Nonincidental diagnoses (vs. incidental) had lower 5-year overall-survival (33.6% vs. 71.1%, p = 0.02). Incidentally-detected recurrences (vs. nonincidental) were more likely offered salvage treatment (75.9% vs. 35.7%, p < 0.001).

Conclusion: Routine clinical examination, nasoendoscopy, and imaging allow early detection of asymptomatic recurrences, with improved outcomes.