Re-irradiation versus surgery for locally recurrent nasopharyngeal carcinoma

In the randomised, controlled, phase 3 trial published in The Lancet Oncology reported by You-Ping Liu and colleagues, 1 Liu Y-P Wen Y-H Tang J et al. Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021; 22: 381-390 Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar 200 patients with locally recurrent nasopharyngeal carcinoma (NPC) were enrolled and randomly assigned to endoscopic nasopharyngectomy (ENPG) or intensity-modulated radiotherapy (IMRT). The aims of the study were to compare the safety and efficacy of the two treatment methods. The results favoured ENPG in terms of toxicity and overall survival, but not distant metastasis-free survival. 1 Liu Y-P Wen Y-H Tang J et al. Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021; 22: 381-390 Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar Exploratory analyses identified no benefit of ENPG for patients with rT3 tumours. We commend the authors on completing the first randomised, controlled trial comparing salvage treatments for recurrent NPC; however, we would like to raise concerns and caution readers to not change practice based solely on these results. Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trialEndoscopic surgery significantly improved overall survival compared with IMRT in patients with resectable locally recurrent NPC. These results suggest that ENPG could be considered as the standard treatment option for this patient population, although long-term follow-up is needed to further determine the efficacy and toxicity of this strategy. Full-Text PDF Re-irradiation versus surgery for locally recurrent nasopharyngeal carcinomaWe read with interest the results of the randomised, controlled, phase 3 trial by You-Ping Liu and colleagues1 in The Lancet Oncology, in which they compared endoscopic nasopharyngectomy (ENPG) to re-irradiation using intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) with an isolated locoregional recurrence. With overall survival as the primary endpoint, the investigators reported that overall survival was better with ENPG than with IMRT (hazard ratio 0·47, 95% CI 0·29–0·76). Full-Text PDF Re-irradiation versus surgery for locally recurrent nasopharyngeal carcinoma – Authors' replyWe thank Melvin Chua and colleagues and Kathryn Tringale and Nancy Lee for their comments on our recent Article in The Lancet Oncology.1 We agree with Chua and colleagues that this trial represents a subset of patients with crucial selection criteria for tumour resectability, and the results do not justify recommending endoscopic nasopharyngectomy (ENPG) as the new standard of care for all patients with locoregional recurrent nasopharyngeal carcinoma (rNPC). Both Chua and colleagues and Tringale and Lee raised the question about the allowance of a relatively hypofractionated intensity-modulated radiotherapy (IMRT) regimen. Full-Text PDF