Clinical Efficacy Of Endoscopic Surgery For Patients With Nasopharyngeal Carcinoma After Radiotherapy Who Were Diagnosed As Recurrent Nasopharyngeal Carcinoma And Extensive Osteoradionecrosis Of Skull Base

1.Analysis of clinical efficacy and quality of life of patients after endoscopic nasopharyngectomy for residual or recurrent nasopharyngeal carcinomaObjective To explore the clinical efficacy of patients who underwent endoscopic salvage nasopharyngectomy for residual or recurrent nasopharyngeal carcinoma(rNPC)after irradiation failure,and examine the quality of life(QOL)of them who were at different stage and given different postoperative treatment.Methods Ninety-six patients who underwent endoscopic salvage nasopharyngectomy for rNPC between June 2009 and March 2015 were retrospectively reviewed.rTNM stage:20 cases were at stage ?,16 at stage ?,44 at stage ?,16 at stage ?;rT1 22 cases(22.9%),rT2 16 cases(16.7%),rT3 42 cases(43.8%),rT4 16 cases(16.7%);rN0 92 cases(95.8%),rN1 2 cases(2.1%),rN22 cases(2.1%);NO with distance metastases.All the patients underwent endoscopic resection of lesions,and four cases with cervical metastasis received neck dissection at the same time.Postoperatively the self-reported,health-related QOL questionnaires were used to assess and compare the QOL of survival patients.Results The overall 1 year survival rates(SR)?2 year SR?3 year SR were 83%?68%?63%,respectively.The median follow-up was 43 months.Cox regression analysis indicated the complete resection for rNPC and pathology were two independent factors affecting survival.The QOL of patients who received endoscopic salvage nasopharyngectomy only were better than the patients who received concurrent chemoradiation therapy or chemotherapy.Conclusions The patients who underwent endoscopic salvage nasopharyngectomy for rNPC had a good survival rates and QOL.However,the patients who received concurrent chemoradiation therapy or chemotherapy after endoscopic salvage nasopharyngectomy had a worse QOL.2.Endoscopic surgery and clinic efficacy on extensive osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinomaObjective To investigate the clinical efficacy of endoscopic surgery for extensive osteoradionecrosis(ORN)of skull base in the patients with nasopharyngeal carcinoma(NPC)after radiotherapy.Methods Seventeen patients diagnosed as ORN of skull base after radiotherapy for NPC were retrospectively studied with their clinic data,and all of them underwent endoscopic surgery.Results Based on the Computed Tomography(CT)and endoscopic examination,all patients had large skull base defects with the area of the bone defects averaged 7.02 cm2(range,3.60-14.19 cm2).Excepting for curetting the sequestra,endoscopic surgery also repaired the wound or protected the internal carotid artery by flap in 12 patients.However,no bone reconstructions were conducted on all patients with the bone defects of skull base.CT examinations were taken periodically after endoscopic surgery.The follow-up ranged from 8 months to 6 years(average,14 months),among them 2 patients had been followed up more than 2 years.Only 1 patient had the delayed cerebrospinal fluid(CSF),and others had no any other related complications.Conclusions The patients with extensive ORN could be treated with endoscopic surgery to curette the necrotic bone of skull base,and endoscopic reconstruction provides an alternative technique.It may not be necessary to reconstruct the bone defects at skull base,however,the important exposed structures of skull base,such as internal carotid artery,need the repairing of soft tissue,such as flap.