Salvage surgery for cervical residual and recurrent lesions of nasopharyngeal carcinoma after radiotherapy

: Recently, in spite of the great progress made in the radiotherapy for NPC, there remains 10 approximately 20% of patients who would die of their cervical lesions, either residual or recurrent after irradiation. It is well known that the skin of the neck can not tolerate too high a dose of radiation and the cervical metastatic lymph nodes of NPC may be less sensitive to radiation than the primary. From April 1977 to March 1987, 79 NPC patients with persistent cervical lymph node metastasis after irradiation were treated by salvage surgery (31 residual and 48 recurrent cancers). Most of the lesions were located in the upper neck (64 cases) and a few along the margin of previous radiation field, such as submaxillary or posterior cervical triangle. Of the 69 patients treated by salvage neck dissection, 38 were confirmed pathologically to have soft tissues involvement, such as sternocleidomastoid, digastric, splenius, and levator scapular muscles, and 2 had hypoglossus nerve and carotid sheath involvement. The authors emphasized that all the involved tissues, such as skin, muscle, nerve or jugular vein should be resected completely. If the neck defect could not be closed primarily, the pectoral major myocutaneous flap (7 cases) or lateral trapezius myocutaneous flap (3 cases) were used for repair. There were no postoperative complications. 32 patients were followed over 3 years with a 3-year survival rate of 34% (11/32). 43 were followed less than 3 years. 31 were alive and 12 were dead.(ABSTRACT TRUNCATED AT 250 WORDS)