Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma – A case-matched comparison

Background: Salvage ENPG and IMRT are more effective treatments for rNPC than traditional 2-dimensional radiotherapy. However, compared with IMRT, the benefits of ENPG have not yet been clearly described. Methods: We defined a resectable area in which the disease could be radically removed using ENPG and our imaging specialists selected eligible patients with tumors confined to this resectable area from a database of rNPC patients. Using propensity scores to adjust for some potential prognostic factors, a well-balanced cohort of 144 limited rNPC patients was created by matching each patient who underwent ENPG (study group) with one who underwent IMRT (control group). Morbidity, long-term oncological results, treatment-related complications, medical costs, and quality of life were compared. Results: Compared with IMRT, ENPG was associated with a relatively good overall survival (5-year OS, 77.1% vs 55.5%, P = .003), QOL conservation (mean global health status score, 57.6 vs 29.8, P < .001), and significant decreases in post-treatment complications (12.5% vs 65.3%, P < .001), medical costs (23 645.90 vs 118 122.53 Yuan, P < .001) ≈ (€2371.71 vs 11,847.80, P < .001). Conclusions: Salvage ENPG may be more effective for maximizing survival and QOL benefits and minimizing treatment-related complications and medical costs for limited rNPC patients, as compared with IMRT