Safety and Efficacy of Salvage Treatment for Recurrent Nasopharyngeal Carcinoma: A Single‐Center Retrospective Study Over 10 Years

BACKGROUND: To analyze survival outcomes and identify prognostic factors in patients with locoregionally recurrent nasopharyngeal carcinoma (NPC) receiving salvage treatment, and to evaluate the safety profile of re-irradiation. METHODS: We retrospectively analyzed clinical data from 95 patients with recurrent NPC (rM0) who were diagnosed and received salvage treatment at the PLA General Hospital between January 2008 and October 2018. Patients were stratified into two treatment groups: the radiotherapy (RT) group (n = 72) and the non-RT group (n = 23). RESULTS: With a median follow-up of 37 months (4-100 months), the 3-year overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) rates were 58.7%, 46.2%, and 33.3%, respectively. The corresponding 5-year OS, PFS, and DSS rates were 34.2%, 31.3%, and 11.1%, respectively. Significant differences in survival outcomes were observed between the RT and non-RT groups: OS (43.4% vs. 0%, p < 0.001), PFS (36.2% vs. 0%, p < 0.001), and DSS (16.2% vs. 0%, p = 0.007). Of the tumor-related deaths, 19 (31.1%) were attributed to massive hemorrhage and 18 (29.5%) to distant metastasis. The univariate and multivariate analyses identified re-irradiation as an independent predictor of superior OS and PFS, and salvage surgery as a predictor of OS improvement. Conversely, advanced nodal disease (rN2-3) independently predicted worse OS and PFS, while local and regional recurrence associated with poorer PFS. CONCLUSION: Salvage re-irradiation significantly improves survival outcomes in locoregionally recurrent NPC, whereas advanced nodal disease (rN2-3) independently predicts poor prognosis. Massive hemorrhage and distant metastasis are the most common causes of death. TRIAL REGISTRATION: Clinical Trial Register: ChiCTR2500098189.