Re-irradiation for recurrent NPC—is the treatment merited at all?

With advances in radiotherapy (RT) technique and chemotherapy strategies, the survival of patients with nasopharyngeal carcinoma (NPC) has improved substantially in the past few decades, with most intensity-modulated radiation therapy (IMRT) series achieving up to 90% loco-regional control (1). The most common site of recurrence remains to be distant. Local recurrence of NPC, albeit uncommon, is extremely debilitating and difficult to manage. Salvage surgery and re-RT are the only curative treatment options available. Randomized study to compare surgery and re-RT is deemed difficult due to the rarity of the condition and the heterogeneity of this heavily pre-treated population. Treatment choice is, therefore, mainly based on each physician’s discretion, availability of expertise and patient’s choice.