Curative surgery for recurrent nasopharyngeal carcinoma via the infratemporal fossa approach

Objective: To determine the proper indications (and thus define good candidates) for the infratemporal fossa approach (ITFA) in the treatment of recurrent nasopharyngeal carcinoma (NPC). Design: Retrospective analysis of 11 consecutive patients who had recurrent NPC after radiation therapy failure and were treated with curative surgery via the ITFA approach from july 1, 1993, to November 20, 1999. The mean follow-up was 32.5 months (range, 9-56 months). Setting: Academic tertiary referral center. Results: Patients who had a recurrent tumor confined to the Rosenmuller fossa (rT1; n = 3) or extending to the parapharynx (rT2; n = 3) maintained a clear surgical margin and were disease free. However, patients who had rT1 (n = 1) or rT2 (n = 1) tumors crossing the midline of the posterior nasopharyngeal wall had surgical margin involvement and their tumors recurred, and all patients with rT3 (n = 2) or rT4 (n = 1) tumors eventually died of the disease. Conclusions: Resection of recurrent NPC via ITFA is useful for tumors located in the Rosenmuller fossa with or without parapharyngeal extension. However, tumors extending to the contralateral nasopharyngeal mucosa and tumors at an advanced stage are not suitable indications for ITFA.