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H. Xu - W. Li - H. Zhang - K. Xue - Y. Gu - H. Li - Q. Liu - D. Wang - Q. Liu

DOI: 10.4193/Rhin26.296

BACKGROUND Salvage endoscopic nasopharyngectomy (SEN) for recurrent nasopharyngeal carcinoma (rNPC) with internal
carotid artery (ICA) involvement carries prohibitive risks of catastrophic hemorrhage and incomplete resection. This study aims to evaluate the efficacy and safety of preoperative ICA embolization.
METHODS: Between January 2006 and December 2022, 535 patients who underwent SEN for rNPC were retrospectively screened. Among 140 patients with radiological ICA involvement, 114 eligible patients were identified after predefined exclusions. Propensity score matching (1:1) yielded 50 well-balanced pairs comparing SEN with preoperative ICA embolization versus SEN alone.
Endpoints included overall survival, progression-free survival, R0 resection rate and the incidence of treatment-related complications.
RESULTS: The embolization group demonstrated a statistically significant improvement in progression-free survival (PFS) compared to the non-embolization group. While overall survival (OS) showed a favorable clinical trend for the embolization cohort, it did not reach statistical significance. Preoperative embolization facilitated a significantly higher R0 resection rate and drastically reduced the incidence of fatal ICA rupture. Swimming plot analysis revealed prolonged disease stability and enhanced responsiveness to subsequent salvage therapies in the embolization cohort. Additionally, this cohort exhibited lower incidence of postoperative cerebral ischemia, while other treatment-related general adverse events tended to be more frequent, especially in dysphagia.
CONCLUSION: Preoperative ICA embolization is a transformative and safe adjunctive strategy that significantly improves PFS and local oncological control for patients with rNPC involving the ICA.

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