Recurrent nasopharyngeal carcinoma: treatment outcomes and morbidity

Purpose of review: This review highlights current management strategies for recurrent nasopharyngeal carcinoma (NPC) and their balance between efficacy and toxicity. Recent findings: Optimal management of recurrent NPC requires individualized, multidisciplinary decisions that consider not only oncologic control but also functional outcomes and toxicity. Advances in imaging and Epstein--Barr virus DNA monitoring are improving early detection and risk stratification, helping tailor salvage approach to patient and disease factors. Recent evidences also shows that severe toxicity is not only modality-dependent but is shaped by patient and disease-related factors. Summary: Endoscopic nasopharyngectomy achieves the best outcomes in resectable cases, with higher survival and lower morbidity than re-irradiation (re-RT). Extended resections are feasible only in selected cases. Re-RT, particularly with hyperfractionated intensity-modulated RT or proton therapy, remains essential for unresectable tumors but demands careful patient selection and vigilant management of late adverse effects. Systemic therapy has uncertain benefit, while immunotherapy is mostly effective in metastatic disease. Nodal recurrence is mainly managed with neck dissection, with prognosis shaped by extranodal spread and recurrence type.