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Page 8 of 11 Pang et al. Mini-invasive Surg 2024;8:27 https://dx.doi.org/10.20517/2574-1225.2023.124

[57]
mortality . Current literature underscores that variables such as expansive tumor volume, advanced-stage
recurrence, and positive surgical margins stand out as independent detrimental prognostic markers
influencing both local control and the overall survival rate post salvage nasopharyngectomy [58,59] .

NON-SURGICAL ADVANCEMENTS IN NPC TREATMENT
[60]
While surgical interventions have historically played a pivotal role in managing NPC , the treatment
landscape has been significantly shaped by non-surgical modalities. Advances in both radiotherapy and
chemotherapy reflect the ongoing efforts of the medical community in improving NPC outcomes.

[61]
One of the landmark developments in this domain has been the advent and adoption of IMRT . IMRT
offers the advantage of delivering radiation doses with precision, targeting the tumor while preserving
adjacent normal tissues. This approach not only diminishes treatment-related side effects but also results in
enhanced local control and overall survival. Parallel to this, the refinement of chemotherapy regimens,
including induction, concurrent, and adjuvant strategies, has further revolutionized the NPC treatment
paradigm .
[62]

Furthermore, the treatment arsenal for NPC has been enriched with the introduction of immune
checkpoint therapies . Agents targeting checkpoints such as PD-1/PD-L1 and CTLA-4 have shown
[63]
exceptional efficacy, rejuvenating the immune system’s ability to recognize and combat NPC cells [64,65] .

Given these technological and pharmacological strides, there is an air of optimism surrounding the future
treatment prospects for NPC . The crux of this optimism lies in integrating radiotherapy, chemotherapy,
[2]
and the nascent immunotherapies. This holistic approach not only aims to improve survival rates but also
prioritizes patients’ quality of life by reducing treatment-induced complications.

In sum, while surgical techniques are invaluable in the management of NPC, the leaps in non-surgical
modalities, ranging from IMRT to immune checkpoint therapies, paint a hopeful picture for comprehensive
NPC treatment in the future.

CONCLUSION AND FUTURE DIRECTIONS
In the management of recurrent nasopharyngeal neoplasms, surgical resection is increasingly favored when
practicable. This preference is due to its potential for greater efficacy and reduced side effects compared to
radiotherapy. Modern surgical paradigms are steadily gravitating towards minimally invasive techniques in
nasopharyngectomy, emphasizing approaches such as TORS and 3D high-definition endoscopic
nasopharyngectomy.

Looking ahead, the evolution of nasopharyngectomy is expected to be significantly shaped by technological
advancements. Promising opportunities include exploring the therapeutic potential of immunotherapy and
integrating strategies such as concurrent radiotherapy and chemotherapy or combining surgery with
chemotherapy. These approaches aim to provide a more comprehensive and effective management of
nasopharyngeal malignancies.

DECLARATIONS
Authors’ contributions
Conceived the study design, undertook the methodology, collected and analyzed data, and edited the
manuscript: Pang F, Guo Y, Liu TR