Efficacy of Chemotherapy with Salvage Surgery for Locoregionally Recurrent Nasopharyngeal Carcinoma: A Multicenter Retrospective Study

Background: The role of chemotherapy combined with salvage surgery for locoregionally recurrent nasopharyngeal carcinoma (lrNPC) remains uncertain. This multicenter retrospective study evaluated whether adding chemotherapy to salvage surgery improves survival outcomes and assessed associated toxicity. Methods: Ninety-one patients with resectable lrNPC treated between August 2013 and August 2023 at five institutions in Guangxi, China, were analyzed. Patients received either salvage surgery with chemotherapy (n = 48) or surgery alone (n = 43). Survival outcomes, including overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS), were estimated using the Kaplan–Meier method and compared by the log-rank test. Prognostic factors were identified with multivariate Cox models, and adverse events (AEs) were graded per CTCAE v5.0. Results: After a median follow-up of 55.0 months, no significant differences were observed between the chemotherapy plus surgery and surgery-alone groups in 5-year OS (64.1% vs 61.0%; P = .894), PFS (45.3% vs 49.9%; P = .740), LRFS (47.6% vs 54.9%; P = .421), or DMFS (52.9% vs 56.4%; P = .836). Multivariate analysis identified a longer disease-free interval as an independent predictor of improved OS, while age > 50 years predicted worse DMFS. Chemotherapy was associated with higher rates of anemia, leukopenia, and gastrointestinal toxicity (all P < .05). Conclusions: The addition of platinum-based chemotherapy to salvage surgery does not improve long-term survival in patients with resectable lrNPC and increases treatment-related toxicity. Salvage surgery alone may represent a more appropriate therapeutic approach pending confirmation in prospective trials.