晚期復發性鼻咽癌之案例報告

A Case Report of Advanced Recurrent Nasopharyngeal Carcinoma

鼻咽癌的治療主要以放射線治療為主，但是部分腫瘤對放射線治療的反應不佳導致腫瘤殘存或是復發。目前針對這類情況可以給予化學治療、手術治療，在某些條件下還可以進行免疫療法。我們經歷一位47歲女性越南裔新住民，於2018年間診斷為鼻咽癌並接受同步放化療。然而蝶竇一直有腫瘤殘存，經內視鏡腫瘤切除手術以及輔助性化學治療，順利控制腫瘤。未料數月之後追蹤發現有翼腭窩轉移並逐漸往顳下窩擴散。因患者條件無法符合健保給付免疫療法，故先行標靶治療搭配放射線治療。爾後腫瘤依舊無法獲得有效控制，遂安排經翼腭窩內視鏡腫瘤切除加上術後輔助化療。但腫瘤依舊在數月之中大量增生擴散，最終採取緩和治療。對於較後期的鼻咽癌復發，採取手術或是放化療一直是值得討論的議題，本文藉此案例回顧過往的文獻比較其優劣。

The primary treatment modality for nasopharyngeal carcinoma is radiation therapy. However, some tumors exhibit poor response to this form of treatment, resulting in residual tumor survival or recurrence. Currently, chemotherapy, surgery and, in certain conditions, immunotherapy, are available treatment options for such cases. In this case report, we examined a 47-year-old female new resident of Vietnamese descent who was diagnosed with nasopharyngeal cancer in 2018 and received concurrent chemoradiation therapy. However, tumor remnants were found in the sphenoid sinus, which were successfully eradicated by endoscopic resection and adjuvant chemotherapy. Unfortunately, a few months later, metastasis of the pterygopalatine fossa was discovered, whereupon gradually spread to the infratemporal fossa. Since the patient’s conditions did not meet the health insurance criteria for immunotherapy, target therapy was used in conjunction with radiation therapy. However, effective control of the tumor remained elusive, necessitating the arrangement of transpterygoid endoscopic tumor resection, followed by postoperative adjuvant chemotherapy. Despite these efforts, the tumor continued to proliferate and spread over several months, and eventually, we had to resort to palliative treatment for this patient. For the recurrence of nasopharyngeal cancer in advanced stages, surgery or chemoradiation has always been a topic worth discussing, and this article reviews the past literature to compare its advantages and disadvantages.