Treatments for recurrent nasopharyngeal cancer

Recurrent nasopharyngeal cancer means that the cancer has come back (recurred) after it has been treated. The following are treatment options for recurrent nasopharyngeal cancer. Your healthcare team will suggest treatments based on your needs and talk with you to develop a treatment plan.

Treatment options depend on where the cancer comes back and which treatments you received for the original cancer.

Chemoradiation is a treatment for recurrent nasopharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. The chemotherapy makes the radiation more effective.

Chemoradiation usually uses cisplatin, with or without fluorouracil (5-fluorouracil or 5-FU) or another drug, and external radiation therapy.

You may be offered radiation therapy for recurrent nasopharyngeal cancer. If you have had radiation therapy to treat the original tumour, treating the same area with radiation again can cause more severe side effects. The radiation team will base treatment doses and schedules on the amount of radiation that was previously used to treat the cancer.

External radiation therapy is the type of radiation therapy that is usually given for recurrent nasopharyngeal cancer.

Stereotactic radiosurgery may also be given as a boost after external beam radiation therapy or chemoradiation.

Brachytherapy may be used to treat a recurrent nasopharyngeal cancer if external radiation therapy was used to treat the original tumour. Brachytherapy may also be given as a boost with external radiation to increase the amount of radiation delivered to the tumour.

Surgery may be a treatment option for nasopharyngeal tumours that come back in the same place as the original tumour. The goal of surgery is to remove the tumour. The type of surgery that may be used is a nasopharyngectomy to remove part of the nasopharynx.

A neck dissection removes the lymph nodes in the neck (cervical lymph nodes). It may be done if the cancer comes back in the lymph nodes.

Other surgeries may be offered to relieve symptoms or give supportive care for advanced nasopharyngeal cancer. These include:

• placement of a feeding tube (usually with a gastrostomy) to make sure you get enough nutrients
• placement of a breathing tube (called a tracheostomy) to help you breathe

You may be offered chemotherapy for recurrent nasopharyngeal cancer. Cancer that comes back in distant places is usually treated with chemotherapy. The following drugs may be used alone or in combination:

• methotrexate
• epirubicin
• doxorubicin
• paclitaxel
• capecitabine
• bleomycin
• gemcitabine
• docetaxel
• cisplatin
• carboplatin

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. Immunotherapy may be used to treat recurrent nasopharyngeal cancer.

Pembrolizumab (Keytruda) may be used as a first-line therapy to treat unresectable recurrent nasopharyngeal cancer, with or without chemotherapy.

Nivolumab (Opdivo) is used to treat recurrent nasopharyngeal cancer that has stopped responding to chemotherapy with platinum drugs such as cisplatin or carboplatin.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with nasopharyngeal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.