Prior internal carotid artery embolization to optimize oncological and surgical outcomes in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma
In brief
Carotid embolization linked to better tumor control in recurrent nasopharyngeal cancer
In a propensity-matched retrospective comparison of 50 patient pairs undergoing salvage surgery, preoperative carotid artery embolization was associated with significantly longer progression-free survival, more complete tumor removal, and fewer fatal carotid ruptures. Overall survival showed a favorable but nonsignificant trend; cerebral ischemia was less common, while dysphagia and other general adverse events tended to be more frequent. Whether benefits outweigh added harms needs further study.
- Journal
- Rhinology (Q1)
- Published
- 14 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- H Xu, W Li, H Zhang, K Xue, Y Gu, H Li, et al.
- PMID
- 42873226
- DOI
- 10.4193/Rhin26.296
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 18 October 2026): Pre‑op ICA embolization improves salvage nasopharyngeal surgery
Abstract
UNLABELLED: BACKGROUND Salvage endoscopic nasopharyngectomy (SEN) for recurrent nasopharyngeal carcinoma (rNPC) with internal carotid artery (ICA) involvement carries prohibitive risks of catastrophic hemorrhage and incomplete resection. This study aims to evaluate the efficacy and safety of preoperative ICA embolization. METHODS: Between January 2006 and December 2022, 535 patients who underwent SEN for rNPC were retrospectively screened. Among 140 patients with radiological ICA involvement, 114 eligible patients were identified after predefined exclusions. Propensity score matching (1:1) yielded 50 well-balanced pairs comparing SEN with preoperative ICA embolization versus SEN alone. Endpoints included overall survival, progression-free survival, R0 resection rate and the incidence of treatment-related complications. RESULTS: The embolization group demonstrated a statistically significant improvement in progression-free survival (PFS) compared to the non-embolization group. While overall survival (OS) showed a favorable clinical trend for the embolization cohort, it did not reach statistical significance. Preoperative embolization facilitated a significantly higher R0 resection rate and drastically reduced the incidence of fatal ICA rupture. Swimming plot analysis revealed prolonged disease stability and enhanced responsiveness to subsequent salvage therapies in the embolization cohort. Additionally, this cohort exhibited lower incidence of postoperative cerebral ischemia, while other treatment-related general adverse events tended to be more frequent, especially in dysphagia. CONCLUSION: Preoperative ICA embolization is a transformative and safe adjunctive strategy that significantly improves PFS and local oncological control for patients with rNPC involving the ICA.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.