Preparatory endonasal surgical modification to create a functional corridor for effective photoimmunotherapy in residual nasopharyngeal carcinoma: a case report

Yoshiya Ishida; Akihito Watanabe; Kaoru Miyakoshi; Shuto Hayashi; Masato Hangai; Kosuke Miyazaki; Ruka Hashimoto; Tetsuji Wada

doi:10.18203/issn.2454-5929.ijohns20260796

Authors

Yoshiya Ishida Department of Otolaryngology–Head and Neck Surgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan
Akihito Watanabe Department of Otolaryngology–Head and Neck Surgery, Keiyukai Sapporo Hospital, Shiroishi, Sapporo, Hokkaido, Japan
Kaoru Miyakoshi Department of Otolaryngology–Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Shuto Hayashi Department of Otolaryngology–Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Masato Hangai Department of Otolaryngology–Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Kosuke Miyazaki Department of Otolaryngology–Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Ruka Hashimoto Department of Otolaryngology–Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
Tetsuji Wada Department of Otolaryngology–Head and Neck Surgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20260796

Keywords:

Photoimmunotherapy, Nasopharyngeal carcinoma, Endoscopic surgery, Functional corridor, Head and neck cancer

Abstract

Delivering effective photoimmunotherapy (PIT) in the anatomically constrained nasopharynx is technically challenging. Optimizing laser access is essential for achieving complete tumor illumination and maximizing treatment efficacy. A man in his fifties with refractory residual nasopharyngeal carcinoma (NPC) underwent preparatory endonasal surgical modification consisting of endoscopic resection of the posterior nasal septum and inferior turbinates. This procedure created a straight transnasal functional corridor and provided an adequate standoff distance for frontal diffuser placement. PIT was subsequently administered using intravenous cetuximab sarotalocan sodium, according to the standard protocol. The newly established functional corridor enabled stable and uniform laser illumination of the nasopharyngeal lesion. The procedure was completed without intraoperative or postoperative complications. Endoscopy and biopsy performed seven weeks after PIT confirmed a complete response, and the patient remained disease-free at 12 months of follow-up. Preparatory endonasal surgical modification can overcome anatomical barriers and facilitate safe and effective PIT delivery for residual NPC. By simplifying laser access and reducing technical demands, this minimally invasive approach may facilitate broader clinical use of PIT in anatomically constrained nasopharyngeal regions.

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References

Lee AWM, Ng WT, Chan JYW, Corry J, Mäkitie A, Mendenhall WM, et al. Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat Rev. 2019;79:101890. DOI: https://doi.org/10.1016/j.ctrv.2019.101890

See A, Chu C, Kiong KL, Teo C, Tan HK, Wong EWY, et al. Surgical salvage of recurrent nasopharyngeal cancer: a multi-institutional review. Oral Oncol. 2021;122:105556. DOI: https://doi.org/10.1016/j.oraloncology.2021.105556

Leong YH, Soon YY, Lee KM, Wong LC, Tham IWK, Ho FCH. Long-term outcomes after reirradiation in nasopharyngeal carcinoma with intensity-modulated radiotherapy: a meta-analysis. Head Neck. 2018;40(3):622-31. DOI: https://doi.org/10.1002/hed.24993

Cognetti DM, Johnson JM, Curry JM, Kochuparambil ST, McDonald D, Mott F, et al. Phase 1/2a, open-label, multicenter study of RM-1929 photoimmunotherapy in patients with locoregional, recurrent head and neck squamous cell carcinoma. Head Neck. 2021;43(12):3875-87. DOI: https://doi.org/10.1002/hed.26885

Tahara M, Okano S, Enokida T, Ueda Y, Fujisawa T, Shinozaki T, et al. A phase I, single-center, open-label study of RM-1929 photoimmunotherapy in Japanese patients with recurrent head and neck squamous cell carcinoma. Int J Clin Oncol. 2021;26(10):1812-21. DOI: https://doi.org/10.1007/s10147-021-01960-6

Okamoto I. Photoimmunotherapy for head and neck cancer: a systematic review. Auris Nasus Larynx. 2025;52(2):186-94. DOI: https://doi.org/10.1016/j.anl.2025.01.005

Okamoto I, Okada T, Tokashiki K, Tsukahara K. Quality-of-life evaluation of patients with unresectable locally advanced or locally recurrent head and neck carcinoma treated with head and neck photoimmunotherapy. Cancers (Basel). 2022;14:18. DOI: https://doi.org/10.3390/cancers14184413

Omura G, Honma Y, Matsumoto Y, Shinozaki T, Itoyama M, Eguchi K, et al. Transnasal photoimmunotherapy with cetuximab sarotalocan sodium: outcomes on the local recurrence of nasopharyngeal squamous cell carcinoma. Auris Nasus Larynx. 2023;50(4):641-45. DOI: https://doi.org/10.1016/j.anl.2022.06.004

Idogawa H, Shinozaki T, Okano W, Matsuura K, Hayashi R. Nasopharyngeal carcinoma treated with photoimmunotherapy. Cureus. 2023;15(11):e49315. DOI: https://doi.org/10.7759/cureus.49315

Kushihashi Y, Masubuchi T, Okamoto I, Fushimi C, Hanyu K, Yamauchi M, et al. Photoimmunotherapy for local recurrence of nasopharyngeal carcinoma: a case report. Int J Otolaryngol Head Neck Surg. 2022;11:258-65. DOI: https://doi.org/10.4236/ijohns.2022.115027

Hanyu K, Okamoto I, Tokashiki K, Tsukahara K. A case of successful treatment with an immune checkpoint inhibitor after head and neck photoimmunotherapy. Case Rep Oncol. 2024;17(1):169-74. DOI: https://doi.org/10.1159/000536166

Cognetti DM, Curry JM, Johnson J, Kwon M, Su SY, Civantos F, et al. Safety and efficacy findings from a phase Ib/II study of ASP-1929 photoimmunotherapy with pembrolizumab in recurrent and/or metastatic head and neck squamous cell carcinoma. Head Neck. 2026; 48(1):160-74. DOI: https://doi.org/10.1002/hed.70014

Enokida T, Ogawa T, Homma A, Okami K, Minami S, Nakanome A, et al. A multicenter phase II trial of paclitaxel, carboplatin, and cetuximab followed by chemoradiotherapy in patients with unresectable locally advanced squamous cell carcinoma of the head and neck. Cancer Med. 2020;9(5):1671-82. DOI: https://doi.org/10.1002/cam4.2852

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. Version 5.2025. Plymouth Meeting, PA: National Comprehensive Cancer Network. 2025. Available at: https://www.nccn.org/professionals/ physician_gls/pdf/head-and-neck.pdf Accessed on 25 September 2025.

Bozkurt G, Turri Zanoni M, Ferrari M, Ioppi A, Kara Peker S, Elhassan H, et al. Salvage surgery in nasopharyngeal cancer: unraveling the efficacy of transnasal endoscopic nasopharyngectomy for advanced stage recurrent tumors. Oral Oncol. 2024;159:107048. DOI: https://doi.org/10.1016/j.oraloncology.2024.107048