Wide variation of probability of local failure and distant metastasis among various stages of patients with nasopharyngeal carcinoma.
OBJECTIVE
Although radiation therapy is the mainstay of therapy in nasopharyngeal carcinoma (NPC), the optimal dosage schemes for treating the primary tumor or cervical lymph node metastases have not been generally agreed upon. NPC is thought to be a tumor well suited to treatment with adjuvant chemotherapy because distant metastases are more common than with other head and neck sites. However, there are several reports that fail to demonstrate improved survival in chemotherapy treated patients. Careful selection of patients for chemotherapy may be required in order to show a benefit.


METHODS
A total of 61 patients with nasopharyngeal carcinoma seen between January, 1972 and December, 1985 who were treated with radiation therapy alone were reviewed. We analyzed the factors influencing distant metastasis and primary control.


RESULTS
The five-year survival rate for observed and relapse-free survival were 44% and 31%, respectively. The survival rates for N3 in TNM classification and for N3 in Ho's classification were significantly worse and distant metastasis rates were significantly higher as compared with N0, N1, N2. 16 of 25 patients who had distant metastases developed them following locoregional failure. No patient with N0, N1, N2a, N2b developed distant metastases without a locoregional recurrence. There were several recurrent cases in which radiation was terminated when tumor disappeared at inspection or palpation. The five-year survival rates for T4 was 0%.


CONCLUSIONS
The patients with N3 in TNM. Ho's classification or locoregional failure may be candidates for chemotherapy, because they have a high probability of distant metastasis. CT should be used in T staging routinely to exclude tumor involvement of the base of the skull. 70 Gy may be appropriate for T3 disease, even if tumor disappeared at lower doses. More than 70 Gy may be required to treat T4 tumors. 50 Gy may be appropriate for N0, N1 and N2b and 70 Gy for N2c and N3, even if tumor was not palpable at lower doses.
Sakata
K
K
Department of Radiology, Tokyo University School of Medicine, Japan.
Aoki
Y
Y
Karasawa
K
K
Hasezáwa
K
K
Muta
N
N
Nakagawa
K
K
Terahara
A
A
Onogi
Y
Y
Sasaki
Y
Y
Akanuma
A
A
D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate