[Analysis of 33 patients with nasopharyngeal carcinoma--surgical management for persistent tumor after radiation therapy].
We report thirty-three patients treated for nasopharyngeal carcinoma (NPC) in our clinic from 1976 to 1997. They consisted of 24 males and 9 females, and their ages ranged from 17 to 76 years with an average of 56 years. Fourteen patients initially presented with ear symptoms due to tubal insufficiency, 11 with cervical lymphadenopathy, 6 with nasal symptoms and 4 with cranial nerve paralysis. The mean interval from the onset of their complaints to the time of difinite diagnosis of NPC was 5.8 months. Seventeen patients (51.5%) had primary sites with T3 or T4. Twenty-four (72.7%) had cervical lymphnode metastases. Thirty (90.9%) were classified as stage III or IV. Radiation therapy is a mainstay of treatment of NPC because of anatomic restrictions and a high degree of radiosensitivity. An average of total radiation dose was 63.9Gy for the primary site except in one patient (28Gy followed by surgery due to poor response to radiation). In two patients, high-dose intracavity radiation by remote afterloading system was performed. They have been free from disease since then for more than 3 years. Radiation therapy was combined with an administrations of 5-fluorouracil and vitamim A (FAR therapy), or a low-dose of cisplatin in 2 and 5 patients, respectively. Local recurrence was detected in none of these patients and this combined therapy seemed to be effective in controlling the primary lesion. The overall 5-year survival rate was 56.9% (Kaplan-Meier method), however, that of patients with stage IV was still poor; 33.2%. This emphasizes the importance of an early diagnosis of NPC. Twelve patients underwent surgical resection of the residual tumor at the primary site after radiotherapy. As a surgical approach to the nasopharynx, the transmandibular transpterygoid approach was employed in five patients. This procedure offers a wider exposure of the nasopharynx than either the transmaxillary or the transpalatal approaches. Although distant metastasis was detected in three of the five patients, none of them developed local recurrence. The 5-year survival rate in 12 patients with surgery was 65.6%, which was better than 49.2% in 21 patients without surgery. Neck dissection was performed on 14 patients after radiotherapy. None had cervical recurrence postoperatively. The surgical treatments are recommended for patients with postradiation residual primary tumor and/or cervical metastasis.
Hyodo
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M
Department of Otolaryngology, Ehime University, School of Medicine.
Yumoto
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate