title: Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  We sought to evaluate the nature and frequency of late toxicities in a cohort of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy alone.
  
  
  METHODS
  Seven-hundred and ninety-six consecutive NPC patients treated using conventional radiotherapy at a single center from 1992 to 1995 were retrospectively analyzed. Patients with histology proven, completely staged, Stage I-IVB World Health Organization Type I-III NPC and completed radical radiotherapy were included. Patients with incomplete staging investigations, distant metastases at diagnosis, previous treatment, and incomplete radiotherapy were excluded. Radiotherapy-related complications were categorized using the RTOG Late Radiation Morbidity Scoring Criteria.
  
  
  RESULTS
  Median follow-up was 7.2 years. The 5-year overall survival and disease free survival were 69% and 56%, respectively, and the corresponding 10-year rates were 52% and 44%. Among 771 patients with at least 3 months of follow-up post treatment, 565 (73%) developed RT-related complications. Diagnosed neurological complications were cranial nerve palsies (n=70; 9%), temporal lobe necrosis (n=37; 5%), Lhermitte's syndrome (n=7; 1%), and brachial plexopathy (n=2; 0.3%). Non-neurological complications included xerostomia (n=353; 46%), neck fibrosis (n=169; 22%), hypo-pituitarism (n=48; 6%), hearing loss (n=120; 16%), dysphagia (n=116; 15%), otorrhea (n=101; 13%), tinnitus (n=94; 12%), permanent tube feeding (n=61; 8%), trismus (n=45; 6%), second malignancies within treatment field (n=17; 2%), and osteo-radionecrosis (n=13; 2%).
  
  
  CONCLUSIONS
  While radiotherapy is curative in NPC, many patients suffer significant late treatment morbidities with conventional radiotherapy techniques.
authors.affiliation: Department of Radiation Oncology, National Cancer Centre Singapore, Singapore. ntrtkl@nccs.com.sg
authors.forename: Jeffrey Kit Loong
authors.initials: JK
authors.lastname: Tuan
authors.forename: Tam Cam
authors.initials: TC
authors.lastname: Ha
authors.forename: Whee Sze
authors.initials: WS
authors.lastname: Ong
authors.forename: Tian Rui
authors.initials: TR
authors.lastname: Siow
authors.forename: Ivan Weng Keong
authors.initials: IW
authors.lastname: Tham
authors.forename: Swee Peng
authors.initials: SP
authors.lastname: Yap
authors.forename: Terence Wee Kiat
authors.initials: TW
authors.lastname: Tan
authors.forename: Eu Tiong
authors.initials: ET
authors.lastname: Chua
authors.forename: Kam Weng
authors.initials: KW
authors.lastname: Fong
authors.forename: Joseph Tien Seng
authors.initials: JT
authors.lastname: Wee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D006801:Humans; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies