Author(s): Lee AW, Poon YF, Foo W, Law SC, Cheung FK,
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Abstract This is a retrospective analysis of 5037 patients with squamous cell carcinoma of the nasopharynx treated during the years 1976-1985. The stage distribution according to Ho's classification was 9\% Stage I, 13\% II, 50\% III, 22\% IV, and 6\% Stage V. Only 4488 (89\%) patients had a full course of megavoltage radiation therapy. The median equivalent dose to the nasopharyngeal region was 65 Gy and cervical region in node-positive patients 53 Gy. Seventy percent (906/1290) of the node-negative patients had no prophylactic neck irradiation. The overall actuarial 10-year survival rate was 43\%, and the corresponding failure-free survival 34\%. Altogether, 4157 (83\%) patients achieved complete remission lasting more than 6 months, but 53\% (2205/4157) of them relapsed after a median interval of 1.4 years. The 10-year actuarial local, regional, and distant failure-free rates were 61\%, 64\%, and 59\%, respectively. Thirty-eight percent (338/891) of all patients with local recurrence achieved second local remission. The local complete remission rate with aggressive re-irradiation alone was 47\% (333/706). But 37\% (124/338) of the responders recurred the second time. The incidence of distant failure correlated significantly with both the N-stage and the T-stage, with the highest (57\%) occurring in patients with N3 disease. The incidence of nodal relapse in node-negative patients was 11\% (44/384) among those given prophylactic neck irradiation, but 40\% (362/906) among those without. Therapeutic irradiation achieved a complete regional remission rate of 90\% (306/339). However, despite successful salvage, these patients had a significantly higher distant failure rate than those without nodal relapse, even if they remained local-failure-free (21\% vs 6\%). Patients treated during 1981-1985 achieved significantly better treatment results than those treated during 1976-1980, especially in terms of the overall survival (57\% vs 47\% at 5-year), the overall failure-free survival (42\% vs 35\% at 5-year), and the local failure-free rate (70\% vs 63\% at 5-year). The possible contributing factors are discussed.
This article was published in Int J Radiat Oncol Biol Phys
and referenced in Journal of Integrative Oncology