Prognostic features and treatment outcome in patients with nasopharymgeal carcinoma: An experience of 20 years

Background. The best treatment of Nasopharyngeal Carcinoma (NPC) is still an open question. The purpose of this retrospective study was to determine risk factors that affect locoregional control and treatment outcome of NPC patients after radiotherapy, with or without chemotherapy. Methods. Between January 1976 and December 1996, 66 consecutive patients (stage I=O; stage II=13; stage III=32; stage IV=21) were given definitive radiotherapy at a single Institution. Concurrent or adjuvant chemotherapy was also given to 14 of them (21%). Multivariate analysis was performed to evaluate age, T stage, N stage, radiotherapy dose, histology, chemotherapy bone of skull erosions or cranial nerve palsies and base of skull involvement as prognostic factors of locoregional control and overall survival. Results. By the end of January 2000, after a median follow-up of 66 months and a minimal follow-up of 36 months, the event-free overall survival rate of 5 years was 48% and the overall survival 54%. Risk factor analysis revealed that radiotherapy dose, age and stage were the most important factors for overall survival of these patients. The 5 year overall survival was 89% for stage II and 49% for stage III-IV (p=0.0004), 62% for dose higher than 60 Gy and 20% for dose below 60 Gy (p=0.007), 62% for age below 65 years and 36% for age higher than 65 years (p=0.027). The concurrent or adjuvant chemotherapy did not have prognostic significance. Conclusions. We confirm the need to determine the risk factors in patients with NPC. The choice of treatment, whether radiotherapy alone, at dose > 60 Gy, or radiotherapy plus chemotherapy, should be made after identification of patients with high risk disease, suitable for the combined modality.