Clinical Studies of 283 Patients With Undifferentiated Carcinoma of the Nasopharynx (UCN) Treated by Radiotherapy

葉 起源(Chi-Yuan Yeh), 邱 仲峯(Jeng-Fong Chiou), 劉 幕台(Mu-Tai Liu)

Research output: Contribution to journalArticle

Abstract

Purpose: Our objective in this study is to review the results of radiotherapy for patients of undifferentiated carcinoma of nasopharynx (UCN), in terms of local control and overall survival. We also evaluated different prognostic factors for patient survival.
Materials and Methods: A retrospective review was done on 283 patients with UNC patients treated at the department of radiation oncology, Changhua Christian Hospital from 1984 to 1997. All cases were classified histologically according to the WHO criteria for nasopharyngeal tumor, and were then re-staged according to the 4th American joint Committee on Cancer (AJCC, 1992) staging system. Radiotherapy (RT) consisted of 70.2 Gy to the primary tumor with optional boost dose depending on tumor response. Regional lymphatics were irradiated with a dose ranging from 50.4Gy to 70.2 Gy, based on the size of the involved lymph nodes. A cobalt-60 or 6 MV X-ray linear accelerator (Seimens Mevatron) was used for radiotherapy. All patients were then followed-up regularly until death. The Kaplan-Meier method was used to determine actuarial survival. Logrank test and Cox regression analysis were used for comparison and determination of prognostic factors.
Results: Among the 283 patients, a total of 50 patients were excluded from our study due to incomplete treatment. The mean dose received by these patients were 27.09 Gy (range: 3 Gy – 47.5 Gy). Their overall 5-year actuarial survival was only 16.1 %, with a median survival of 14 months. Thirty-seven of 50 patients died. The mortality rate was 74% (37/50), with most of them dying from systemic disease. The remaining 233 patients were analyzed. The male to female ratio was 2.4:1. Three were 28 patients with local recurrence, reflecting a local control rate of 87.9%. Cox regression analysis revealed that N stage was the only significant factor for local control. Sixty (26%) patients developed distant metastasis, mainly to the bone, the lung, and the liver. Analysis revealed that N stage, WHO type and stage were significant factors affecting distant metastasis. The 5-year survival for stage I / II , III, and IV patients were 80% , 65.7% and 49.7%, respectively .Our analysis revealed that N stage were significant prognostic factors for overall survival.
Conclusion: Radiotherapy remains the treatment of choice for undifferentiated carcinoma of the nasopharyns (UCN). However, due to a high rate of distant metastasis, chemotherapy in addition to radiotherapy should be the direction for future clinical trial.
Translated title of the contribution283位未分化鼻咽癌細胞型態(UCN)病患放射治療後之臨床探討
Original languageEnglish
Pages (from-to)233-242
Number of pages10
Journal放射治療與腫瘤學
Volume7
Issue number4
DOIs
Publication statusPublished - 2000

Keywords

  • Undifferentiated carcinoma of the nasopharynx
  • Nasopharyngeal carcinoma
  • Radiotherapy

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