Definitive irradiation of nasopharyngeal carcinoma: analysis of results and failures in 103 cases.

: During the period 1975-1984, 103 patients were treated for nasopharyngeal carcinoma. Most of them presented with an advanced stage: 64 stage IV and 26 stage III. Sixty-one patients presented with neck nodes, which was the most frequent symptom of presentation. The histologic subtypes included 64 squamous cell carcinoma and 39 undifferentiated carcinoma. All patients were treated by high energy sources with portals encompassing the primary and the whole neck. Doses ranged from 50-55 Gy in T1 patients to 65-70 Gy in T4 patients. The mean survival was 58.5 months, and 31 patients were alive and disease free at 60 months from treatment. A clear difference in survival emerged among T1, T2-3, and T4 patients (p greater than 0.01), whereas there was no significant difference between T2 and T3 patients. Also, N0 and N1 showed no significant difference in 5-year disease-free survival (38% and 41%, respectively); only 20% of N2 and 7% of N3 patients survived for more than 5 years. As regards histology, 25% of patients with a squamous cell carcinoma and 36% of those with an undifferentiated carcinoma were alive at 5 years. The presence of distant metastases (in 20 patients) was not correlated with T stage but was strongly correlated with N stage; histology did not affect the development of metastases. There clearly was no correlation between T and N stage, a behavior which probably constitutes a characteristic of these tumors. From our analysis we can affirm that N stage has a greater influence on prognosis and final outcome than T stage, at least using the UICC staging criteria.