Prognostic Factors of Nasopharyngeal Carcinoma Treated by Radiotherapy

This study was a retrospective analysis of 82 patients with histologically confirmed nasopharyngeal carcinoma, who were treated at Keio University Hospital from March 1983 to March 1993. We studied all cases (62% of them were stage IV) with regard to their prognostic factors and chronic side effects induced by radiation. All patients were received extended-field radiotherapy from the base of the skull to the supraclaviclar lymph node area. The five- and ten-year overall survival rates for the entire group were 59% and 49%, respectively. Three stage I patients were alive without recurrence or métastases for more than 5 years. The ten-year survival rate stage II-III for patients (23 patients) was 78%, and for stage IV (56 patients) 37%. The five-year survival rate of patients in T2-3 group without lymph node metastasis was 88%, while it was reduced to 55% for patients with metastasis. The prognosis of T4 patients was very poor: their five-year survival rate was 37% with lymph node metastasis, and 35%, without lymph node metastasis. Patients under 46 years old showed an increased survival rate compared with patients over 46 years old. Patients who completed less than 52 days of radiation therapy found to have a better prognosis than those receiving radiation for a longer period. Our multivariate analysis indicated that age, radiation period and N-factor were statistically significant in influencing prognosis. Hearing loss occured relatively high with 2096 of cumulative incidence in our study, probably because they received radiation therapy with the extended field including bilateral midle and inner ear. Extended-field radiotherapy for patients with nasopharyngeal carcinoma might contribute to improving their cure-rate, and precise radiation planning is warranted to avoid the late complications such as hearing loss.