Nasopharyngeal carcinoma in the young

Abstract

This study was carried out to determine whether locoregional control of nasopharyngeal carcinoma in the young by irradiation has improved since 1975. Fifty-seven consecutive, previously untreated, patients, less than 30 years old, were diagnosed and treated at University of Toronto Hospitals between 1958 and 1990; 21 patients were treated before and 36 after 1975. Staging was as follows: M 0, n=54; M 1; n=3; T 1 + T 2, n=26; T 3 + T 4, n=31; N 0, n=10; N 1 + N 2a, n=10; N 2b + N 2c, n=24; N 3, n=13. All patients were irradiated. The primary tumour dose was 3500–7000 cGy (median 5450). Adjuvant chemotherapy was introduced in 1977. Subsequently, 10/26 (38%) M 0 patients received this treatment. For all 57 patients, 10-year survival was 56%. For 52 M 0 patients with complete follow-up data, 10-year survival was 63%; 10-year relapse free survival (RFS) was 61%. Age, sex, race, and histology were not significant variables. Ten-year RFS results were: T 1 + T 2,M 0 (n=24) 70%, T 3 + T 4,M 0 (n=27) 52%, ( P = 0.25); N 0–N 2c (n=41) 64%, N 3 (n=ll) 54% ( P = 0.31). Relapse occurred in 20/52 (38%) patients. Survival from the date of first relapse was 10% at 10 years. No patient with systemic relapse survived. Only 1/32 (3%) patients treated after 1975 developed an isolated locoregional relapse, giving a 10-year isolated locoregional relapse free rate (LR RFS) of 96%, compared with 5/20 (25%) prior to 1975, which gave a 10-year LR RFS of 75% ( P = 0.05). Two of the five patients who relapsed before 1975 were salvaged by re-irradiation. Systemic relapse, either alone or combined with locoregional relapse, accounted for 6/11 (55%) relapses before 1975 and 8/9 (89%) after 1975. Ten-year systemic RFS was 90% for patients who received adjuvant chemotherapy (n=10) and 72% for patients treated since 1977 by irradiation alone (n=16) ( P = 0.41). Isolated local relapse was exceptional in patients treated after 1975 (1/32). Local control was obtained with radiation doses in the range 3500–6600 cGy (median 5600). Effective systemic treatment will be required to further improve overall results.