Treatment Result after Radiotherapy Alone for Patients With Early Stage Nasopharyngeal Carcinoma

Abstract

To analyze the treatment result of patients with early stage nasopharyngeal carcinoma after radiotherapy alone and discuss the impact of different T and N stages on the prognoses. From January 1999 to December 2000, 362 consecutive patients with early-stage (T1-2N0-1M0) nasopharyngeal carcinoma were hospitalized for curative radiotherapy in the Cancer Center of Sun yat-sen University. All the patients had undergone CT scans to evaluate the tumor before the treatment. Tumor-node-metastasis Stage (92' Fuzhou staging system) was T1N0 in 17%, T2N0M0 in 36%, T1N1M0 in 13% and T2N1M0 in 34% of patients. Conventional RT was applied to the whole group. 300 patients were treated with external radiotherapy alone while high dose rate intracavitary brachytherapy was delivered to 62 patients after completion of external radiotherapy. All the patients were divided into four groups according to the T and N stages: T1N0, T2N0, T1N1 and T2N1. Overall survival, local-recurrence free survival, regional-recurrence free survival and distant-metastasis free survival were compared between the four groups. Treatment failure was summarized in Table 1. Median follow-up was 70 months (3–100 months). 5-year overall survivals of the whole group was 85%. Difference of 5-year overall survivals between T1N0, T2N0 and T1N1 was not statistically significant, while 5-year overall survival of T2N1 was significantly different from the former three groups. 5-year local-recurrence free survivals and 5-year regional-recurrence free survivals between the four groups had no significant difference. 5-year distant-metastasis free survivals between T1N0, T2N0 and T1N1 were not statistically significant different and that of T2N1 was significantly different from the other three groups. Radiotherapy alone for T1N0, T2N0 and T1N1 yielded satisfactory result. Outcome of T2N1 is obviously poorer than the others, and the main reason of treatment failure for this group is distant metastasis. Patients who have high risk of distant metastasis in the T2N1 group may need combined treatment instead of radiotherapy alone.Table 1Comparison of survivals in subgroups of early-stage NPC according to T/N stagesSurvivalStagesT1N0T2N0T1N1T2N1χ2/p5y-OS96.6%91.3%85.8%73.1%χ2 = 32.28T1N0————p = 0.000∗T2N0χ2 = 1.08———p = 0.299T1N1χ2 = 3.77χ2 = 1.51——p = 0.052p = 0.219T2N1χ2 = 17.92χ2 = 19.52χ2 = 3.95—p = 0.000∗p = 0.000∗p = 0.047∗5y-LRFS96.5%88.9%92.1%87.1%χ2 = 4.13p = 0.2485y-RRFS98.2%97.4%94.4%93.4%χ2 = 1.94p = 0.5855y-DMFS94.9%97.5%95.6%81.2%χ2 = 26.84T1N0————p = 0.000∗T2N0χ2 = 0.52———p = 0.472T1N1χ2 = 0.12χ2 = 0.07——p = 0.732p = 0.798T2N1χ2 = 7.58χ2 = 18.87χ2 = 6.37—p = 0.006∗p = 0.000∗p = 0.012∗5y-OS: 5-year over survival; 5y-LRFS: 5-year local-recurrence free survival; 5y-RRFS: 5-year regional-recurrence free survival; 5y-DMFS: 5-year distant-metastasis free survival: p < 0.05. Open table in a new tab