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Treatment Outcome for Nasopharyngeal Carcinoma in University Malaya Medical Centre from 2004-2008

  • Ee Phua, Vincent Chee (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Loo, Wei Hoong (Faculty of Medicine, International Medical University) ;
  • Yusof, Mastura Md (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Ishak, Wan Zamaniah Wan (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Tho, Lye Mun (Clinical Oncology Unit, Faculty of Medicine, University of Malaya) ;
  • Ung, Ngie Min (Clinical Oncology Unit, Faculty of Medicine, University of Malaya)
  • Published : 2013.08.30

Abstract

Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with NPC referred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), locoregional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentation was common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage 3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. The stipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OS was 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%), neck stiffness (3.1%), dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism (1.2%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.

Keywords

Nasopharyngeal carcinoma;outcome;radiotherapy

References

  1. Ali H, Al-Sarraf M (1999). Nasopharyngeal cancer. Hematol Oncol Clin North Am, 13, 837-48. https://doi.org/10.1016/S0889-8588(05)70096-4
  2. Al-Sarraf M, Pajak TF, Cooper JS, et al (1990). Chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma: a Radiation Therapy Oncology Group study. J Clin Oncol, 8, 1342-51.
  3. Baujat B, Bourhis J, Chan AT, et al (2006). Chemotherapy in locally advanced nasopharyngeal carcinoma: An individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phy, 64, 47-56. https://doi.org/10.1016/j.ijrobp.2005.06.037
  4. Chan ATC, Gregoire V, Lefebvre, et al (2012). Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 23, 83-5. https://doi.org/10.1093/annonc/mds304
  5. Chao KSC, Deasy JO, Markman J, et al (2001). A prospective study of salivary function sparing in patients with head and neck cancers receiving intensity-modulated or three-dimensional radiation therapy: Initial results. Int J Radiat Oncol Biol Phys, 49, 907-15. https://doi.org/10.1016/S0360-3016(00)01441-3
  6. Cox JD, Pajak TF, Marcial VA, et al (1992). Interruptions adversely affect local control and survival with hyperfractionated radiation therapy of carcinomas of the upper respiratory and digestive tracts. New evidence for accelerated proliferation from Radiation Therapy Oncology Group Protocol 8313. Cancer, 69, 2744-8. https://doi.org/10.1002/1097-0142(19920601)69:11<2744::AID-CNCR2820691119>3.0.CO;2-U
  7. Hsu MM, Huang SC, Lynn TC, et al (1982). The survival of patients with nasopharyngeal carcinomas. Otolaryngol Head Neck Surg, 90, 289-95.
  8. Kam KM, Leung SF, Zee B, et al (2007). Prospective randomized study of Intensity-Modulated Radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol, 25, 4873-9. https://doi.org/10.1200/JCO.2007.11.5501
  9. Kwong LW, Sham ST, Chua TT, et al (1997). The effect of interruptions and prolonged treatment time in radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys, 39, 703-10. https://doi.org/10.1016/S0360-3016(97)00339-8
  10. Langendijk JA, Leemans CR, Buter J, et al (2004). The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Onco, 22, 4604-12. https://doi.org/10.1200/JCO.2004.10.074
  11. Lee AW, Poon YF, FOO KW, et al (1992). Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: overall survival and pattern of failure. Int J Radiat Oncol Biol Phys, 23, 261-70. https://doi.org/10.1016/0360-3016(92)90740-9
  12. Lee AWM, Law SCK, Foo W, et al (1993). Retrospective analysis of patients with nasopharyngeal carcinoma treated during 1976-1985: survival after local recurrence. Int J Radiat Oncol Phys, 26, 773-82. https://doi.org/10.1016/0360-3016(93)90491-D
  13. Lee N, Xia P, Quivey JM, et al (2002). Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: An update of the UCSF experience. Int J Radiat Oncol Biol Phys, 53, 12-22. https://doi.org/10.1016/S0360-3016(02)02724-4
  14. Lin SJ, Pan JJ, Han L, et al (2009). Nasopharyngeal carcinoma treated with reduced volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys, 75, 1071-8. https://doi.org/10.1016/j.ijrobp.2008.12.015
  15. Lin ZX, Li DR, Chen ZJ, et al (1999). What is the significance of nasal involvement in nasopharyngeal carcinoma? Int J Radiat Oncol Biol Phys, 45, 907-14. https://doi.org/10.1016/S0360-3016(99)00297-7
  16. Luo RX, Tang QX, Guo KP, et al (1994). Comparison of continuous and split-course radiotherapy for nasopharyngeal carcinoma-An analysis of 1446 cases with squamous cell carcinoma grade 3. Int J Radiat Oncol Biol Phys, 30, 1107-9. https://doi.org/10.1016/0360-3016(94)90316-6
  17. Malaysian Cancer Statistics-Data and Figure Peninsular Malaysia 2006. National Cancer Registry, Ministry of Health Malaysia.
  18. Phua CE, Tan BS, Yong TK, et al (2011). Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Penang General Hospital from 2001-2005. Asian Pac J Cancer Prev, 12, 3197-200.
  19. Phua CE, Tan BS, Tan AL, et al (2012). Intensity-modulated radiotherapy for nasopharyngeal carcinoma: Penang General Hospital experience. Asian Pac J Cancer Prev, 13, 3287-92. https://doi.org/10.7314/APJCP.2012.13.7.3287
  20. Qin DX, Hu YH, Yan JH, et al (1998). Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation. Cancer, 61, 1117-24.
  21. Shu-Chen H (1980). Nasopharyngeal cancer: a review of 1605 patients treated radically with cobalt 60. Int J Radit Oncol Biol Phys, 6, 401-7. https://doi.org/10.1016/0360-3016(80)90052-8
  22. Terence PF, Fernando LD, Roberto AL, et al (2003). Prognostic Factors and Outcome for Nasopharyngeal Carcinoma. Arch Otolaryngol Head Neck Surg, 129, 794-9. https://doi.org/10.1001/archotol.129.7.794
  23. Vikram B, Mishra UB, Strong EW, et al (1985). Patterns of failure in carcinoma of the nasopharynx: I. Failure at the primary site. Int J Radiat Oncol Biol Phys, 11, 1455-9. https://doi.org/10.1016/0360-3016(85)90332-3
  24. Wang DC, Cai WM, Hu YH, et al (1998). Long term survival of 1035 cases of nasopharyngeal carcinoma. Cancer, 61, 2338-41.
  25. Wang JH, Shi M, Hsia YS, et al (2012). Failure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China: A pilot study. Radiat Oncol, 7, 2. https://doi.org/10.1186/1748-717X-7-2

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