Abstract
One hundred and one patients with nasopharyngeal squamous cell carcinoma (NPC) were treated with irradiation. The UICC TNM staging system (1978) was applied: 6 patients were T1NO, 10 T2NO, 5 T3NO, 13 T4NO, 11 T1N+, 18 T2N+, 19 T3N+ and 19 T4N+. Since 1978, computed tomography (CT) was available, and 34 patients were examined with CT at first presentation. The technique of radiotherapy was markedly changed around 1978. The field to the primary site and neck were enlarged. Two-year relapse-free survival was significantly better for the post-CT era than pre-CT era. This was mainly due to improved local-recurrence-free survival and cervical-relapse-free survival. Improvement of local-recurrence-free survival, however, was appreciated in only T3+T4 patients, there were no differences in Ti+T2 patients. This failure to increase local-recurrence-free survival in the T1+T2 patients may relate to the fact that a large number of these patients showed T3 or T4 tumors on CT. In 34 patients with CT examination, 14 patients were upstaged based on CT findings alone. Since many clinical T1 or T2 tumors determined without CT information were upstaged to T3 or T4 after performing CT, we studied treatment results of them according to CT staging. Nine of 16 clinical T1+T2 tumors upstaged to T3 or T4 after performing CT, 3 of which had local recurrence. Seven patients remained as T1+T2 after performing CT, only one of which experienced local recurrence. It is suggested that mere enlarging of radiation fields or increasing radiation doses could not be curative for a certain group of patients. In order to further increase local control rates, we have started to use intracavitary irradiation with an after-loading technique as a boost. No acute or chronic complications due to intracavitary irradiation have developed. Preliminary results were encouraging.
