SIGNIFICANT PROGNOSTICATORS AFTER PRIMARY RADIOTHERAPY IN 903 NONDISSEMINATED NASOPHARYNGEAL CARCINOMA EVALUATED BY COMPUTER-TOMOGRAPHY

Purpose: To evaluate the significant prognosticators in nasopharyngeal carcinoma (NPC). Methods and Materials: From 1984 to 1989, 903 treatm ent-naive nondisseminated (M0) NPC were given primary radical radiothe rapy to 60-62.5 Gy in 6 weeks. All patients had computed tomographic ( CT) and endoscopic evaluation of the primary tumor. Potentially signif icant parameters (the patient's age and sex, the anatomical structures infiltrated by the primary lesion, the cervical nodal characteristics , the tumor histological subtypes, and various treatment variables wer e analyzed by both monovariate and multivariate methods for each of th e five clinical endpoints: actuarial survival, disease-free survival, free from distant metastasis, free from local failure, and free from r egional failure. Results: The significant prognosticators predicting f or an increased risk of distant metastases and poorer survival include d male ses, skull base and cranial nerve(s) involvement, advanced Ho's N level, and presence of lived or partially fined nodes or nodes cont ralateral to the side of the bulk of the nasopharyngeal primary. Advan ced patient age led to significantly worse survival and poorer local t umor control. Local and regional failures were both increased hy tumor infiltrating the skull base and/or the cranial nerves. In addition, r egional failure was increased significantly by advancing Ho's N level. Parapharyngeal tumor involvement was the strongest independent progno sticator that determined distant metastasis and survival rates in the abscence of the overriding prognosticators of skull base infiltration, cranial nerve(s) palsy, and cervical nodal metastasis. Conclusions: T he significant prognosticators are delineated after the advent of CT a nd these should form the foundation of the modern stage classification for NPC. Copyright (C) 1996 Elsevier Science Inc.