Radiotherapy for carcinoma of the posterior pharyngeal wall

Posterior pharyngeal carcinoma has an extremely poor prognosis regardless o f the method of treatment. The purpose of this study was to assess the loca l control and survival in patients with carcinoma of the posterior pharynge al wall treated with definitive radiotherapy and to determine prognostic fa ctors which may be relevant to the current UICC staging classification. Bet ween January 1991 and December 1995, 22 patients with a mean age of 60 year s (range 44-82) received definitive radiotherapy, using a homogeneous techn ique, for carcinoma of the posterior pharyngeal wall. The median follow-up was 42 months (range 25-66). The overall 3-year survival and local control for the whole group was 50% and 73% respectively. Patients with early stage (T1 and T2) disease had a significantly better overall 3-year survival rat e of 77% compared to 11% for patients with advanced stage (T3 and T4) disea se (p=0.0010), Similarly, patients with early stage disease had a significa ntly improved 3-year local control rate compared to patients with more adva nced stage disease (92% and 44% respectively, p=0.0080). Patients with node positive disease had an inferior survival rate of 29% compared to 60% for those with node negative disease though the difference did not reach statis tical significance, In addition only one patient with initial node negative disease had isolated nodal relapse. There was no significant late morbidit y. For patients with early stage disease we have obtained local control and survival rates comparable to other groups with a once daily, short fractio nation radiotherapy scheme but with reduced morbidity. In late stage diseas e altered fractionation schemes should be considered in order to achieve be tter local control and survival. Isolated nodal relapse was not a significa nt problem in this cohort of patients. Outcome correlates with primary tumo ur size and this is reflected in the current UICC staging classification.