Radiotherapy alone for T3～T4N0～N3 nasopharyngeal carcinoma

Objective To discuss the impact of different T and N stages for local-regional advanced nasopharyngeal carcinoma(NPC) on the clinical gains of radiotherapy(RT) alone. Methods From January to December in 1999, the data of 556 patients with 92' Fuzhou Staging System T3-4N0-3 in China were initially treated by conventional RT alone with the facio-cervical field were retrospectively reviewed. The total dose was 66-80Gy/6.5-8.0 weeks in the nasopharyngeal lesion, and 60-70Gy/6-7 weeks for the neck lymph nodes. Results The overall 5-year survival rate(OS) was 66.4%, with 69.1%,59.0% for T3,T4 lesions( P0.05). However, the difference between local control, disease-free survival, relapse-free survival or metastasis-free survival rate was not significant in T3,T4 lesions. The 5-year OS was 74.0%,66.0%,57.6% and 29.4% in N0,N1,N2 and N3 lesions, respectively(P0.01).The higher the N stage, the higher relapse and distant metastasis rate. Conclusions N stage is the dominant factor influencing the effect and prognosis of patients with local-regional advanced NPC treated by conventional RT alone. T stage was only the minor correlative factor. Using stratified combined radio-chemotherapy modality for different N stages of local-regional advanced NPC may act positively and effectively on resolving the cause of treatment failure--relapse and distant metastasis.