Cancer of the nasopharynx.Factors influencing prognosis

The characteristics of 79 patients with malignant tumors of the nasopharynx are correlated with their survival. A modification to the TNM classification is presented, as well as a definition of the different pathologic types of tumors. Twenty-four out of 70 patients survived 5 years tumor free (34%). However, 4 of these surviving patients developed recurrent tumor and/or distant metastasis at a later date. Early lesions, without neurologic findings, bony destruction, or large metastatic lymph nodes, had a better prognosis. This was true also for the lymphoepithelioma and the well-differentiated squamous carcinoma. Over 40% of the patients that failed developed local recurrence, even with doses in the range of 6000 rads. Small fields used before 1958 were found to correlate with a higher local failure rate, probably due to geographical miss resulting in marginal recurrences. Elective irradiation of the neck resulted in a high degree of sterilization of metastatic tumor in die lymph nodes. From the experience in 7 patients, it was concluded that radical neck dissection, after a full course of radiation therapy, adds nothing to the treatment of these patients and is associated with a significant number of complications.