Clinical Features and Management of Distant Metastases from Nasopharyngeal Carcinoma

Purpose: To evaluate the clinical features and the results of patients of nasopharyngeal carcinoma (NPC) with distant metastases. Materials and Methods: This study enrolled 70 patients of NPC development of distant metastases from March 1991 to September 2005. Fifty-three patients (76%) were male, and 17 (24%) were female. The median age of initial diagnosis as NPC was 50 years (ranged from 17 to 87 years). Five patients (7%) were WHO type Ⅰ nasopharyngeal carcinoma, 30 (43%) were type Ⅱ, and 35 (50%) were type Ⅲ. According to AJCC (American Joint Committee on Cancer) 2002 TNM staging system, 2 patients (3%) were T1, 11 (15%) were T2 (4 were T2a, 7 were T2b), 18 (26%) were T3, and 39 (56%) were T4. Four patients (6%) were N0, 9 (13%) were N1, 10 (14%) were N2, and 47 (67%) were N3 (32 were N3a, 15 were N3b). Sixteen patients (23%) were initially M0, and 54 (77%) were initially M1. Forty-six of all 70 patients (66%) received radiotherapy/concurrent chemoradiotherapy to the primary sites of nasopharynx and neck lymph nodes. The median cumulative irradiation dose was 7380 cGy. The sites of initial distant metastases included bone (54%), liver (34%), lung (24%), brain (6%), and others (6%). Twenty-one patients (30%) received palliative irradiation to sites of distant metastases, 24 (34%) received chemotherapy, 5 (7%) received salvage surgery, and 26 (37%) received supportive care. Results: The median duration of survival after distant metastases of all patients was 9.4 months (ranged from 1 to 51.3 months). Nine patients (13%) survived for more than 2 years. In Kaplan-Meier survival evaluation, age (p=0.0388) and metastastic site (p=0.0390) were prognostic factors for survival since distant metastasis. Patients with age less than 50 years or with bone and lung metastases had longer survival, while patients with age larger than 50 years or with liver and brain metastases had shorter survival. Conclusion: With managements of palliative irradiation, chemotherapy, salvage surgery and supportive care, the median survival was 9.4 months for patients of nasopharyngeal carcinoma developing distant metastases. Age and metastastic site were prognostic factors for survival since distant metastasis with Kaplan-Meier survival evaluation.