CANCER OF THE NASOPHARYNX

142 PATIENTS TREATED IN THE 11 YEAR PERIOD 1950-1960

¹ Mayo Clinic and Mayo Foundation: Section of Therapeutic Radiology
² Mayo Graduate School of Medicine (University of Minnesota), Rochester: Resident in Otolaryngology and Rhinology
³ Mayo Clinic and Mayo Foundation: Section of Surgical Pathology
⁴ Mayo Clinic and Mayo Foundation: Section of Plastic Surgery
⁵ Mayo Clinic and Mayo Foundation: Section of Otolaryngology and Rhinology

In 142 patients with primary nasopharyngeal cancer encountered at the Mayo Clinic in the years 1950 through 1960, sex, age, site of primary tumor, presenting symptoms, or duration of symptoms did not seem to bear any relationship to the ultimate salvageability of these patients. The ratio of males to females was 2.4:1. The 5 year survival rate was 29 per cent for males and 33 per cent for females. Seventy-one per cent of the patients and 75 per cent of the 5 year survivors were in the age period 40 through 69 years. None of 10 patients less than 20 years of age and only 2 of 10 aged 70 years or more survived 5 years. Site of the primary tumor in the nasopharynx did not seem to carry a prognostic implication : the 5 year survival rate was 37 per cent for lateral wall lesions, 29 per cent for vault lesions, 37 per cent for combined lateral-wall and vault lesions, 14 per cent for lesions of the anterior vault and posterior nares, 30 per cent for posterior wall lesions, and 18 per cent for extensive lesions filling all or most of the nasopharynx.

The pathologic characteristics, as expected, had a definite bearing on the outcome of the disease: the 5 year survival rate was 22 per cent for patients with keratinizing squamous cell epithelioma, 32 per cent for patients with Grade 4 undifferentiated carcinoma (combined lymphoepithelioma and transitional cell group) and 35 per cent for patients with miscellaneous cancers.

Localization of the tumor in the nasopharynx per se was associated with a remarkably high 5 year survival rate (67 per cent). Extension upward to involve either the base of the skull or one or more of the cranial nerve groups, as well as extension downward to involve the draining deep jugular lymph nodes, markedly reduced the 5 year survival rate. Thus, the rate was 19 per cent for patients with involvement of the base of the skull as determined roentgenographically, 14 per cent for those with involvement of the anterior cranial nerves via the petrosphenoid route, 25 per cent for those with involvement of the posterior cranial nerve group via the retroparotidean route, and 20 per cent for those with involvement of cervical lymph nodes. A 5 year survival rate of 30 per cent for the series is in accord with most of the rates given in the recently reported series.

Dose range, as expected, had a bearing on 5 year survival rates. Thus, patients receiving less than 5,000 r had a rate of 23 per cent, as contrasted to 35 per cent for patients receiving 5,000 r or more. The over-all salvage rates obtained with cobalt 60 teletherapy were approximately the same as those obtained with orthovolt roentgen therapy. The addition of splitdose methods, however, apparently more than doubled the 5 year survival rates: 25 per cent for continuously treated patients vs. 58 per cent for patients treated by splitdose methods. The extent of the coverage of the draining regional lymph nodes appeared to have a minor but definite effect on salvageability of the patients. Coverage of the nasopharynx and immediately adjacent lymph nodes in the upper third of the cervical chain gave a 5 year survival rate of 23 per cent as contrasted with 35 per cent when the nasopharynx plus the upper two-thirds of the neck were covered and 29 per cent when the nasopharynx and entire bilateral cervical chains were covered. Of the patients receiving unilateral coverage of the neck over the site of involved lymph nodes, 20 per cent survived 5 years, in contrast to 30 per cent for the patients receiving bilateral coverage.

Our results in the treatment of nasopharyngeal cancer have improved appreciably in the last decade, the 5 year survival rate having increased from 17 per cent to 30 per cent. It is thought that the addition of split-dose methods will enhance our salvage rates still further.

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