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Retrospective analysis of nasopharyngeal carcinoma treated during 1976–1985: late complications following megavoltage irradiation

Anne W. M. Lee, FRCR Stephen C. K. Law, FRCR S. H. Ng, MRCP ^* David K. K. Chan, PhD Y. F. Poon, FRCR William Foo, FRCR S. K. O, FRCR Stewart Y. Tung, FRCR Fred K. Cheung, MSc and John H. C. Ho, MD, DSc, FRCR ^*

Institute of Radiology and Oncology, Queen Elizabeth Hospital, Wylie Road, Kowloon, Hong Kong ^* Baptist Hospital, Waterloo Road, Kowloon, Hong Kong Physics Department, Princess Margaret Hospital, 500 Sherbourne Street, Toronto, Canada

A retrospective analysis was undertaken of the late complications observed in 4527 patients with nasopharyngeal carcinoma treated by megavoltage radiotherapy during the years 1976–1985. Unconventional fractionation schedules were used because of serious resource limitations. The median equivalent doses were 65 Gy to the nasopharyngeal region and 53 Gy to the cervical region. 707 patients had reirradiation for local recurrences and 250 for regional relapses. The 10-year actuarial cancerspecific survival was 47%, and the corresponding all-complication-free and neurological-complication-free rates were 40% and 72%, respectively. Altogether, 1395 (31%) patients developed one or more late irradiation sequelae. The majority were mild softtissue damages, but 322 (7%) had significant functional disturbances, from which 62 (1%) died. Neurological damage that occurred in 450 (10%) patients constituted the major morbidity and accounted for all but three of the treatment mortalities. The cumulative incidence of the various complications is summarized, and the data recorded in the literature reviewed in order to give a proper perspective of the problem. Patients treated during 1981–1985 had a significantly higher actuarial encephalomyelopathyfree rate than those treated during 1976–1980, but the incidence-free rates for the other neurological complications remained unimproved, suggesting that the improvement could be mainly attributed to additional shielding for the brainstem rather than the reduction of dose from 3.8–4.2 Gy to 2.5 Gy per fraction.

Key Words: Nasopharyngeal carcinoma • Late irradiation complications

Received for publication November 28, 1991. Revision received April 15, 1992. Accepted for publication May 8, 1992.

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