RESULTS OF “DOKUZ EYLUL HEAD AND NECK CANCERS GROUP (DEHNCG) -TREATMENT PROTOCOL” IN THE NASOPHARYNX CARCINOMA AND TO EXAMINE OF PROGNOSTIC FACTORS
The aim of this trial was to evaluation the effectiveness of radiotherapy and chemotherapy in the treatment of nasopharynx carcinoma retrospectively. The prognostic factors were also analysed in the frame of “Dokuz Eylul Head and Neck Cancers Group (DEHNCG) Treatment Protocol”.
PATIENTS AND METHOD
In January 1991-December 2002, 97 (70 men, 27 women) patients diagnosed with nasopharynx carcinoma have been evaluated. Median age was 48 (13-76). WHO system for the histological evaluation, AJCC 1989 and 1997 for the clinical staging were used. Sixty five (67%) patients were WHO tipe III. As to AJCC 1989, 80 (83%), as to AJCC 1997 51 (52%) patients had locally advanced stage IV disease. The neoadjuvant chemotherapy has been given to 58 (60%) patients. Median radiotherapy dose was 70 (50-72,2) Gy and has been applied to 70 (72%) patients with conventional, and to 27 (28%) patients with concomittant boost techniques. Early and late toxicity were evaluated according to the EORTC / RTOG system.
The median follow up was 43 (3-147) months. Total response rate was %76 after neoadjuvant chemotherapy [ complete response 3 (5%) patients, partial response 41 (71%) patients]. After radiotherapy total response rate was 98% [complete response 86 (89%) patients and partial response 9 (9%) patients]. Acute Grade III mucositis has been seen in 39% patients. In 71 evaluable patients for late side effects the grade III-IV effects were detected in soft tissue in 6% of the patients, in salivary glands in 1% and in medulla spinalis in 1%. Five year overall, locoregional relaps free, distant metastasis free and cause spesific survival rates are 55, 74, 73 and 65% respectively. In the evaluation of overall survival spesific prognostic factors, the multivariate analysis, has shown that to be older than 50 years is a negative prognostic factor for overall and locoregional relaps free survival (p=0.001, p=0.003). As to AJCC 1997 advanced nodal stage is a statistically significant parameter for overall, distant metastasis free and disease spesific survival (p= 0.024, p=0.008, p=0.003).
Radiotherapy alone in early stage and chemoradiotherapy in local advanced disease is used by DEHNCG. To use conformal treatments to increase the tumor control and prospective trials for quality of life are our new targets.