Cancer of the Nasopharynx
Abstract
This study was undertaken with three related purposes in mind:
| 1. | To review the experience of Roswell Park Memorial Institute in the treatment of primary nasopharyngeal cancer. The period 1941 to 1957 was chosen for this purpose. | ||||
| 2. | To attempt to determine whether inadequate treatment of any kind, given prior to definitive therapy administered at this Institute, influenced survival. | ||||
| 3. | To discover any of the factors which may influence the results of treatment. | ||||
The anatomy, physiology, pathology, and natural history of cancel of the nasopharynx have been magnificently presented by Lederman (1) and Lenz (2). Because their writings are readily available, no attempt will be made to include a review of these important aspects of the disease.
Initially the study included 111 patients. Eight cases were excluded: 7 in which the histologic diagnosis of primary nasopharyngeal cancer was not establishable, though all 7 patients died of progressive malignant disease within forty-four months; 1 with 2 primary malignant growths, in which it was impossible to decide which was the cause of death. These 8 patients are not further considered in this paper. The final group included 103 patients, 26 having received some form of definitive therapy prior to their admission and 77 previously untreated.
The clinical staging at the time of admission was as follows:
Stage I: The lesion is limited to the soft tissues of the nasopharynx.
Stage IIA: The lesion has metastasized to the cervical lymph nodes, unilaterally.
Stage IIB: The lesion has metastasized to the cervical lymph nodes, bilaterally.
Stage III: The lesion has metastasized to distant sites and/or involved cranial nerves, irrespective of involvement of the cervical lymph nodes.
In 3 cases the primary lesion was not discovered until two, ten, and twenty-four months following admission for cervical lymphadenopathy. In 2 cases a lesion was not visible but a “blind” biopsy of the nasopharynx was positive for carcinoma.
The patients were further subdivided by stage as related to previous therapy (Table I). Such procedures as tonsil-lectomies, incision and drainage of enlarged tonsils, or biopsies were not classified as previous treatment. The 2 cases of primary lymphosarcoma do not appear in Table I.
Sex and Age Incidence
The previously untreated group of patients consisted of 50 males and 25 females, a sex ratio of 2:1. The various clinical stages were further subdivided according to sex (Table II). The ratio of males to females in Stage I was 2:3 and in Stage IIA, 8.5:1. According to our statistician, the unusual preponderance of females without demonstrable lymph-node metastases approaches statistical significance and may well reach significance when a sufficient number of cases has accumulated. Russell (3) noted the influence of sex on prognosis following radiotherapy.
