Nasopharyngeal Carcinoma- An Update of Treatment and Acute Radiation Induced Reactions from a Tertiary-Care Hospital in Pakistan

Introduction: Nasopharyngeal carcinoma (NPC) is a diverse entity with a multi-factorial etiology and a distinctracial and geographical distribution. It is curable if diagnosed and treated early.
Methods: This descriptive studycovered 30 patients who underwent radiotherapy (RT) for nasopharyngeal malignancies during February 2006till November 2010 at the Department of Radiation Oncology, Aga Khan University Hospital (AKUH), Karachi.
Results: Thirty cases of nasopharyngeal tumors were registered; a case of embryonal rhabdomyosarcoma andanother of diffuse large B-cell lymphoma were not included in the final analyses. There were 20 (71.0%) malesand 8 (29.0%) females, 2 and 5 being observed in adolescents. The mean age of the male and female patientswas 43.7 [SD 20.1] and 30.3 years [SD 17.9], respectively. Nodal involvement was seen in 23 cases and cranialin 8. Almost two-thirds the patients presented with a stage IV disease and all but two received chemotherapy.Electrons or photons were used for 23 cases; low anterior neck field was used in 25 cases. The doses of radiotherapydelivered ranged between 2000cGy to 7400cGy, the lower ones being given for palliation only. Once spinal cordtolerance was reached, electron boost fields were used in order to treat the posterior neck. A nasogastric tubewas required for feeding in 2 (10.0%) male and 2 (25.0%) female patients; gastrostomy was needed for 1 (5.0%)patient. Radiotherapy (RT) induced reactions were observed in 90% of the patients, but were mild in most cases.
Conclusions: In the presence of clinician based expertise and technical constraints in Pakistan, nasopharyngealtumors are still being treated optimally with the need of creating a better awareness in public for early detection.