Treatment Outcome for Nasopharyngeal Carcinoma in University Malaya Medical Centre from 2004-2008

Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. Thisstudy aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated inUniversity Malaya Medical Centre (UMMC). Materials and
Methods: All newly diagnosed patients with NPCreferred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatmentoutcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), locoregionalcontrol (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survivalanalysis and differences in survival according to AJCC stage was compared using the log-rank test.
Results: Atotal of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentationwas common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. Thestipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvantchemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OSwas 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I,77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonestwas xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%),neck stiffness (3.1%) , dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism(1.2%).
Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especiallythose utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.