Origin

Nasopharyngeal cancers: A retrospective

al
Article comparative analysis of radiotherapy alone
versus chemo-radiation (Benghazi experience)
Pakkirmasthan A,
Kurakula S1
Departments of Oncology and 1Gynecology, Specialist, Sekgoma Memorial Hospital, Serowe,
Botswana, Africa
Correspondence to: Dr. Sowjanya Kurakula, E-mail:
Abstract
drksowjanya@gmail.com
INTRODUCTION: Cancer of Nasopharynx is an important disease in Maghreb region. 75 patients (4.3%) of cancer nasopharynx
between the years
1995 to 2000 were referred to our centre in Benghazi out of total 1757 patients. This study was done to analyze the clinical
presentations and to study response to the treatment practiced. MATERIALS AND METHODS: 59 patients were available with
full records excluding the recurrent and metastatic presentation. 37 were males with 22 females (1.7:1), (31/59) 52%
patients were from 25-49 years, (17/59) 28.8% were from 50-60 years. 44/59 (74%) patients presented with
Lymphadenopathy either unilateral or bilateral. 46/59 (78%) of patients were in clinical stage II or
III. 44/59 (74%) of patients were of undifferentiated histology. RESULTS: The pattern of clinical response and trend of follow up
those that received neoadjuvant chemotherapy and radiotherapy and radiotherapy alone are discussed. DISCUSSION: In our
analysis, we also found that the patients who had received chemotherapy by and large had a less trend to towards
developing metastatic disease and local recurrence and faired better. CONCLUSION: We are now following the protocol of
Neoadjuvant chemotherapy followed by chemo-radiotherapy and followed by chemotherapy and results will mature in the
years to come.
Key Words: Clinical presentation, nasopharyngeal cancers,
response

Introducti Indian Journal of Cancer | July-September 2015 | Volume 52 | Issue 3

on

The nasopharynx is a cuboidal shape structure located

below the base of skull and behind the nasal cavity
communicating through posterior choanae. Posterior wall
is made up of clivus and the first two cervical vertebrae
and continues with the roof, which is made of
basisphenoid, basioccipital and anterior arch of atlas the
soft palate and nasopharynx lies inferiorly. The eustachian
tube opens in the lateral wall. The foramen lacerum lies
with the boundaries of oropharynx hence it is an important
route of spread in middle cranial fossa. The cranial
nerves, second, third, fourth, sixth and gasserian ganglion
are in close relation to it [Figure 1].
Cancer of nasopharynx is uncommon in most countries
of world, but its highest incidence is seen in South China
followed by Kenya and Hong Kong in North Africa in
Maghreb populations of Tunisia and other Mediterranean
countries. Its incidence is 2-10/100,000 populations/year.
Environmental factors are associated in the etio-pathogenesis
of cancer nasopharynx; salted fish, smoke from wood ruff,
etc., are some of them. The relationship of Epstein-Barr
virus (EBV) has been extensively studied by Ho and his
associates. [1,2] The elevated levels of serum EBV antibody
are present in patients of nasopharyngeal cancers (NPCs)
Henle and Henle.[3]
Recently, Ji et al.[4] showed after screening for 15 years,
a subset of population with significant elevated EBV
antibodies has period of sustained elevation of 2-10 years
before the clinical onset of disease.
The NPC is usually seen between the age group of 30 and
60 years and male female ratio is 3:1.[5]
Cancer of nasopharynx presents with unilateral or bilateral
lymphadenopathy in 75% of cases. Nasal obstruction, epistaxis,
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DOI:
10.4103/0019-509X.176718
headache, diminished hearing, orbital symptoms, change
in voice difficulty in swallowing and cranial nerve
involvement (I, VI, XI and X)[6] are common symptoms
[Figure 2].
The most common site of distant metastases is
bone (48.5%) followed by lung (30.3%) and
liver (29.3%).[7,8] Gender, age, lymph node involvement
size, number, tumor extent cranial nerve involvement
and ear symptoms were significant factors affecting
survival rates in nasopharyngeal carcinoma.
Materials and
Methods
The record files of 1757 patients referred to our
department, Benghazi radiotherapy and Diagnostic Centre
between the years 1995 and 2000 were scanned. A total
of 75 patients of cancer of nasopharynx were found.
We excluded 17 patients who were either defaulters or
were recurrent or met static presentations for our survival
analysis.
The Kaplan Meier method of Statistical Package for
the Social Sciences version 10.0 was used to analysis the
data. Follow-up has been poor and we took the data as
per the record files. The record of the ear/nose/throat
(ENT) and Medical Oncology were also scanned for
follow-up.
Resul
ts
The age distribution of 59 patients revealed that majority of
the patients were in two age groups either 25-49 years (31)
(52%) or 50-60 years (17) (28.8%) patients [Table 1].
The overall male female ratio was 37 males for
22 females (1.7:1) [Table 2]. The neck swelling either
unilateral or bilateral was the presenting complaint in
44/59 (74%) of our patients and it was also the presenting
symptom in them, followed by the nasal symptoms
obstruction or epistaxis 24/59 (40.6%) patients. Headache
was present in 19/59 (32%) patients. The other symptoms
were change in voice, otologic, neurological and orbital are
according to [Table 3].
Most of the patients 44/59 (74.4%) presented with
undifferentiated histology, 10/59 (16.9%) were differentiated
squamous cell carcinoma, 5/59 (7%) had Anaplastic or
poorly differentiated presentation.
391
 Pakkirmasthan and Kurakula: Nasopharyngeal cancer- chemoradiation

Figure 1: The anatomy of nasopharynx

Table 1: The number of patients in various age

groups
Age groups No. patients %
<15 year 1 1.65
15-24 4 6.7
25-49 31 52.5
50-59 12 20.3
60-69 5 8.4
70-79 4 6.7
This table shows the number of patients in various age groups

392

Figure 2: The computed tomography films shows the extent of disease

with
regard to treatment
planning

Most of our patients were in clinical Stage II (AJCC/

UICC1992) 18/59 (30.5%). 28/59 (47.5%) of patients were
in clinical Stage III and 13/59 (22%) were in advanced
Stage IV. Most of our patients were in clinical Stage II
or III 46/59 (78%) [Figure 3].
35/59 (59%) patients were given combined treatment, i.e.
neoadjuvant chemotherapy and radiotherapy and quite a
large number 18/59 (30%) of patients were treated with
radiotherapy alone. The status of six patients regarding
chemotherapy could not be ascertained [Figure 4].
Majority of the patients were given Cisplatin and 5 Flouro
Uracil infusion.
The patients were given chemotherapy (2-3 cycles) prior to
radiotherapy and then 2 cycles after radiotherapy. Majority
of the patients completed 2-3 cycles (85%) [Figure 5].
The patients were on monthly follow-up after treatment
either in radiotherapy or medical oncology clinic and were
assessed clinically including ENT examination and computed
tomography scan.
25/59 (42.3%) achieved complete response, i.e. complete
regression of disease clinical and on ENT examination after
the II, III follow-up.
Table 2: Tumour, nodes, metastasis status Nasal obstruction 8 13
of patients Epistaxis 16 27
Nodal status Tumor status Headache 19 32
Change in voice 4 6.5
T1 T2 T3 T4 Sixth nerve palsy 3 5
N0 - 5 1 - Dysphagia 1 1.65
N1 - 13 7 3 Ear pain 2 3.5
N2 - 8 13 3 Decreased vision 1 1.65
N3 - 2 1 3 Decreased hearing 1 1.65
This table shows the tumor and nodal status of the patients Frequency of presenting symptoms in cancer of nasopharynx (most of patients
present with multiple symptoms)

Table 3: Frequency of presenting symptoms in 10/59 (16.9%) patients achieved partial response while
cancer of nasopharynx (most of patients 10/59 (17%) patients could not achieve any response.
present with multiple symptoms)
Indian Journal of Cancer | July-September 2015 | Volume 52 | Issue 3
Symptoms No. %
Neck swelling 44 74
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