RÉSUMÉ
Purpose:To investigate the influence of MRI on the Chinese 1992 staging system of nasopharyngeal carcinoma(NPC).Methods:From Oct.1992 to Jan.1996,86 patients with NPC who had MRI and CT prior to radiotherapy were retrospectively analyzed.The total dose to the primary tumor was 60.4～85.0 Gy(median,72.5 Gy).The fractionation schedule used was five daily fractions of 1.8～2.0 Gy per week.The survival rates were estimated by the Kaplan-Meier method.Log-rank was used to identify the prognostic factors.Results:The loco-regional control rate at 5 year was 84.2%,distant metastasis-free survival 80.1%,disease-free survival 73.9% and overall survival 82.7% with a median follow-up interval of 65.5 months(range 2～108 months).According to the Chinese 1992 staging system,there were 25 vs 14(25 by CT and 14 by MRI) patients with T_(1),21 vs 8 with T_(2),31 vs 42 with T_(3) and 9 vs 22 with T_(4) lesions.As a result,42.9%(12/28) of cervical nodal and 28.6%(8/28) of retropharyngeal lymphadenopathy alone should downstage from N_(0) to N_(1).Conclusions:The influence of MRI on the Chinese 1992 staging system was significant and the authors observed a worse distribution of patient numbers as well as poorer separation of survival curves among different stage groups.
RÉSUMÉ
Objective To evaluate the clinical characteristics,treatment,outcome and complications of child and adolescent nasopharyngeal carcinoma (NPC). Methods From January 1970 to April 1997, the records of 145 NPC patients younger than 21 years of age were reviewed. The clinical stages according to 92'Chinese NPC Staging System were :stageⅠin 1, Ⅱin 8, Ⅲ in 79 and Ⅳ in 57. All patients were treated with external beam radiotherapy. Before 1988, parallel opposed lateral pre-auricular portals were chiefly used in 75 patients and after 1988, parallel opposed lateral facio-cervical portals were adopted in 70. The radiation dose to the primary tumor ranged 45-80?Gy: 70?Gy in 50 cases and 32 of them also received chemotherapy. Results Distant metastasis developed in 26 cases, while local and/or regional recurrence in 14. The actuarial overall survival rates of 1-, 3-, 5, and 10-years were 96.3%, 79.9%, 76.5% and 69.4%, respectively. Among 45 dead cases, 16 did so of metastasis, 11 of local and/or regional recurrence and 18 of other reasons. Univariate analysis suggested that clinical stage, size and site of involved lymph nodes, skull base involvement were significant prognostic factors of survival, whereas sex、age、dose、therapeutic method and chemotherapy were not. Conclusions 1. Even though the majority of pediatric and adolescent NPC were advanced, it signifies a relatively good survival. 2. As the normal tissue of pediatric and adolescent patients tolerates radiation poorly, prudence should be meticulously practiced in deciding the radiation dose and radiotherapeutic fields.