Nasopharyngeal carcinoma in Saudi Arabia: a retrospective study of 166 cases treated with curative intent.

A retrospective review was performed of the medical records of 166 adult patients with biopsy-proven carcinomas of the nasopharynx treated with curative intent at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. All patients were treated between June 1975 and December 1985 using megavoltage therapy equipment. Most patients presented with advanced nodal disease: 23 patients (13.9%) were N0, 16 patients (9.6%) were N1, 29 patients (17.5%) were N2, and 98 patients (59%) were N3. The overwhelming majority of patients had nonkeratinizing lesions (158/166). At the time of analysis, mean follow-up time was 24.2 months (range 2-108). Actuarial curves are presented for local/regional control as a function of T-stage and N-stage and for survival and time to development of distant metastases as a function of N-stage. At 4 years local/regional control was 70% for T1 lesions, 59% for T2 lesions, 30% for T3 lesions, and 35% for T4 lesions. There was little correlation between local/regional control and N-stage being about 50% at 4 years for all nodal subgroups. Only six patients exhibited an isolated first failure in the regional nodes alone, whereas 60 patients failed initially at the primary site (either alone or in conjunction with a simultaneous nodal failure). The development of distant metastases correlated to some extent with nodal disease ranging from 20% at 4 years for T1/T2 N0 patients to 70% for patients who initially presented with N3 disease. Survival data was more difficult to obtain due to cultural biases in a medically unsophisticated patient population. True survival curves are bounded by calculating actuarial curves in two ways: death as the failure endpoint and death plus lost-with-active-disease as failure endpoints. In terms of the latter curves, at 4 years "survival" ranged from 39% for patients with T1/T2 N0 lesions to 23% for patients with N3 lesions.

Pattern of cancer in Saudi Arabs referred to King Faisal Specialist Hospital.

A total of 7251 histologically confirmed new cases of cancer (4117 males and 3134 females) were seen in the 6-year period 1979 to 1984 at the King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. The crude relative frequencies of cancer at various primary sites have been determined with reference to sex, age, geographic origin, and year of diagnosis. The most common cancer sites among males were non-Hodgkin's lymphomas, esophagus, lung, liver, stomach, and nasopharynx. Breast cancer was the most common tumor among the females, followed by non-Hodgkin's lymphomas and cancers of the thyroid, esophagus, cervix, and ovary. The most marked deviations were found in the Southern Region for cancers of the oral cavity (2.4 times higher), bladder (1.8 times higher), and lung (4.3 times lower). Known etiologic factors, such as local chewing, smoking habits, and schistosomiasis are likely to be responsible for these differences. Upward trends in cancers of lung, breast, colon and rectum, and the downward trend in esophageal cancer may reflect the rapid pace of modernization.