Carcinoma of the nasopharynx. An analysis of 91 cases and a comparison of differing treatment approaches.

Ninety-one patients with malignant epithelial tumors of the nasopharynx seen in our department from 1970 to 1982 were evaluated. The 5- and 10-year actuarial survival rates were 62.0% and 42.0%, respectively. Patients seen from 1970 to 1979 were treated by radiotherapy to the primary site and upper neck, the lower neck being irradiated only in instances of massive disease. Those treated from 1980 to 1982 received elective irradiation of the whole neck, as well as adjuvant chemotherapy (consisting of cyclophosphamide, methotrexate, and either 5-fluorouracil or bleomycin) for 6 to 12 months after completion of radiotherapy. Comparison of 3-year actuarial survival (61.4% versus 83.3%) and disease-free survival (49.7 versus 77.0%) rates show significantly improved results (P less than 0.05) for those receiving combined therapy. In addition, significantly fewer (P less than 0.05) distant metastases appeared in the combined therapy group at 18 months. A retrospective analysis comparing those patients who received full-neck irradiation and adjuvant chemotherapy with those who received full-neck irradiation alone showed a significantly improved survival (P less than 0.02) and disease-free survival (P less than 0.05) for those patients with undifferentiated carcinomas, including lymphoepitheliomas, who received adjuvant chemotherapy.