Squamous cell carcinoma of the nasopharynx. An analysis of failure patterns after radiation therapy.

Seventy-seven patients with nasopharyngeal squamous cell carcinoma were treated with irradiation, with or without chemotherapy. Sixty-three (82%) developed a relapse in some part of the body; the first relapse appeared at primary, cervical and distant sites in 45 (71%), 30 (48%) and 12 (19%) of the 63 relapsing patients, respectively. In 22 of the 63 relapsing patients, the first relapse occurred simultaneously in two or more sites. Local recurrence-free survival was higher for the T1 + T2 group than for the T3 + T4 group (p less than 0.02). Cervical relapse-free survival was higher for N0 patients than for N+ patients (p less than 0.02). Distant metastases frequently developed as a component of the first relapse. Distant metastases were more common in N+ patients than in N0 patients. Forty-two patients received adjuvant chemotherapy. Although local recurrence-free survival tended to be higher in patients with chemotherapy than without chemotherapy, survival rates and relapse-free survival rates did not differ in the two groups.