Nasopharyngeal carcinoma: our experience

  • Carla d’Espiney Amaro
  • Pedro Montalvão
  • Pedro Henriques
  • Miguel Magalhães
  • João Olias
Rhinology

Abstract

The objectives of our study were to characterize nasopharyngeal carcinoma patients in the Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG) and identify the main factors that interfere with patients survival rate. We performed a retrospective study involving 157 patients (65% male and 35% female) between the years 2000 and 2005, and a histological classification according to Health World Organization. We constructed a Kaplan–Meier survival curve for the studied patients and evaluated the significance of the different studied factors with a Pearson correlation study. With an average age of 53 years, most of the carcinomas were type III (58%), followed by type II (30%) and at last type I (8%). Fifty-one of carcinomas were in stage IV at time of diagnosis. Ninety-five patients (60%) had remission. Five-year actuarial survival rate of all patients was 65.1%. There was a significant difference (P = 0.033) in the actuarial survival rate of staged IV patients treated with adjuvant chemotherapy. Undifferentiated nasopharyngeal carcinoma is the most frequent type in our geographic area. Chemotherapy improves survival rate, mainly in late stages.

Keywords

Nasopharyngeal carcinoma Survival Lisbon Chemotherapy 

Notes

Acknowledgments

My deepest gratitude to my friend and great mathematician Lucian Rhadu, for his precious help in the statistical study. Also to Pedro Miguel Viana Baptista and to Pedro Miguel Lourenço for their advices in revision this work.

References

  1. 1.
    Boussen H, Bouaoina N, Gamoudi A, Moukni N et al (2007) Cancers du nasopharynx. In: Encyclopédie Médico-Chirurgicale. 2007, 20-590-A-10Google Scholar
  2. 2.
    Chang ET, Adami HO (2006) The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 15(10):1765–1777. doi:10.1158/1055-9965.EPI-06-0353 PubMedCrossRefGoogle Scholar
  3. 3.
    Jiong L, Berrino F, Coebergh J (1998) Eurocare working group. Variation in survival for adults with nasopharyngeal cancer in Europe, 1978–1989. Eur J Cancer 34:2162–2166. doi:10.1016/S0959-8049(98)00322-0 CrossRefGoogle Scholar
  4. 4.
    Nichols J, Agathanggelou A, Fung K, Xiangguo Z et al (1997) The association of squamous cell carcinomas of the nasopharynx with Epstein–Barr virus shows geographical variation reminiscent of Burkitt’s lymphoma. J Pathol 183(2):164–168. doi:10.1002/(SICI)1096-9896(199710)183:2<164::AID-PATH919>3.0.CO;2-JCrossRefGoogle Scholar
  5. 5.
    Pegtel D, Subramanian A, Meritt D, Tsai C et al (2007) IFN-α-syimulated genes and Epstein–Barr virus gene expression distinguish WHO type II and type III nasopharyngeal carcinomas. Cancer Res 67(2):474–481. doi:10.1158/0008-5472.CAN-06-1882 PubMedCrossRefGoogle Scholar
  6. 6.
    Punwaney R, Brandwein M, Zhang D, Urken M et al (1999) Human papillomavirus may be common within nasopharyngeal carcinoma of Caucasian Americans: investigation of Epstein–Barr virus and human papillomavirus in Eastern and Western nasopharyngeal carcinoma using ligation-dependent polymerase chain reaction. Head Neck 21(1):21–29. doi:10.1002/(SICI)1097-0347(199901)21:1<21::AID-HED3>3.0.CO;2-ZPubMedCrossRefGoogle Scholar
  7. 7.
    Marks J, Phillips J, Menck H (1998) The national cancer data base report on the relationship of race and national origin to the histology of nasopharyngeal carcinoma. Cancer 83:582–588. doi:10.1002/(SICI)1097-0142(19980801)83:3<582::AID-CNCR29>3.0.CO;2-RPubMedCrossRefGoogle Scholar
  8. 8.
    Sun L, Li C, Huang E, Vaughan T (2007) Survival differences by race in nasopharyngeal carcinoma. Am J Epidemiol 165:271–278. doi:10.1093/aje/kwk008 PubMedCrossRefGoogle Scholar
  9. 9.
    Vaughan T, Shapiro J, Burt R, Swason G et al (1996) Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer Epidemiol Biomarkers Prev 5:587–593PubMedGoogle Scholar
  10. 10.
    Ou S, Zell J, Ziogas A, Anton-Culver H (2007) Epidemiology of nasopharyngeal carcinoma in the United States: improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology. Ann Oncol 18:29–35. doi:10.1093/annonc/mdl320 PubMedCrossRefGoogle Scholar
  11. 11.
    Klemenc P, Marin J, Soba E, Gale N et al (2006) Distribution of Epstein–Barr virus genotypes in throat washings, sera, peripheral blood lymphocytes and in EBV positive tumor biopsies from Slovenian patients with nasopharyngeal carcinoma. J Med Virol 78(8):1083–1090. doi:10.1002/jmv.20666 PubMedCrossRefGoogle Scholar
  12. 12.
    Plaza G, Manzanal A, Fougué L, Santón A et al (2002) Association of Epstein–Barr virus and nasopharyngeal carcinoma in Caucasian patients. Ann Otol Rhinol Laryngol 111:210–216PubMedGoogle Scholar
  13. 13.
    Pai P, Tseng C, Chuang C, Wei K et al (2007) Polymorphism of C-terminal activation region 2 of Epstein–Barr virus latent membrane protein 1 in predicting distant failure and post-metastatic survival in patients with nasopharyngeal carcinoma. Head Neck 29(2):109–119. doi:10.1002/hed.20483 PubMedCrossRefGoogle Scholar
  14. 14.
    Zhou G, Zhai Y, Cui Y, Zhang X et al (2007) MDM2 promoter SNP309 is associated with risk of occurrence and advanced lymph node metastasis of nasopharyngeal carcinoma in Chinese population. Clin Cancer Res 13(9):2627–2633. doi:10.1158/1078-0432.CCR-06-2281 PubMedCrossRefGoogle Scholar
  15. 15.
    Chen S, Liang S, Zheng W et al (2008) Meta-analysis of nasopharyngeal carcinoma microarray data explores mechanisms of EBV-regulated neoplastic transformation. BMC Genomics 9:322. doi:10.1186/1471-2164-9-322 PubMedCrossRefGoogle Scholar
  16. 16.
    Fachiroh J, Schouten T, Hariwiyanto B, Paramita D et al (2004) Molecular diversity of Epstein–Barr virus IgG and IgA antibody responses in nasopharyngeal carcinoma: a comparison of Indonesian, Chinese and European subjects. J Infect Dis 190(1):53–62. doi:10.1086/421245 PubMedCrossRefGoogle Scholar
  17. 17.
    Pratesi C, Bortolin M, D’Andrea M, Vaccher E et al (2003) Quantitive plasma/serum EBV DNA load by LMP2A determination in an Italian cohort of NPC patients. J Clin Virol 28(2):155–164. doi:10.1016/S1386-6532(02)00276-7 PubMedCrossRefGoogle Scholar
  18. 18.
    Twu C, Wang W, Liang W, Jan J et al (2007) Comparison of the prognostic impact of serum anti-EBV antibody and plasma EBV DNA assays in nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 67(1):130–137. doi:10.1016/j.ijrobp.2006.07.012 PubMedGoogle Scholar
  19. 19.
    Farrow D, Vaughan T, Berwick M, Lynch C et al (1998) Diet and nasopharyngeal cancer in a low-risk population. Int J Cancer 78(6):675–679. doi:10.1002/(SICI)1097-0215(19981209)78:6<675::AID-IJC2>3.0.CO;2-JPubMedCrossRefGoogle Scholar
  20. 20.
    Chan ATC, Teo PML, Johnson PJ (2002) Nasopharyngeal carcinoma. Ann Oncol 13:1007–1015. doi:10.1093/annonc/mdf179 PubMedCrossRefGoogle Scholar
  21. 21.
    Ma BBY, Hui EP, Chan ATC (2008) Systemic approach to improving treatment outcome in nasopharyngeal carcinoma: current and future directions. Cancer Sci 99:1311–1319. doi:10.1111/j.1349-7006.2008.00836.x PubMedCrossRefGoogle Scholar
  22. 22.
    Friborg J, Yuan J, Wang R, Koh W et al (2007) A prospective study of tobacco and alcohol use as risk factors for pharyngeal carcinomas in Singapore Chinese. Cancer 109(6):1183–1191. doi:10.1002/cncr.22501 PubMedCrossRefGoogle Scholar
  23. 23.
    Gregoire V, Levendag P et al (2003) CT-based delineation of lymph node levels and related clinical target volume in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol 69:227–236. doi:10.1016/j.radonc.2003.09.011 PubMedCrossRefGoogle Scholar
  24. 24.
    Breda E, Catarino R, Azevedo I, Fernandes T et al (2007) Characterization of the clinical evolution of nasopharyngeal carcinoma in a Portuguese population. Acta Otorrinolaringol Esp 58(5):191–197PubMedCrossRefGoogle Scholar
  25. 25.
    Mendenhall W, Christopher M, Hinerman R, Malyapa R et al (2006) Definitive radiotherapy for nasopharyngeal carcinoma. Am J Clin Oncol 29(6):622–627. doi:10.1097/01.coc.0000248895.90193.7e PubMedCrossRefGoogle Scholar
  26. 26.
    Kristensen C, Kjaer-kristoffersen F, Sapru W, Berthelsen A et al (2007) Nasopharyngeal carcinoma. Treatment planning with IMRT and 3D conformal radiotherapy. Acta Oncol 46(2):214–220. doi:10.1080/02841860600635862 PubMedCrossRefGoogle Scholar
  27. 27.
    Huang C, Huang S, Lee T, Ng S et al (2007) Postirradiation sinus mucosa disease in nasopharyngeal carcinoma patients. Laryngoscope 117(4):737–742. doi:10.1097/MLG.0b013e3180325b6c PubMedCrossRefGoogle Scholar
  28. 28.
    Ku P, Yuen E, Cheung D, Chan B et al (2007) Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: symptomatology and videofluoroscopic findings. Laryngoscope 117(1):142–146. doi:10.1097/01.mlg.0000248738.55387.44 PubMedCrossRefGoogle Scholar
  29. 29.
    King AD, Ahuja AT, Yeung DK et al (2007) Delayed complications of radiotherapy treatment of nasopharyngeal carcinoma: imaging findings. Clin Radiol 62:195–203. doi:10.1016/j.crad.2006.10.011 PubMedCrossRefGoogle Scholar
  30. 30.
    Kong L, Lu J, Hu C, Guo X et al (2006) The risk of second primary tumours in patients with nasopharyngeal carcinoma after definitive radiotherapy. Cancer 107(6):1287–1293. doi:10.1002/cncr.22119 PubMedCrossRefGoogle Scholar
  31. 31.
    Ozyar E, Selek U, Laskar S, Uzel O et al (2006) Treatment results of 165 pediatric patients with non-metastatic nasopharyngeal carcinoma: a rare cancer network study. Radiother Oncol 81(1):39–46. doi:10.1016/j.radonc.2006.08.019 PubMedCrossRefGoogle Scholar
  32. 32.
    Wei WI, Mok V (2007) The management of neck metastases in nasopharyngeal cancer. Curr Opin Otolaryngol Head Neck Surg 15:99–102. doi:10.1097/MOO.0b013e3280148a06 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Carla d’Espiney Amaro
    • 1
    • 2
    • 3
    • 5
  • Pedro Montalvão
    • 1
  • Pedro Henriques
    • 1
    • 4
  • Miguel Magalhães
    • 1
  • João Olias
    • 1
  1. 1.Otorhinolaryngology DepartmentPortuguese Institute of Oncology Hospital in Lisbon (IPOLFG-EPE)LisbonPortugal
  2. 2.Department of OtorhinolaringolyPortuguese Navy HospitalLisbonPortugal
  3. 3.Department of OtorhinolaryngologySão José HospitalLisbon Portugal
  4. 4.Otorhinolaringology DepartmentEgas Moniz HospitalLisbonPortugal
  5. 5.Serviço de OtorrinolaringologyInstituto Portugês de Oncologia de Francisco Gentil de LisboaLisbonPortugal

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