Patterns of failure in carcinoma of the nasopharynx: Failure at distant sites

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Abstract
Between 1970 and 1980, we treated 107 previously untreated patients with biopsy‐proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, the base of the skull, and both sides of the neck. Eighty‐seven percent of the patients had stage IV disease (American Joint Committee, 1980). Eighteen patients developed distant metastases as the first site of relapse. Metastases appeared within 6 months after treatment in 50% of these 18 patients, and in 94% within 2 years. Median survival after the development of distant metastases was 6 months. The most sensitive predictor of which patients would develop distant metastases was the size of cervical lymph node metastases at initial presentation (P = 0.003); patients without palpable cervical nodes or with cervical nodes smaller than 3 cm were the least likely to develop distant metastases (10%), followed by those patients who had cervical nodes measuring 3 to 6 cm (25%), followed by those who had cervical nodes larger than 6 cm, (almost 50%). The incidence of distant metastases was not significantly influenced by age, sex, birthplace, histology, or T‐stage. Studies aimed at decreasing the morbidity and mortality from distant metastases in carcinoma of the nasopharynx should be undertaken in patients who present with bulky cervical metastases.

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