Nasopharygeal carcinoma in Queensland, Australia: a review of 10 years experience

The purpose of this study was to compare the treatment outcomes of patients with nasopharyngeal carcinoma in Queensland in a 10-year period during which synchronous chemoradiotherapy has come into use and to compare characteristics of patients of different racial origins and their prognostic factors. Eighty-one patients treated between 1991 and 2001 at the Queensland Radium Institute, Brisbane, Queensland for histologically confirmed nasopharyngeal carcinoma were included. Seventeen patients were treated using the Intergroup protocol, 32 patients with miscellaneous synchronized chemoradiotherapy, 6 patients with neoadjuvant regimens and 26 patients with radiotherapy only. Asian patients were found to present earlier than White Australian patients (P < 0.02). No significant difference was identified in the histological presentation between the two ethnic groups. Asian patients were more likely to have a relapse and poor loco-regional control. Overall survival, however, was not different. Patients treated according to the Intergroup protocol had better disease-specific survival and relapse-free survival than the other groups. The median follow up was 36 months. Twenty-five patients (30%) developed recurrent disease. The 5-year salvage survival or survival after relapse was 15%. Our experience with the Intergroup protocol in our population is similar to other studies, with likelihood of improved results.

Pituitary adenomas: long-term results for radiotherapy alone and post-operative radiotherapy

PURPOSE

Analysis of prognostic factors and long-term results of treatment of pituitary adenomas.

METHODS AND MATERIALS

The study involved a retrospective review of outcome in a series of 268 patients with pituitary adenomas, treated at the Queensland Radium Institute from January 1962 to December 1986. The study population included 108 patients treated with radiotherapy alone and 160 patients treated by surgery and post-operative radiotherapy. In each group, univariate and multivariate analyses were conducted of possible prognostic factors including age, sex, performance status, tumor type, tumor extent, visual disturbance, radiotherapy dose, and field size.

RESULTS

For radiotherapy alone, the 10-year progression-free survival rate was 60%, and overall tumor control was obtained in 77%. Univariate analysis suggested that tumor type and radiotherapy field size were of prognostic significance. Multivariate analysis confirmed that Prolactinoma subtype and increasing radiotherapy field size were independently predictive of reduced progression-free survival. Long-term visual complications occurred in 1% of patients treated by radiotherapy alone. In patients treated by surgery and post-operative radiotherapy, the 10-year progression-free survival rate was 77%, and overall tumor control was achieved in 83%. Univariate analysis suggested that tumor type, completeness of surgical excision, and radiotherapy dose were predictive of outcome. However, on multivariate analysis, only the extent of surgical excision predicted prognosis independently. Long-term visual sequelae were noted in 3% of patients treated by surgery and post-operative radiotherapy.

CONCLUSION

Both radiotherapy alone and post-operative radiotherapy are effective in long-term control of pituitary adenomas, and produce acceptably low complication rates.

Prognostic variables in malignant epithelial tumors of the parotid

A retrospective analysis was performed on 209 patients with carcinoma of the parotid who were treated with curative intent using surgery and post-operative irradiation. The five and ten-year actuarial survival were 71% and 65%. Failure at the primary site occurred in 24%, at nodal sites in 14%, and distantly in 23%. Multivariate analysis of prognostic variables identified age greater than 60 years, involved nodes, post-surgical residual disease, and poor differentiation to be bad prognostic variables.

Nodal recurrence in primary malignant epithelial tumours of the parotid gland

An analysis has been made of the incidence of nodal recurrence in 237 patients with primary carcinoma of the parotid gland. Fifty eight patients (24.4%) developed nodal metastases; mostly in the cervical region. Eighteen of these metastases were within the radiation field and 13 were outside the radiation field. Factors which were predictive for nodal relapse were: Age greater than 60 years, T3 and T4 tumours, node metastases at initial presentation, and macroscopic disease at either the primary site or the nodal site. The complete response rate for treatment of nodal relapse was 19% and the partial response rate was 17.2%. The 5 year actuarial survival from the time of first presentation was 58%. The pattern of nodal recurrence in this study indicates that radiation portals should cover more than the first eschalon (upper deep cervical) nodes. Our current policy is to recommend elective irradiation of the lower cervical nodes in patients with primary parotid malignancies.