Between January 1, 1971 and December 31, 1983, sixty three patients received radiotherapy for advanced (Stage IV) carcinoma of the nasopharynx confined to the head and neck at Yonsei University College of Medicine, Yonsei Cancer Center. Fifty seven of those 63 patients received at least 6,000 cGy. The 5 and 10 year actuarial survival rates were 21.8 and 13.1% and those median survival was 24 months. The actuarial survivals (median survival months) for Group 1 (16 who had sufficiently advanced primary tumor to qualify for Stage IV : T4 N0orl), Group 2 (34 who had sufficiently advanced adenopathy to qualify for Stage IV: T1-3N2or 3) and Group 3 ( 13 who had advanced both of primary and adenopathy: T4 N 2 or 3) were 9.7(19), 32.9(44) and 0%(9) respectively. The survival of the patients in Group 2 was better than that of those in either Group 1(p<0.005) or Group 3(p<0.001). Local persistence or recurrence of tumor in the nasopharynx was the primary cause of failure and occurred in 39.1%(18/46) of evaluable patents. Distant metastases was the next and occurred in 28.3%(13/46). There was a definite correlation between recurrence at primary site and T-stage; 61.5%(8/13) of evaluable Group 1 and 61.9%(13/21) of T 4 patients (Group 3 included) had local failure. Similary, failure in the neck (regional failure) correlated with N-stage, being 24%(9/25) for evaluable Group 2. The incidence of distant failure had no correlation with T-stage but correlated with N-stage; 40%(10/25) of Group 2 developed distant metastases. Treatment failure occured in 95%(36/38) of the patients by 2 years after therapy.
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