A der e.,u?Iufi9tufluu Original ArticleY--. 4 all tt, cJ

dn fl tooiil 10 fl to.rq{rhsilst5{fi ff.rftnr:.rorynlul:r uulurailfi r:rrun:rrrGirurl0 Years survival Analysis of Nasopharyngeal Cancer patients in

Maharat Nakhon Ratchasima Hospital

'[r,rYu rir.rrJ:srffo lru._.r s anail{]l{tdgt flo urcin

I:{fl srurailfi l:lrila::rrEfu rvvdo.t?t?oilnt:1rciil1

aat*iilrsrrYndraror:

Phairuch Changprayad n[n.Department of Otorhinolaryngology

Maharat Nakhon Ratchasima Hospital

Nakhon Ratchasima

Sawanpracharak Medical ]ournal

VoLl Noa SeptemberDecember zoozflii l oriufi g ffuursu-ffuarnu zaoo

ultoouo :

99---, I J 4 v diotqiltvolrfl : tfraFlnurd'n:r:anfir,r s fluag to tl gasrJoo-gdfir^rarianr::anfirryza,r

(rJ r a el r ri.,: m n-,,:In :.,: o ry

ntul:.: n u 1 u 1 a il fi 1 :1 tu n ::t u f, ru rA4

do't1{1lflRUt : n{ru.,:rulan no urfrn l:.,:nururarJfil:1tuFrfi1tfril1I augtJuuunrriffu : nr:6nuruuulrJ{r.,:mrir

n{ilffaorir{ : rirhailvr5,,:m#.,:br:.,:oryn1ul:,,:flsrurailfi1:1uun::1dern rrfuui 1 ilnflail2540 6.: go o'urtrrru zsag siruru 2s1 T,tEt

Ad 4 .9- d y y tt I v?finl?rlRu'l : vlrnrafruiaila{druriaufnut zfiora.:nmintnuay6rrrtrrunr:inurrilu,strcL? a1 r o i1" {rla crdr.,, nl#*.o"lfi n.ra r rl il ctnluydrtfir fl or nfia il arirfnnumrru'uu:rug{'irfiffi nrn6orfr sffi niliailu.,,, 4n.r,eaffi n i rn:1;{{oryarrdn:rnr::aotfifl s tl uav 1o fl lrrstfi Kaptan Meier survivatanalysis Bactilielu tfi uuflo{udfi zunrianr::aorfivrlrr H'lfi cox-regressionanatysis rirruornmrurdo*iukifiaan,jriouas gs

ruanrrFinul : riilran-.:rrua 2s1fl?I a1q14-82 tl arquoder m.g (t 14.1) il dn:rdrururrrmE ri,urnun.,:viti, l.s '; r{r#i;Er50sa, *.r dro.a6uiauasO.A zfio?a':ilct5.lv'lu poorly differentiated iauac 47.4 :a{a.,:rur6aundifferentiated Saaac 34.3 :cus?a.,:Irndyru 6a rrfl# + faunr a+.a:4.:4.,:en6arra# g Saan; a.a dn:rnr::ooftr,r s tlloEl:ruryirfuiagac28.5 (95o/" Cl = 22.65-34.63) unco"n:tnt::aafiu tO tl brenulvirriuiosav 16.3 (9s% ct = 9.23-2s.tg) flod'fldfizuaoionr::oorfinrarfrrlra

Ifiuri orq (p=0.02) uaynr:uyrdn:salsto{trri,,r1rJ{aiartdu 1e=o.ot ;

? t rt oi* av opJ' $l;.'ilj]ffi*;It l,*'I ?,THffi ll;,T;lil [}xtl#:flu:n u#.:o'rnUf5unrfifiodEln#ntn Sasac zt.s uau #',:fln 5 flttld?

dn:rnr:t6lafitn rfiru{uhimn darfi Huriudr',: s fl u:n

nflo : o-trr:1 fl ITTO nfi r r tfoo-fl fi fi H a ri o nr::o nfl rr.r rucr5,,lm f,.:Inr.:o t n

Abstract :

Obiective

Setting

Design

Subiects

Method

Results

Conclusion

To study S-years and 1O-years survival rate and prognostic factors of

Nasopharyngeal cancer patients in Maharat Nakhon Ratchasima.

Deparbnent of OtorhinolanTngology, Maharat Nakhon Rahfrasima Hospital'

Prospective studY.

Nasopharyngeal cancer patients in Maharat Nakhon Ratctrasima Hospital

during January 1, 1997 to December 31, 2006'

Nasopharyngeal cancer patients medical record were collected and

followed for 1Q-years. Data analysis by Kaplan-Meier survival analysis

and cox-regression analysis with a significant level at 0,05.

Ol two hundred and fifty one Nasopharyngeal cancer patients, there

were 179 males and72 females witr a Inean age of 50.9 (J 14.1) rangp

14-82The majority of the patients were Thai (249 patients, 99.2ol"). 114

tumors (47.4%) were poorly differentiated squamous cell carcinoma, 82

(U.g./"\ undifferentiated carcinoma. According to the p'^JCC 1997 staging

system, 3.2Y" of the patients had stage l, 3.2o/o in stage ll, 8.8% in

stage lll and}4.}o/oin stage lV. The overall S-years and 10 years survival

rate were 28.5"/o and 16.30lo respectively. The poor prognostic factors

were age and distant metastasis.

Our results have shown that most of the patients was in Stage lV and

had poor S-years and 10-years survival rate. 71.50/" of patient died

during the first S-year after diagnosis.

survival rate, prognostic factor, nasopharyngeal cancer'

ocR1d"l

Keywords

dn:r:onir ro fl to{dri:uucrilttit'l'ln:.rolnh'l:{ilt,rutaurl: ltlrfl :5rlalt-t

id + ofufr 3 n.U.-8.4. 2550 to Years Survival Analysis of Nasopharyngeal Cancer Patients in Maharat Nakhon Ratchasima Hospitar ${$

J,ad,uilrn rir,:arsfriluiloaFo 40-59 ill a-'n:rdeu

u1a : il€.: rvirriu 3 : 1 f,1tfiQtatl:nnu'jr

fi nm ru #r.n{udtiuil ar s 1 rloo'u rfir rutd Enf, a',1 ii nr tf; nu r

unrird vr dr .r J

ust5.,:fi a{ Ly{:iloil ntUuilct:{mTluua uo d e d |I|9 f-Lud'lttotE'gns?uaanLag\: Ln Lng[av't1s

m?6un?fifr.,: ria.,:n.o unv a{,ilil5tt-sr fl2sq

AeuacA.{'r?r.l??1'riluuas ounnl:6ua1nnn1n 1

v{uiltsilltuiagac 0.25-5 fl o.tilst5.:#.:fi ilFt

drutuil:cryrnlnEJv{urfl ua-uriudo.,ttta{ilst5.:

'[uu? re ru d:Ec ua vn a :o{ rJ1 01 fl tt ;rit'[udo.,:

ldu neru fi nrln6nr.:nTuon::il In:Iultru

nr:finrda Epstein-Barr virus nqfin::runr:AftJova

uSLn n La g tQ1rt1301fi 1:Ylu1tj1fi il ntnaA tdu

rlaru6u uagv{u'ilnudhinrur.lalfian rin

unl:fiu fi nerrutds.:tfi ru{u(')q u Aa r a vtrlo{ufi fl il a ri a nt::o otn'u4.,: {dr u

d u f 19 | a Ir.lrL5\:fia{[v{:{ailfl Lnttn o1u dunga.0tdaa{q

-oYaytlrt:it ?lu1FruarFt1 ufi u{?lo{no3Ju1tfi aa{fl 'lil

no nr:ufl dnrralsra{ilcr5l}Jdo{srrdu ua,0A U I stl_ r agilafl annlT:nt,rl annnlToultJ u [anuu{luuFl

< a !* - J J . aflaitr{anillri.]iltilu 3 f,iln ?r\lilfluuaflri 2

tflo 6o n{r.l ruon-Keratinizing squamousq

cell carcinoma uac undifferentiated carcinoma

:rruudril:vurruiaElac 70-80 lo,s?l't 2 lita

d v I O , ll t I IilBL5itfi a{ L}tt:{ari n [uU:rLTt F[LYlElFtou?1'lua?l{

,Ar,tauLtactYtlfl n:1u [tJv{u?'ttJ n1::'l th]1uan:1 n1:

d d, eh c a et:aatl'{ 1 0 ilta.:r,Jil?gus[:ir{uFru Luu:ctnF[

ru

lm s rr ri au 6trir nr: fi nurln er n'i'n qil:sar d'Aaudd.d.

rv{oHnulan:1n1::o0tflY'l 5 UtLac 10 U ua3A q - Ja r a vi d

dnuilaauytil zuaFro nt::anufl m.,1 ryU? gilc[T\:

ra d.,:}^r :to ru ntul:.,:fl sr u1 a il u'r r1{u ntr1{q

f,rur

finuruuu Prospective study '[u

fr rt a H dl diu n T :i fi o ds'i r rfl u ru v r5.,: u ai'.:In :.,:

0

ory n'[ul:rn g1u1 a ilfi 1:1f,u nrfl geilr rr&.,: upi

'l iln:1nil 2540 61 30 fiYu?1nil 2549

:2rJ:srjs!?arfinur r o fl lorer{il2H4nflfllfiUU,9A:unl:flnu:r?nunenT?Q:'h:fl1un1{fi na

ailn lorsasrdEJo d.,:n:rorua{utdonr.:nHrE{A a s I Gt, d u'l'

?Yt Er1 tlro uu EJU?1 tilu ilst:{fi a{ [1^l:{o{ no A t d ur

y{5ailyr".,:mi.,rtfi oruo.:I:nrrliloitFrnt:amilu[an

(WHO classification)(1) ut-i.,t:cEJrtla.lf:n

(staging) mil A.JCC staging criteria (1997)(1)uehtA-v

uasttu{nailn1::nulruu 4 nasJ Fro 1. :nu1ql

Insi.:dinur z .inudor ui.:dinr*T dtr riu rnfr

t d, vau A dtilnsu 6lufl .,1d nan1lo1 El:.,:61:fl u1 sdtuun1Tvvda!-a-d,-q-r-^----o^-^-y-^.^^^.4-y^.4^^,^^-aainwtmanto.ltJstS\:giinfr aot:r:aoZyr S fl firj:ama''tnr:inuroufi',:ar-udounr:finu1fi34

rqduiasac 5g-76{r-s) oiotrirrm6o.-:frrlaofi t-udnulflrdaffin uiamnm:Anmilnr:inu

dru-n g. inurloarnfitirfor uas 4. h16:uu a 9i ra u a

fl1T:nu1fi:ofl u?Eru0r6D'fl1::nu1 nnn1il{

ooyv d i t t I a,Jam1 114fl ,t:1n1::oFltTtnla{ La uy{u?1n1N

tr ur n'[ra qj ua c n"r ura il.,, d n u a qi :r riu otrt ( I owe r

neck) osdr"lr{n'r:ilmn?nll:nh,i6ruT n{u(')CdAvdy

riia,:ornfi nr:fi nur dor:1:a nAfl ? at {dra

A v" r a v qY1i.1rJill?.lnAilt1An1:nAn1ilfl 1::nMOs t{n1:gq

fi n nrraarusdnfi1sar nfroruazotdT rinq{

rurfi au:ru6f'jr s-{ fi ffi no qjnio rdaffi niltoilUaao

7h: 611 rfi Fl fl 1:t6l Etd',l nt

644 lnYr d'rqj:rufia(, I C

d?::nil:su1:nut?{6117

ae &rnrfi m:r#f,a runrihhflfr,i1u?u;a Er nc (Undifferentiated carcinoma) ioaas g+.9

v r O tA @ilvde t vfl 1::fl U16l2U lfi rUnA n1: [fi :{61:fl 1*1:? rJ nU

doeo-avdvtFrilu'tun :ouas 44.6 :o{ndil1no :itdTntrl

r d I f dY n YaE1{LFtEr'l :AgA3 39.0 LnUilr.ru?s:auav 9.6

,J,Jacrir uofr g ua;rir tit Er.,r tuuerl fl TSlu i trr:rcfi

rjfrraonr:inu4ntfia 1nr:r.,:d t;dn:r:oorfln s tlIorEJ:ui fihe overatt

S-years survival rate) tyilfiuiaaas ze.s

(95% Cl = 22.65-34.63) uas0-0r:1fl1:dd,av

:oFt{Y{ 10 u ana{lfiao:auas 16.3

(e5% cr = e.23-25.1ex?ilfr r) nu'jr{rJru

vi o <A v t

,Jll?fl :fl HAv 84.8 8J'rYrU [tY{Tr U rSJortlrlTeElcJJ r 4 A e t ei &v- u f ovedqfifisa.,:t:n :a{a{il16a:cssfid1il 5aEJav 8.8 ilu'i1frrhsfitfriunr:inprlorstfri.,tflinpruacriile utaEaE 1 5.9 r,ru'irfi nr:n:re1 Ei?roir

ud'dd4on:1:antvll LtasLu:uutmuuzunnl:fl nu't

:trn'jr.,:n{r.rlrrg Kaplan-Meier survival analysis

unrLilSuu Lfi fl uflo6'sd fi ru a ri a nr::a ofiv{

(Multivariate analysis) Ios Cox-regression

analysis rirmuor rirnmru rdariuhjrioan'ir

iosav gs

,{aRttflnHtA Y h C, Uf

m n n1?Antrl ryU? ErsJvl:{fi a{r L?\:{0{nord&'Lu[:.,rnaru1ailfi1:1tun::rgfrilr d'.:rLpi 1

auilnr1nil 2540 n{ 30 o'u?1nil 2549 :?ni

TsUsf?a1 ro fl rrurirlxil 251 :'rEr rvrFlmEJru

5aflav 71.3 rv{flfifi.,: SaEIac ea.z a'n:rdruAt'ra : u{.: rrirrTu 2.5 : 1 dr.:orqfir,ru6a

a, J .1,14-a2 fl arqrada so.9(114.1; fl nun{ru

o1g 41-so fl tauas za.z tilatrfilnau"aadv:aflas 99.2 ttas ttratrlnflu Tauas 0.8

ddAotd,Y.r6lEjt?nLut?d 5 uLr:n rasac 71.5 unfia\:

&ua&rftvaJA1 nUUA n:1 n1:trt gt? Fl lil il1 nU n0UO\:Y.l:3 gc

1o fl 6orrilua-n:1or1EJIafl:?rJ o.2s :18r dr v O A gttnau ilfiur1ur?a1 [un1:nnn13JHu?g

(Median follow-up time) 2.1 tJ

dn:rnr::aofiv{ s tluav 10 flsir uunorril:vEr?o.il:n(stage) t{u'jr:sa# +dv d 6 J a Ailanfl f:r1?:a n?Y'l nlnqa :a'ta'til1 no:&fl eTl

s, 1 uas z nrrudrffu (grJd z1 uacrdaAAavtvdlIOlTrUlndtilntA\: n1:Tnl*'l nAO nT1:O 0l{71

ru"r5.:lrlda{ge"du Io,Erl'{udn:snn Soerac laflif;du :rou.:r,r6anr:inurlasi.:frinu1{d

57.5 :o{a{il1 6a riuuavilannlildlnuJ

(Fl'rT1.:n 1)

,.la n:?ailfi v'l u1mfl m drulu qj 5a emc

qZ.4 tflu poorly differentiated squamous

cell carcinoma :a{a{8Jr6o undifferentiated-Aoacarcinoma :oHnE 34.3 Lilooluuntunflail

ilBtf.ln1ru WHO classification Svylu WHO

type I (Keratinizing squamous cellcarcinoma)

taaas 65.7 [!nc WHO type ll, lll

t a t vh J,o u dvafl 1\:tFltl? 6?U[!U?fl nUflt6fi'n1:1fl 1*.1ilon:1{

d 6J ,J:oa{v{n1?lqo (?llYr 3)

J a a ot - Aatil allo1:fu10{uao uYtil zua n 0 n''l:

:snfrfl f O fuo,r{rhfl lu univariate analysis,

t c { , r -

'e

ilu?1 nlTn:3Q1 Ufl O.: ilBr5.rlil dA{rJrsAU.u

(M-stage) rfl ufloa-Eld fi zua oio nr::o nfi r,tei t du

' J

? O il 9,1 il ? tl fl tl 1 il tJ U B 611 n il n 1',1 6f tl Fl ttrl t 3J Ao,e-OAY{AlTfmLU multivariate analysis UAflIUUA

qr n #o.,: nr:n:ra1 u?a{ ilvr5.,:hJ do{EJrrdu rrf,r

d,J u e d'n:l:onir rofl toldtJrul;ri'rnti.rln:lrgnlul:rnurrLrauxr:rrun::17?ilrUm 4 auuYl 3 n g'-E'a' 2550 ro Yem Survival Analvsis oft'{ampharyngeal cmcer patients in Mahdat Nakhon Ra6hasima Hospita ${$

T{u'j1 ar qfi ru a rio nl::o oty{ a drril'u-s dr Fr"ruq -- '--'----' --

yrr.,: a6 fi da s eirniurlao"a fir urur nz a.:crYau

,JsL:{(T-stage) ?u1nt a.,:riaruilr tmda.:{1nno

(N-stage) uar:ssc?a,:I:nlstaging) y{u,jrfi

carcinoma) nuiagac S+.g d.:Mtnoirtorn--.4 AA )- a SnlTFlnu1fiAuff ilnflu{iiafr 2 uar g rnnn,ilrfi prd 1

(1,3,8) fn af itila'nrt:aorfinza.,:dod t3,a

ovairn'irriinfi z uas g adrofarou(3'B) lnEln:TldEj.Jdo;rflufiinlnelative risx) rfirudu tfind 1 fia-n:rnrr?onfiy{ s tl iagas toFrlr?u1 Fr uasrsErs?ra 0I:rrd rfl u{unr rudr riu

raAdruzfinfi 2 uaa g fia'n:r:oprfir,r s tlfauac soG) rftrfutunl:finudnudlnd r

uavfi nm ru ru nsir.,: a drrfi riu rir riryn1,,r dA fi dNs uav stage 4 zo{l:n rJo{flfirurfinm.o l.rrn aloLf,un"rurJ:rirn"'rgdrirlfrd'0,:r:anfifltradilct5',lttar?fin?a',tnr:inur lanr{uairJru 0r'rn'jrnr:6ntnddu tteia1nn1:irn:rni{aruadrJfrraonr:inw1) trifin?lruunnoirtadr',rfiritl udrna'utrjflun?1ilunnsir,,:adr.,:firisrirFifl3.u-aaooclv)adlnruml{dnn 6r'1fi?uiloaufrilrunrionr: nr.,:f,fifi(p =O.zz) {rJrudrulnqjrurxuuuvrd:a ofin s tlza.: {rJr er filff r.r atn f, rd Er.,r riuln Er

4- d A c. da ; til n?1 il r6tEh:TlOsrdudaq rfl r,tu n.l il?tu.t q uac

:crls? a.:I:n uor1rin u n ar il um n 0i1{ a Eir.: fi riggvaa)

AlnfuTllilrlnn (n1:1\:m 2)

ad?0r:ot

9\ d _ef A Xrytl? g SJet:\:fi a.: [r,n,:OrunOrn fn:fr nUija.i

Jd,arqrofra s0.9 [lrrruturyrflz,rEJ il1nn,j1

rvrfl?1€{ 2.5 ryir d.:'lnfil6tJ.0n-unr:6nwrd

f,rr -zr udrfr aurft uu prfi r{am filn u d.:urr noirr

11 fl :1 EJt'ru rir.,:rJ:crm adyrulu r{azr fi 6urfl udru'lmqj fnural,{rcr?nnar.:frr ciaon.: uac

fi ,,: nTrl i ria urin :rri.,: n u 6 u d frr u n fi rir ru rhl^^rC4- 1 a dv t dvoqjfidu rdu arruinr fiEl-.:flu'i1fioirr:rnr:rfin il:slnFl(e,a, lgrtd r uaqild 4) ua3o1nn1?

ucL5.,rfia-tlfl:.,:a{nd,,:n'irz1?fi?fl.tr6.,: z ryir(,) frnurddor:rnr::aorfin s tl mc to fl druun

.-4--- -l- d'. v dy tt arilE01n1:?ta{[:nruut rnu6a un;ilriilaafr.,:

24 :1s(;asas 9.6) dr.tfr raonr:fnr*rd.:aroovrfi oror n frdr azror nr1 ui nrrru rfr,rl,otu

q?n1y{so., iu raorJ:rn m nt ri. n r.ioouol,ui.gror_- a-tyaAl:ilj nuo gfi a{ ty{r{o{ nE.: ri auir,: d n il.: n.jro sud qn a1 n1 Ta a n il1lfr fr rh ain"r fi ru"n o ; rfl u

:rucnd{ g uto ufi nrrrio uni rird'.hl fi aroo cdr u r n'[u nr:i fi o q-utu :c gc riil u: nlfi

o-n:1n1::oorfrn s il lora:ur gne

overall S-years survival rate) vitn-ufogas28.5 (95% Cl = 22.65-94.69) uac 10 fl rhveanu:oaac 16.3 (95% Cl = 9.23-25.19) i'{A,3Jd6 o'ir oir rur n rfi a rfi uu riu nr : 6 nurlu oir.r

_.-e--._ . d a A J auflotta',:ttarfrust5tfivrururnfiqn6a poorty n1il:cElrto.,:I:n ilu:cg# r fia-onr:onfiyrvtJila fl n'ir:yEJafi z aGur s1d.j.r'irurufirhgtrstd t uur e fisirurufiagrdafinl:rfraffinrfius

t nia 2 :ilu n:rvnlwlildEruuila.0riau{r,rrurn

rfr o rfi Hu riurrs# + d.:qiruru rirh uur nn,ir

differentiated carcinoma :0.,:n{il1n0Undifferentiated carcinoma frrsirttunnrilWHO ctassification fiosnuzfind 1

(Keratinizing squamorJs cell carcinoma) iaaa;6s.z druzfi

^d z unc g (Undifferentiated n:T y{osrrl d EJu uiln.rfia Er ndr

646 lnir rir.rfisrdnl, v I

6{?::nU:rt1:nu2t6l1:

flo,i'a# fi am oi a nr::a ninta.: ftJr alu---4t t Aqv afl1:f,f]t*1u tilA [g univariate analysis HO

nl :n:3ol sfl on il cr5.tlil fl or-err "du

g

(M-stage) unrrdalfi muttiva'riate analysist dd r A t dv . u

v{u'tlmunilalanonl::anff{au1ililuEt6nnfli-.aa ,C a a I J I

Yl1{ dn n un Hl o?tQ'] tu1 n {:sEsft E.,l t:a fi fl .ttuetdJJd&fi ocfiamurtla.ofiocrdsffi n6etative risk) rfi xt c erfiunrrdT n-uloruraflrrtu Advance N-stage

M-stage [ta! stage + druiEnr:inurnu'jrnr:h{ir 6in ur a dr.o 16 s11dru atri un n 0i1.:

0']n?{f,?nu1t?Nnutnilu"tuFt ununnriln.! ..1 d e , -I ry- A?q routrJErnsunu nqiln Lil m:nu1 E{un n 0i1{t

a1nnr:6nuturir.,:rj:crmndr ru'ir nr:o'tttuao I v ac u ov u:{61:ntrlT?il nu mtailulu Ftor lfi Ha n1?Tfl trl)a I v d r 09fr 6n'jr uasdnrlnl:?aailn6.,:n'irnT :lfift f,

inwrrfi s.raeir.,rrdsr(t'''-tu) fnsrarqrrjtutas+J

ta,,:I:nfiqna1ilil1n[f,r (Advance stage)

oc6 odr tfl u nrtinu ruu rJ1 nrfl udocda,,fl?iudutudoo,a:{d:nu1 :2ilnurnilu1un rhun;r:.::csc

efovududtt:n 5J n1::nu1 !n un1: []1:.:61:nu1ty{ait

t .a rny Aa,asfi [n g?fl [14r{nnn11 ) Irr gtql,trcflooriufi nr:

't

rir rn nfi ntu n1:o1 ui{ ein ur uu ulu ri rurlfr

tdu lntensity-modulated radiation d.:rfl unr:qrsi.,r;luuu g fi fi il?inauriutirriorirrsad

duyttAy.lts!:i [a3aunfl uuo stdo riia Ga:ouir.:rirtri

valvdytilan1?inulniu unuetail{reH{ilos(1'17)

drurJnn"sdu sl rdu rr{Ft r-stage uarnfia?a{t C, rl rd I v A 9 t

r{ad illr5.rlil fr ar a si a o n:1:o oi?r?o{ {d? rlt da, o U aoA u v )a

afllirrJuu6llnrum1.ilrlon it0uaaufi ilrJadon1:daJda:an?fifl nn1:dnu1alnyln"lit j nocnnmil

Unndl{n-U(l,3,e-11)

n?il

In s ?i'dil d'n:1 n1 ?:o n ir{r odru s ri{u fr.rlt,r :.,: o X nlu riT .,ril :crn fl ri a u{r I 6.,1 uri a1 n

atvtvdAn1:flnulunauytu'l1 an?1n1::onf?IYht 5

ttas 10 fl ],ul:.:ns1u1arilt1gun:flieil1tr,,a..lduAAqycea

n8ul1{n1rilEry'luununou uoo galnrlJaa

ftir a mnu urnrn eirda:cs!fl a.oilcr5.,ta narrulilt.avd'-'--'-

rn n rd?ilia uin:n{lrlfi raonr:intn drlfinr:intnldr,ralilriasd d.:Hnoiaudorhlfirdnm

4_ f ) v *ty a ttontTa !n gn:{ {\:?otan LaalnnltFlnulilrir o ; rfl urJ:rlanioi atiltu nr:r,r fl 1 a1 r, du6unr {rJr a uaciiiodtrl:atu:cecrdu u:n

y & v ovc o I

vr:oN7h121{ uilun1T:nM uar lil n1 [ugu1 unv \ a A ) o ys aalu?uuacru1n tfl ona, lfian:1:andfltait,r,5ond'ol*:io{ nl,uil:rl, ot* 6r{*iufrl

AA'nnnflt:ilutsRtfl

Iso?ounfu uil.n.,rqm6 f,muFndni

qruim {1ilqil6qa uasrirufird6urinTnrur

4 run1flI:,:fl a1u1 a l:.:fl srul n il?11:1i

un::1!6lm ddrulunrfliufin uarirn:r#,AA?ailan1{dnR

4) u ) dn:r:onin ro il to-r{tlrtls6lm'ilr:ll1n1u1:rilururn!fir:rrrrR:rrriilrf,fi A ouTufi 3 n.g,-6.4. 2550 10 Ym Swival Analysis of Nsopharyngal cam Patimts in Mahmt Nakhon Ratchaima nmpita ${/

ronmrdr{6{1. Sivanandan R, Fee WE. Benign and malignant tumors of the nasopharynx. ln :

Cumming CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbin Kf,

et al, editors. Cumming Otolaryngology head and neck surgery. 4hed. Philadelphia:

the Curtis center 2005; 1669-84.

2. Ondrey FG, Wright SK. Neoplasms of the Nasopharynx. ln : Snow JB, Ballenger

JJ, editors. dallenger's Otolaryngology head and neck surgery. 16th"d. Ontario :

BC Decker 2003; 1392-407.

3. Eisele DW, Clitford AR, John M. Carcinoma of the oral cavity and larynx. ln : Lee

KJ, editor. Essential Otolaryngology. 6thed. Connecticut: A Simon & Schuster

company 1995; 535-78.

4. drura doqrri. Nasopharyngeat carcinoma. ?1T6t1t U no a{n uarXumrir 2531; 3:

191-5.

5. nt6un{ urri6n:. Nasopharyngeal carcinoma. ?1:611:lj! na oiln uastuufir 2530;

1: 35-9.

o. a.:6 qflnilElt, irua q?nilm. rust5wa.:tultv'l'ri.:d.ar:ffi:rt 2523: 32: 392-7.

T. fifio ri'cuaur?st{Ei, qG ln:n:aqa, drJt1fi rr6h:6t&o1n, a1m vt"rlnl:ori. tvr5.:nd.t

Inro.ryn. ?1:6t1:fi no a{n rac'lufifir 2531;2: lilt-zl.8. Reddy SP, Hasian WF, Goonerahe S, Kahurio S, Marks JE. Prognostic significance

of keratinization in nasopharyngeal carcinoma. American Joumal of CIolaryngdogy

1995; 16: 103-8.

9. Geara FB, Nasr E, Tucker SL, Brihi E, Zaytoun G, Hadi U, et al. Nasopharyngeal

cancer in the Middle East: experience of the American University of Beirut Medical

Center. lnt J Radiat Oncol Biol Phys 2005; 61(5): 1408-15.

lO.Sanguineti G, Geara FB, Garden AS, Tucker SL, Ang KK, Morrison WH, et al.

Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of

local and regional control. lnt J Radiat Oncol Biol Phys 1997; 37(5): 985-96.

1'1. Cao KJ, Li Y, Xie GF, Hong MH. Prognostic factors in nasopharyngeal carcinoma

in childhood and adolescence. lnt J Radiat Onool Biol Phyts tg98; 41(5): 109$111.'l2.Chua DT, Ma J Sham JS, Mai HQ, Choy DT, Hong MH, Lu TX, et al. Long-term

survival after cisplatin-based induction chemotherapy and radiotherapy for

nasopharyngeal carcinoma: a pooled data analysis of two phase lll trials. J Clin

648 lnlr iNrj:crf,nd, v C

6t?:TAu?fl1:nur?t6l1T

Oncol 2005; 23(6): 1118-24.

13.Prasad U, Wahid Ml, Jalaudin MA, Abdullah BJ, Paramsothy M, Abdul-Kareem

S. Long-term survival of nasopharygeal carcinoma patients treated with adjuvant

chemotherapy subsequent to conventional radical radiotherapy. lnt J Radiat Oncol

Biol Phys 2Oo2;53(3): 648-55.

14.Cheng SH, Jian JJ, Tsai SY, Yen KL, Chu NM, Chan KY, et al. Long-term

survival of nasopharyngeal carcinoma following concomitant radiotherapy and

chemotherapy. lnt J Radiat Oncol Biol Phys 2000; 8(5): 1323-30.

15. Lin JC, Ma J, Mai HC. Phase lll study of concurrent chemoradiotherapy versus

radiation alone for advanced nasopharyngeal carcinoma: positive effect on overall

and progression free survival. J Clin Oncol 2003; 21: 631-40.

16. Huncharek M, Kupelnick B. Gombined chemoradiation versus radiation therapy

alone in locally advanced nasopharyngeal carcinoma: results of a meta-analysis

of 1528 patients from six randomized trials. Am J Clin Oncol 2OO21'25:219-24.

17.O'Meara WP, Lee N. Advances in nasopharyngeal carcinoma. Curr Opin Oncol

2005; 17(3): 225-30.

tihnrmin ro i te{ilrauri*rf;rlm*qnlllrlrfluramnnlut :rfirild + qriud g n.u.-E.i. 2550 to Ym swival Analysis of Nasophryngcd cmccr psricnrl in Mahenr Nd&o Rsrchasimr u*eru ${$)

J v Ltmfl.ofr t iaranalil{

{aXarirhl drurul:T a;,.:aflat

IIIf,

t'lEl

m{rlatrofln

lnErA0u

doffiil

oq (fl) (mean t SD = s0.9 I 14.1)

<30

31 -4041 -5051 -6061 -70>71

INr*A?N:Tilv9:ue1il

lilrir.rT uAaulf,1mEr

{u:rtnr:T-stage

T1

T2T3T4

26

25

67

65

55

13

179

72

249

2

136

53

22

19

12

I

38

89

g2

92

10.4

10.0

26.7

2s.9

21.9

5.1

71.3

28.7

99.2

0.8

il.221.1

8.7

7.6

4.8

3.6

15.1

35.5

12.8

36.6

6-50_ lrrh dr,nlmda d?fiirhs^mfn*rrar:

J v d,rmrn{ff t iataftlil (oia)

fioXaYirhl o&ruru6ra1 t,TAg6s

N-stage

NO

N1

N2N3

M-Staging

MO

M 1 (bone = 25, liver = 9, lung = 6, brain = 2)

TNM Staging (A!CC 10e?)

stage I

stage ll

stage lll

stage lV

Histological diagnosis

Poorly differentiated squamous cel! carcinoma

Undifferentiated carcinoma

Moderately differentiated squamous cell carcinoma

Well differentiated squamous cel! carcinoma

Treatment

XRT + ChemoRx

XRT

Non - Treatment

ChemoRx

dA^r6tH{?n

ilt?n

57

32

122

40

2'.11

40

II

22

213

119

86

31

15

112

98

24

17

176

75

?2.7

12.8

48.6

15.9

84.1

15.9

3.2

3.2

8.8

84.8

47.4

34.3

12.3

6.0

4.639.0

9.6

6.8

70.1

29.9

rogoL*

dn:r:onftr ro fl ml{rJrol:ri.rr,rdiln:.rc1n1ul:,uuutnuur:uuR::rtiiurfld + qfud 3 n,a.-8.4.2550 1o Yes swival Analysis of Nmpharyngesl cms Patienrs in Maharar Nakhon Rarchasim nospitar $$l

t

qonC\T

I

I

q

+rod$C\t

I

-F

\NUoociq?o:gFrC4,tttaqrOOF

o)o)c\loroooo

qqo?FFC\Itttqu?o?ooo

cD ro l'^6I quoocis?\u?

F(\Jttt$@o,dcici

$ro$lq\Iooo(o o, (f)JJcrirltqqolooo

$CJ

o?(\I

ICD

C;

a

o)(oFqu?o?oooqq\(\IF(\Ittrq\\ooo

o? c! -qOrr

NNo,c!\qooo

\qa?ot (\t (f)ttl@roo)

OC,Ci

@

Ci

(\{C\I

Io)ci

q1

(o$l$ro) u? o?oooqo?qC\l F Altttu?\\ooo

oo$FF

OOr$F

aq\rFF

\o{qOrr

OF-(\1 (OOrF

oorNt-O--

r@o

o?r

Iqo

O)Ci

o?o

Iqo

*oloooC\i

Iq

a

o)qo

\I

o?o

(D

6&

os|oo,

tEtr

o,=EA

osroo,

tEtr

$CJ

o?

I(od

oqo

a?oa?

Iqo

ro@ct

qI\o

(ou?oq

Iqo

ostoCD

(Et

G'(d

Los!oo,

qqoco qoqo

orN@-\qooooq oq a?c\t c\t c4trttoroo)ddc;

€ I I FnF'$- N o, ..'$. F or.'$= F

E=,1 2*

O,FO@O|o(\I@-;-Ci----

o(U'=(U

=l

o(UL(U

c:f

o(t,.E(U

J

o(U.Eocf

t-=rS

ItJoU)

Eo(U(L

(ULoo

!-J[o

u,co(U(L

(6

oo

4Jc!?)3"q6d

rl=ottGJ

fFro

=TFGGIll-lrtCcGI'6G3

IB-!F^dJJ6

CE

Er(\I

nF.7ClrlC6

loqovL

I

o(E.E(U

=

lrEl"l'E,l

glclelr-rl (l)lolElFlaLl

Ellalr=l-rs I

nEl@lrtI#l7lr!lEI

o(E.E(U

Ef

o(E.E(d

5

o(U'E(u

cl

r.arf,

C\I(\lo

IIqo

qo

na?c!Fgr(oltlf\ O) Gld c, c\i

@ooLqq6ooci!oolq,;rRl\l/ c\l Al+"tJoc,-

F\@:-qqbooci.<tFCO-ctdtrl\olroo(\l

aI@:^qq6ooct@cl-aPP+,A:od-

q55ocici

F-\o?_$$J.iio oi c'i

F-FO)oi+cilolortt(\t@o)dcici

lOqoq

IlOd

q\FO

(f)rrqqqoool\o?I-$s{iio c\i t'i

@CD@ai-otr tO liftllcY oq olooo

o*'oct)

G,AE

E rHt Eo F= E oro

Eegg$EEtEEHE;E$*

oF

C,

I-Iqo

oo-d

loqoqF

Iu?o

\o

qs?-osfro

@F--CtF.

(O r.- lf)qqqooo

ot.loo)--dd

(\r(orqqbooci

Of\F.--Ctj

-qrF(gt-

q\q\ qq\u?;O$l$FrF(r)

sf l- lr)(oooci c, cj

o=ELoslr)o,

trtr

q)=EA-

6s!oo,

E.E

IELobetOCD

rrE.

qIqIFF(clN

100

?76L.Itt.a 50EIaU

!+aoBQ 26

o

r* n oura, n.,.-o.", *.o ,, ,,.,*.i1111?,ll'n1ilfl##,*H*lffioHiffill'*,* *r, 66a

6 years survival28.6%

cl-22.66-84.03) 10 ycius rurvival16.9%

cL0.28-C[.10)

o6

fl1fi 1 dn:r:aniln s fluas to flIns:ril

Surrival time (year)

gttd , dn:r:enfivr s f,unc to t nril:cffiha

G,

EtC"

EaUt+{0

BS

(E

Lt6

EtUl+roBe

100

76

50

26

o

ChemoRx alone

SurYival time (year)

$td g dn:r:anin s fluac to fl arunT:intn

XRT + ChemoRx

dn:r:onin ro f, tor{rJrolvtErniiln:wqnlul:uoruautr:uuR::tr3utfld + gfud 3 n.u.-g.n. 2550 10 Years swvival Anrlysis of Nasopharyngeat cancer Patients in Maharat Nakhon Ratchasima nospial $$$

I:agat

A = Reddy SP, et al(6)

D = Cao KJ, et al(11)

G = Cheng SH, et al(la)

co

B = Geara FB, et al(s)

E = Chua DT, et al(tz)

C = Sanguineti G, et al(10)

F = Prasad U, et al('3)

fl1:f,ntrlau6l

;rld + a-n:r:oofin s fl lers:rilrdarfisuriunr:fintndu1

:t't.llrt:rfla::rt6lu