Radiation therapy and concurrent cisplatin in management of locoregionally advanced nasopharyngeal carcinomas

Radiation therapy in combination with chemotherapy in the management of locoregionally advanced nasopharyngeal carcinomas is evaluated in an attempt to improve locoregional response, reduce locoregional failure and reduce systemic failure. The current study was designed to investigate radiation therapy and concurrent cisplatin in this context. From 1992 through 1997, 70 patients with locoregionally advanced nasopharyngeal carcinomas were treated with radiation therapy and concurrent cisplatin. External beam radiation dose was 60 Gy for T1, T2 and T3 tumors, 70 Gy for T4 tumors and 70 Gy for metastatic cervical lymph nodes. An intracavitary brachytherapy boost (10 Gy) was applied for T1, T2 and T3 tumors. Cisplatin (30 mg/m2) was administered weekly during external beam radiation therapy. Locoregional complete response was achieved in 63 patients, locoregional failure was observed in 4 patients and systemic failure was observed in 15. N-stage predicted systemic failure. Overall survival, locoregional failure-free survival and systemic failure-free survival were 63%, 79% and 75%, respectively, at three years. Grade 3 acute skin toxicity was observed in 2 patients, Grade 3 acute mucous membrane toxicity was observed in 6 and Grade 3 acute hematological toxicity was observed in 2 patients. Despite improved locoregional response, reduced locoregional failure and improved survival with radiation therapy and concurrent cisplatin, systemic failure remains prevalent for locoregionally advanced nasopharyngeal carcinomas.     

Prognostic factors affecting the outcome of nasopharyngeal carcinoma

BACKGROUND: The aim of the study is to evaluate patients with nasopharyngeal carcinoma treated with multisegmental intensity-modulated radiotherapy with or without chemotherapy and analyze patient, tumor and treatment characteristics, determining outcome. METHODS: From June 1999 through to April 2003, we treated in our institution 83 patients with nasopharyngeal carcinoma, 70 males and 13 females, their ages ranging from 25 to 85 years (median, 48 years). Nineteen patients had T1 tumors, 35 had T2 tumors, six had T3 tumors and 23 had T4 tumors. Sixty-four patients had cervical lymph node metastasis. Twenty patients were treated with radiation therapy alone and 63 patients with concurrent chemoradiotherapy. Cumulative radiation dose to primary tumor ranged from 70.2 to 77.4 Gy (median, 75.6 Gy). Follow-up ranged from 3 to 41.53 months (median, 17 months). RESULTS: Local complete response was achieved in 81 patients (97.5%). Local failure was observed in two patients, nodal failure in one patient and systemic failure in 14 patients. Overall survival, disease-free survival and disease-specific survival were 83, 84 and 93%, respectively, at 1 year, 82, 74 and 88%, respectively, at 2 years and 82, 61 and 88%, respectively, at 3 years. In univariate analysis, T stage of disease was a significant predictor of disease-free survival favoring those with early-stage (T1 + T2) disease (P = 0.040). Cumulative radiation dose to primary tumor was a significant predictor of disease-specific survival favoring those with >75.6 Gy (P = 0.010). Stage of disease (P = 0.007), N-classification (P = 0.046) and cumulative dose to primary tumor (P = 0.046) were significant prognostic factors for overall survival. CONCLUSIONS: High locoregional control for nasopharyngeal carcinoma was achieved with multisegmental intensity-modulated radiotherapy. Distant metastases are still the main impact on survival. More effective chemotherapy regimens and other systemic agents are needed to decrease the rate of distant metastasis.     

Radiation therapy, cisplatin and hyperthermia in combination in management of patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes.

Twenty-one patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes were treated with radiation therapy, cisplatin and hyperthermia in combination, in an attempt to investigate any potential contribution in terms of safety, response, duration of palliation and quality of life. Patients not initially treated with radiation therapy were treated with a median dose of 70 Gy and patients initially treated with radiation therapy with a median dose of 30Gy. The median number of weekly cisplatin courses was five and the median number of twice weekly local external ultrasound hyperthermia sessions was five. Average T90, Average T50 and Average T10 were 39.9 +/- 1.2 degrees C, 42.4 +/- 1.3 degrees C and 44.5 +/- 0.8 degrees C, respectively, and Average CEM 43 degrees C T90, Average CEM 43 degrees C T50 and Average CEM 43 degrees C T10 were 7.8+/-9.6min, 22.6 +/- 18.8min and 39.3 +/- 25.1min, respectively. Mean follow-up was 1 year. Nodal complete response was achieved in eight patients and palliation of presenting symptoms in 19. Overall survival was 39% at 1 year. Grade 3 acute skin toxicity was observed in one patient and Grade 3 acute haematological toxicity in one. Radiation therapy, cisplatin and hyperthermia in combination appear to be safe and might improve response, prolong duration of palliation and reinstate quality of life in patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes.     

Radiation therapy, cisplatin and hyperthermia in combination in management of patients with carcinomas of the head and neck with N2 or N3 metastatic cervical lymph nodes.

Fifty-three patients with carcinomas of the head and neck with N2 or N3 metastatic cervical lymph nodes were treated with radiation therapy (median, 70 Gy), cisplatin (median, 6 weekly courses) and hyperthermia (median, 6 twice weekly sessions). Local complete response was achieved in 82% and nodal complete response in 85% of patients. Overall survival was 51% and disease-free survival was 54% at 2 years. Toxicity was acceptable. Radiation therapy, cisplatin and hyperthermia in combination prove to be effective and safe in management of these patients.     

调强放疗模式下局部晚期鼻咽癌诱导化疗后同期化疗与单纯放疗疗效比较

目的:探讨调强放疗模式下局部晚期鼻咽癌诱导化疗后同期化疗与单纯放疗临床疗效的比较。方法:回顾性分析2010年-2012年期间在本院采用调强放疗技术治疗的局部晚期鼻咽癌,分期为Ⅲ-Ⅳ期的鼻咽癌患者共120例。所有患者都进行过诱导化疗。放疗范围及剂量为鼻咽原发灶、阳性淋巴结的大体肿瘤体积处方剂量为T1、T2期69.96Gy,T3、T4期72~74Gy;亚临床高危区靶体积处方剂量为60~64Gy;淋巴结阴性引流区处方剂量为50~54Gy。分为单纯放疗组60例,同期化疗组60例。同期化疗方案为单药顺铂为基础的方案。主要观察两组的近期疗效、3年无瘤生存率(DFS)、3年无局部区域复发生存率（LRFS）、3年无远处转移生存率（MFS）、3年总生存率（OS）及治疗的毒副反应情况。结果:两组性别、年龄、病理类型及临床分期的构成比均有可比性。两组患者中位随访36个月。治疗结束3个月两组患者的完全缓解率分别为83.3％、80.0％,3年无瘤生存率分别为78.3％、75.0％,3年的无局部区域复发生存率分别为93.3％、90.0％,3年无远处转移生存分别为81.7％、83.3％,3年总生存率分别为88.3％、86.7％,两组统计学无明显差异。同期化疗组急性毒副反应高于单纯放疗组。结论:在调强放疗治疗模式下,局部晚期鼻咽癌同期化疗与单纯放疗相比,患者的3年总生存率及无瘤生存率未能进一步提高,而急性毒副反应增加,同期化疗在调强放疗模式下治疗策略需要行进一步的临床研究。     

N0期鼻咽癌颈部可疑阳性淋巴结64Gy放疗疗效观察

[目的]观察N0期鼻咽癌患者颈部可疑阳性淋巴结（最大横断面短径≥0.5cm但〈1cm、包膜完整、无中央坏死）给予放疗剂量64Gy时的疗效,患者的不良反应及预后。[方法]66例N0期鼻咽癌患者,颈部可疑阳性淋巴结予以64Gy的放疗剂量,以MRI检查为标准,评价疗效。[结果]放疗剂量达64Gy时颈部淋巴结转移灶完全缓解62例,有效率达93.9%,放疗前后淋巴结消退情况差异有统计学意义（P〈0.05）。在治疗结束时所有患者均出现Ⅰ级放射性皮炎,并在5年随访过程中无颈部淋巴结复发,无颈部皮下组织纤维化患者。[结论]64Gy的放疗剂量对鼻咽癌颈部可疑阳性淋巴结转移能很好地控制,且不良反应较轻,患者可耐受。     

鼻咽癌缩小临床靶体积调强放疗疗效探讨

目的 探讨鼻咽癌(NPC)缩小临床靶体积(CTV)调强放疗(IMRT)的疗效及毒副反应.方法 2003年8月到2007年3月共380例NPC患者入组研究,其中AJCC分期Ⅰ期1例、Ⅱ期71例、Ⅲ期197例、Ⅳ期111例.高危临床靶体积(CTV1)包括肿瘤靶体积(GTV)及整个鼻咽黏膜,低危临床靶体积(CTV2)包括整个鼻咽腔(包括鼻腔后部5 mm)、上颌窦(后壁前5 mm)、翼腭窝、后组筛窦、咽旁间隙、颅底、斜坡及颈椎前1/3、咽后淋巴引流区(内侧组从颅底至第2颈椎上缘).处方剂量GTV 66.00～69.75 Gy,CTV160.00～66.65 Gy,CTV2或CTVN54.0～55.8 Gy,分割次数均为30～33次.其中308例局部进展患者接受了以铂类为基础的诱导化疗.结果 随访率为100%,随访满3年者145例.3年局部控制率、区域控制率、无远处转移生存率、无瘤生存率及总生存率分别为94.9%、97.4%、86.2%、80.9%和89.0%.多因素分析表明N分期是影响无远处转移生存率(x2=20.80,P=0.001)的预后因素,N分期(x2=18.30,P=0.003)及年龄(x2=7.31,P=0.004)是影响总生存率的独立预后因素.5.6%患者放疗后2年仍存在2级口干,未观察到4级远期副反应.4.2%、2.6%和12.1%患者分别出现局部、区域复发及远处转移.结论 采用缩小CTV2IMRT方法治疗NPC可获得较好的局部区域控制率及总生存率,急慢性副反应可接受.     

Radiation therapy,cisplatin and hyperthermia in combination in management of patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes

Twenty-one patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes were treated with radiation therapy, cisplatin and hyperthermia in combination, in an attempt to investigate any potential contribution in terms of safety, response, duration of palliation and quality of life. Patients not initially treated with radiation therapy were treated with a median dose of 70Gy and patients initially treated with radiation therapy with a median dose of 30Gy. The median number of weekly cisplatin courses was five and the median number of twice weekly local external ultrasound hyperthermia sessions was five. Average T₉₀, Average T₅₀ and Average T₁₀ were 39.9±1.2°C, 42.4±1.3°C and 44.5±0.8°C, respectively, and Average CEM 43°C T₉₀, Average CEM 43°C T₅₀ and Average CEM 43°C T₁₀ were 7.8±9.6min, 22.6*plusmn;18.8 min and 39.3±25.1 min, respectively. Mean follow-up was 1 year. Nodal complete response was achieved in eight patients and palliation of presenting symptoms in 19. Overall survival was 39% at 1 year. Grade 3 acute skin toxicity was observed in one patient and Grade 3 acute haematological toxicity in one. Radiation therapy, cisplatin and hyperthermia in combination appear to be safe and might improve response, prolong duration of palliation and reinstate quality of life in patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes.     

Split course radiation therapy for adenocarcinoma of the pancreas

Ninety-five patients with biopsy proven adenocarcinoma of the pancreas were treated with split course radiation therapy. Fifty-five patients had disease confined to the peripancreatic tissues and lymph nodes. Forty patients had metastatic disease. The intended radiation therapy scheduled consisted of two courses of 25 Gy in 10 fractions each followed by a 3 to 4 week rest period. Depending on the response and the patient's clinical status, another 10 Gy in 5 fractions was administered as a final boost. The median survival in patients with metastatic disease was 3 months and the median survival in patients with localized disease was 8 months. Twenty-seven of the fifty-five patients with localized disease received chemotherapy (5 FU or FAM) combined with radiotherapy. There was no significant difference in median survival between the patients treated with radiation alone and those with combined radiation and chemotherapy. The median survival for patients with localized disease receiving 25, 50, and 60 Gy were 3, 7, and 12 months respectively. After a dose of 50 Gy in 20 fractions, CT scan showed no evidence of tumor in 6%, smaller tumor size in 31%, stable tumor size in 41%, and tumor growth in 22% of patients. The split course radiation therapy was well tolerated and no late complications were detected. The medical and economic advantages of using split course radiation therapy and in using CT scan response to plan boost therapy are discussed.     

A combined therapy for maxillary cancer

Forty-three patients with cancer of the maxillary sinus were treated by surgery combined with radiation and regional chemotherapy as a series of treatment in 1978-1989. The combined therapy consisted of the followings: 1) Operation to reduce tumor-mass. 2) Irradiation of total dose of 16 Gy, that is, 8 Gy preoperatively and 8 Gy postoperatively. 3) Chemotherapy with arterial infusion of 1,000 mg fluorouracil (5-FU) and 2,000 mg broxuridine (BUdR) for 4 days after operation. Of the 16 patients with neck metastasis, 14 accepted extirpation of the metastatic cervical lymph nodes and upper neck dissection was performed in other 2 cases. Five-year survival was 87% in the 32 patients of stage II and III but 41% in the 11 of stage IV. The combined therapy for patients of stage II and III disease is recommended because of the satisfactory results. However, a further study is required in our therapeutic schema for the case of stage IV since the prognosis was poor.     

49例复发鼻咽癌的调强适形放射治疗

目的 评价调强适形放射治疗(IMRT)对复发性鼻咽癌的疗效、放射反应以及对肿瘤的控制。方法 49例鼻咽局部复发的鼻咽癌患者(KPS≥80)均采用全程IMRT,其中伴有颈淋巴结转移的3例患者(N12例,N3l例)在IMRT后,给予PDD 5-Fu方案5～6个疗程化疗。结果 治疗计划结果显示,覆盖鼻咽GTV D95的平均剂量为68．09Gy,GTV V95的平均体积为98．46％,靶区内GTV、CTV1和CTV2的平均剂量分别为71．40Gy、63．63Gy和59．81Gy。49例患者的中位随访时间为9个月(3～16个月)。局部无进展生存率100％,IMRT结束时有3例(6．1％)出现局部残留,14例(28．6％)出现鼻咽腔黏膜坏死。结论 IMRT能有利覆盖肿瘤靶区而使邻近敏感器官获得有效分隔,对复发性鼻咽癌的再程放疗不失为一种有效方法。值得注意的是高剂量的鼻咽局部IMRT治疗对于复发性鼻咽癌容易导致鼻咽黏膜坏死,故应适当减少GTV的处方剂量以60～65Gv为宜。     

延伸野IMRT对宫颈癌预后研究进展

近几十年精确放疗技术发展迅速,IMRT在妇科恶性肿瘤中的应用也逐渐增加。研究表明在晚期宫颈癌患者中有很高的隐匿性腹主动脉旁淋巴结转移的发生率,而盆腔和腹主动脉旁淋巴结状态是宫颈癌患者重要预后影响因素。既往预防性延伸野常规放疗存在严重胃肠道副反应,联合同步化疗也存在争议。现有研究对于转移性盆腔及腹主动脉旁淋巴结的最佳放疗剂量也未达成共识。本文主要分析预防性延伸野IMRT联合同步化疗对宫颈癌患者预后影响和淋巴结阳性区域剂量效应关系。     

Efficacy analysis of simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with neck and upper thoracic esophageal carcinoma

For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes.Three radiation treatment volumes were defined: PGTVnd, with which 68.1 Gy was delivered in high dose group (hsIMRT group), and 60 Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9 Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54 Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P <0.05). The differences in 1-, 2- and 3-year relapse-free survival rates were all statistically significant (P <0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better short-term efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.     

介入插管化疗在晚期鼻咽癌综合治疗中的应用

目的 研究介入插管化疗在晚期鼻咽癌综合治疗中的作用。方法 对３０例晚期鼻咽癌患者采用Ｓｅｌｄｉｎｇｅｒ法选择性咽升动脉或上颌动脉插管化疗,灌注化疗药物,其中顺铂（ＤＤＰ）１００ｍｇ,氟脲嘧啶（５－Ｆｕ）１０００ｍｇ,平阳霉素（ＢＬＭ）１６ｍｇ。若病变超过鼻咽中线,则行双侧插管,病变主侧注入药量为２／３,其余１／３注入对侧。介入治疗后１周开始常规放疗,原发灶总量为６０￣７０Ｇｙ／８周,颈部病灶则为５     

鼻腔非何杰金淋巴瘤的放射治疗

 目的:分析鼻腔非何杰金淋巴瘤(NHL)治疗方法和疗效。 方法:1975年6月～1993年3月收治30例鼻腔NHL。 单纯放疗16例, 综合治疗(放疗＋化疗)14例。 照射剂量:<45Gy15例, ≥45Gy15例。 结果:全组5年生存率为70.8％(17/24)。 病变局F民于鼻腔和超出鼻腔组的5年生存率分别为85.7％和50.0％。 单纯放疗组和放疗＋化疗组的5年生存率分别为57.1％和90.0％。 照射剂量<45Gy和≥45Gy的5年生存率分别为64.3％和80.0％。 建议:病变局限于鼻腔者不必做颈部预防性照射。 对病变超出鼻腔或有区域淋巴结受侵者, 应采用放疗与化疗综合治疗。     

Consolidation radiotherapy following brief chemotherapy for localized diffuse large B-cell lymphoma: a prospective study

Many physicians administer involved field radiation therapy (RT) following brief chemotherapy for localized aggressive non-Hodgkin's lymphoma. Involved field irradiation usually implies treatment to the involved nodal regions with and without the contiguous lymphatic region, however, there is no agreements about its definition. Here we assess the appropriateness of RT irrespective of lymph node regions (localized field) following chemotherapy for patients with early stage diffuse large B-cell lymphoma. The localized field encompassed all original gross tumor volumes before chemotherapy with at least a 2- to 3-cm margin irrespective of lymphatic regions. We also evaluated the suitable radiation dose on the basis of response to chemotherapy. Twenty five eligible patients were treated with 3 cycles of chemotherapy (CHOP) followed by RT. All 25 patients had disease confined to Waldeyer's ring and/or cervical lymph nodes. Twenty two patients in complete response following chemotherapy received 30 Gy, and the remaining 3 in partial response received 40 Gy. With a median follow up of 42 months, both event free and overall survival rates at 2 years were 96.0%. There were no in-field recurrences, however, two patients experienced relapses. One developed central nervous system involvement and subsequently died of his disease. The other had mediastinal and submental lymph node relapse at 32 months, and is alive after salvage chemotherapy. Our study demonstrated that it should be possible to reduce treatment volume to less than the conventional involved field, and to limit the dose of RT in the range of 30-40 Gy.     

Prognostic factors in patients with nasopharyngeal carcinoma treated in Hospital Kuala Lumpur

Background: Nasopharyngeal carcinoma is the third most common cancer among men in Peninsular Malaysia.However, no information is available about the prognostic factors. The objective of this study was to identifyfactors with an influence on outcome in patients treated in Hospital Kuala Lumpur. Methods: A total of 159patients with non-metastatic nasopharyngeal carcinoma treated during 2002-2003 in Hospital Kuala Lumpurwere included in this study. All received radiotherapy. Fifty three patients were treated with radiotherapy alone,while 106 patients received combination chemotherapy. Overall survival and local recurrence-free survival wereanalyzed using the Kaplan-Meier method and univariate analysis was performed using the log-rank test. Results:This study found out that 5-year overall survival and 5-year local recurrence-free survival rates were 58.6% and54.2% respectively. The stage specific 5-year overall survival rates were: Stage I, 100%; Stage II; 93.3%, StageIII, 62.7%; Stage IVA, 42.2%; and Stage IVB, 40.6%. On univariate analysis, gender (p<0.05), T-classification(p< 0.001), N-classification (p<0.05), stage (p<0.05) and cranial nerve involvement (p< 0.001) were found to besignificant prognostic factors for 5-year overall survival, while gender (p<0.05) and N-classification (p<0.05)were significant prognostic factors for 5-year local recurrence-free survival. Conclusion: The overall survivalrate of patients for this study was low. The patient factor that significantly affected 5-year overall survival wasgender, while disease factors were stage, T-classification, N-classification and cranial nerve involvement.     

Extended-field radiation therapy for prostatic carcinoma with para-aortic lymph node metastasis

The finding of involvement of para-aortic lymph nodes in patients with adenocarcinoma of the prostate has been considered so ominous that further therapy has often only been palliative. What is the proportion of patients with carcinoma of the prostate with regional metastasis limited to the infra-diaphragmatic lymph nodes who might be cured or at least offered long-term progression-free survival by aggressive treatment? From June 1970 through March 1983, 114 patients were treated with curative intent for adenocarcinoma of the prostate, clinical Stage III, at the Medical College of Wisconsin Affiliated Hospitals. Twenty-three of these patients had evidence of metastasis to the para-aortic lymph nodes. These patients were treated aggressively with external radiation therapy to the entire pelvis and para-aortic region. The median dose to the prostate was 70 Gy, the pelvis 54 Gy, and the para-aortic region 50 Gy. The median period of observation after treatment was 53.5 months. The actuarial survival was 90% at 5 years and progression-free survival was 73% at 5 years. The rate of major complications was 4.3%. Although the number of patients is small, the data suggest that extended field radiation therapy can result in prolonged progression-free survival and perhaps cure many patients with juxtaregional dissemination of adenocarcinoma of the prostate.     

非高发地区初诊远处转移鼻咽癌患者生存及预后的单中心分析

  目的  分析非高发地区初治远处转移鼻咽癌患者的生存情况及预后因素。  方法  回顾性分析2008年6月至2015年12月四川省肿瘤医院收治的91例初诊远处转移鼻咽癌患者,所有患者均接受原发灶的根治性放疗,放疗剂量为66.0~76.6 Gy（中位剂量71.0 Gy）。87例患者采用以铂类为基础的化疗方案（1~7个周期）,未行化疗4例,放疗期间同步靶向治疗17例（尼妥珠单抗或西妥昔单抗）。初治时完成转移灶的局部治疗49例（放疗48例,孤立肺转移手术1例）。患者治疗结束后每3个月随访1次。采用KaplanMeier法计算生存率,采用Cox回归模型进行多因素分析。  结果  中位随访时间41个月。患者1、2、3年生存率分别为83.4%、58.6%、43.3%,中位生存期为32（6~87）个月。转移灶数目>3个（P=0.020）及转移灶无局部治疗（P=0.034）是患者总生存预后不良的独立影响因素。  结论  对于初诊远处转移鼻咽癌,予原发灶根治性放疗（≥66.0 Gy）剂量联合转移灶局部治疗可以改善患者生存率。      

Nodal control and surgical salvage after primary radiotherapy in 1782 patients with laryngeal and pharyngeal carcinoma

The purpose of this study was to evaluate the ultimate neck control after primary radiotherapy and surgical salvage in laryngeal and pharyngeal cancer patients. Some 1 782 consecutive patients with squamous cell carcinoma were treated by radiotherapy. At presentation 26% of the patients had metastatic lymph nodes. A total of 298 primary or secondary nodal recurrences were seen, 159 were treated, and 53 (53/298∼18%) were controlled. Isolated N-recurrence was fatal in 2.7% (36/1 324) of the N0 patients. Univariate actuarial analysis of nodal control demonstrated that the region of origin, T-classification, T-size, N-classification, tumor stage, differentiation, hemoglobin, and radiation time were significant prognostic factors. In a Cox analysis the independent significant parameters were gender, region of origin, N-classification, and differentiation. The conclusions were that in patients with nodal recurrence a little over half were treated and of these a third of the nodal recurrences were controlled. Significant prognostic factors in multivariate analysis were gender, region of origin, N-classification, and tumor differentiation.