Brief Communication The Treatment of Nasopharyngeal Carcinoma (NPC)
There is an urgent need for a general agreement on a system for the stage classification of NPC, without which the evaluation of the effectiveness of different techniques employed in the treatment and the comparison of treatment results between centres will not be meaningful. If a comparison is to be made between different systems, it has to be a prospective one. A good system should have clearcut definitions of the criteria used in classifying the stages and allowing them to be identified without ambiguity. In this respect T1 (tumour confined to one wall of the nasopharynx) and T2 (confined to two walls) in the UICC and the AJC systems could well be combined under T1, because one cannot be certain from clinico-radiological examination that the tumour is confined to just one wall of the nasopharynx, and it has yet to be shown that the subclassification has anything to offer in guiding treatment or prognosis. Most NPC are eccentric in origin and a small tumour in the fossa of Rosenmuller (lateral pharyngeal recess) is in fact astride two walls. Classification of cervical nodal metastases by size is an arbitrary decision. There will always be some variation in personal judgement when the measurement is done by palpation, and yet a difference of 1 mm in the measured diameter of the node separates N1 from N2, and N2 and N3. Furthermore, Ho (1978) has shown that the laterality or mobility of the cervical nodal metastases are far less important prognostic factors compared with the level of the nodal involvement, and yet this factor was ignored in either the UICC or AJC classification.
- Ho, J.H.C.: Stage classification of nasopharyngeal carcinoma. In: Nasopharyngeal Carcinoma: Etiology and Control, eds. G. de The and Y. Ito. Lyon, IARC Scientific Publ. No. 20 (1978), pp. 99–113.Google Scholar