Cancer du cavum d’emblee metastatique: étude clinique et pronostique (à propos de 51 cas)

This retrospective study aimed to highlight the different epidemiological, clinical, therapeutic and prognostic features of nasopharinx cancer with inaugural metastases in patients hospitalized in a Tunisian Hospital. We here report 51 cases of histologically diagnosed nasopharynx cancer (NPC) with inaugural metastases. Data were collected in the ENT departments and in the radiation therapy departments at the University Hospital Farhat Hached, Sousse, Tunisia as well as at the Centre Medical Ibn Khaldoun, Hammam Sousse, between January 1995 and December 2010. We collected data on 51 patients with metastatic nasopharynx cancer at diagnosis. The average age was 49 years. Sex ratio was 6,2. Bone metastases were the most common finding (94.1%), followed by liver metastases (34.6%). In the majority of our patients therapeutic approach was based on chemotherapy (41 patients); 31 of these patients underwent chemotherapy in combination with radiation therapy. Adriamycin+cisplatin protocol was the most frequently used (92.6%). Twenty patients underwent cervicofacial radiation therapy with curative purposes (doses ≤ 70 Gy), fourteen patients underwent radiation treatment to the nasopharynx with symptomatic purposes (doses of 30Gy in 10 sessions) associated with radiation treatment to the metastatic sites in 9 cases. Overall survival at 2 years and 5 years was 29% and 10%, respectively. Nasopharinx cancer with inaugural metastases is a serious disease, rapidly fatal despite therapeutic advances. In view of our data and of those from the literature cisplatin-based chemotherapy and cervicofacial radiation therapy with curative doses and that of metastases resulted in long-term survival and even in complete responses. Future trials should focus on new molecules for therapeutic intensification.