To compare the local control rate and side effects of external radiation combined with brachytherapy and external radiation alone for early nasopharyngeal carcinoma (NPC).

A total of 124 patients with T₁, T₂ NPC was evaluated in this study between March 1990 and November 1996. The median follow-up periods were 62 months with 5 cases lost. There were male 86, female 38. The ages ranged from 16~70 yrs. Poorly differentiated squamous cell carcinoma except 1 adeno-squamous cell carcinoma were proved by histopathology at the primary sites. The external radiation was given by 6~8 MV X-rays and ¹⁹² Ir was used for intracavitary brachytherapy. The patients treated by RT alone group received a total dose of 70~86 Gy in 7~9 weeks and that of RB group was 50~70Gy in 5~7 weeks. The dose of brachytherapy ranged 8~24 Gy in 1~3 fractions in 1~3 weeks. Kaplan-Meier and log-rank test were used for evaluating the results of the local control and survival rates in this series.

Two patients in the RT group presented resistant disease in the primary site were salvaged by brachytheray. Eight patients had local recurrence (2 in RB, 6 in RT group). The 5-year local control rates were 93.9% in RB group, and 85.2% in the RT group (P > 0.05). The 5-year survival rates were 88.0% and 85.2% in the RB and RT groups (P > 0.05). Three patients developed bleeding in the nasopharynx and all of them died from it. No necrosis of nasopharyngeal mucosa or perforation of soft palate was observed in this series.

Both RT and RB groups present a satisfactory 5-year local control and survival rates in this study. Although the 5-year local control rate seems better in the RB group than the RT, no significant difference was observed. The lower dose of external radiation in the RB group may cause milder complication than the higher dose of external radiation without reducing the local control rate. Appropriate brachytheray technique is able to render the treatment safe and effective.