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1 鼻咽癌診療指引頭頸癌多專科團隊擬定初訂修訂修訂修訂

2 前言鼻咽癌, 乃中國人特有之癌症根據統計, 男性每十萬人每年罹患鼻咽癌的人數在台灣是 7.7 人美國 0.63 人日本 0.27 人即使移居美國的第二代中國人也比當地白人罹患率多 7 倍一般而言, 男性比女性易患鼻咽癌, 其比例約 3 比 1 好發年齡在 40 至 50 歲國內最近之統計, 每年約有 1000 人左右發病, 鼻咽癌佔男性十大癌症之第十位鼻咽癌發生之原因乃多重因素所構成, 經研究結果約有三項, 即遺傳因子 EB 病毒感染環境因素鼻咽癌之治療主賴放射治療, 早期 ( 第一期 ) 單用放射治療之結果就很好, 但晚期 ( 第二三四期 ) 或復發之病人可能需要併用化學及手術治療經正規治療之結果, 全部病人五年之存活率約有 60%, 早期病人可高達 90% 以上, 而晚期病人也有 50% 以上除了少數病人在治療開始就有遠端轉移其病情較難控制之外, 鼻咽癌並不是絕症, 是一種可以控制及治癒的癌症經正規方式治療以後, 病人多數能夠恢復, 而回去工作治療後, 少數病人可能復發, 所以定期追蹤檢查是必要的本院自民國 99 年藉由多專科醫師參與團隊會議共同討論的機制, 參酌 NCCN (National Comprehensive Cancer Network) 診療指引及國內外相關文獻, 進行指引改版, 以期更貼近國內民情及國際鼻咽癌診療潮流 1

3 指引修訂紀錄 ( 一 ) 本共識與上一版之差異治療前評估檢查項目 MRI with gadolinium of nasopharynx and base of skull to clavicles and CT (as indicated) with contrast 修改成 CT with contrast and/or MRI with contrast of primary and neck;consider PET-CT for stage III-IV disease 修改成 PET-CT (option) ( 二 ) 本共識與 NCCN 差異 NCCN guideline 於 T1, N1-3; T2-T4, Any N 這族群中建議做 CCRT+Adjuvant chemotherapy 或是 Induction C/T +CCRT, 因健保規範化學治療抗癌藥物 Docetaxel ( 如 Taxotere) 符合健保適應症為局部晚期且無遠端轉移之頭頸部鱗狀細胞癌且無法手術切除者, 作為放射治療前的引導治療, 限使用 4 個療程, 故經本團隊決議 T1, N1-3; T2-T4, Any N 這族群中建議做 CCRT+Adjuvant chemotherapy 或是 Induction C/T+RT or CCRT 版本生效日期文件制定記錄新訂定 CLINICAL STAGING:T1, N1-3;T2-T4, any N, TREATMENT OF PRIMARY AND NECK: 原為 Induction chemotherapy followed by chemo/rt 修改成 Induction chemotherapy followed by RT or chemo/rt CLINICAL STAGING:Any T,any N, M1,TREATMENT OF PRIMARY AND NECK: 新增另一治療途徑為 Concurrent chemo/rt 治療前評估檢查項目 MRI with gadolinium of nasopharynx and base of skull to clavicles and CT (as indicated) with contrast 修改成 CT with contrast and/or MRI with contrast of primary and neck; Consider PET-CT for stage III-IV disease 修改成 PET-CT (option) 2

4 目錄一鼻咽癌診療指引流程圖二診斷共識三治療共識四追蹤共識五鼻咽癌院內通用抗癌藥物處方六鼻咽癌放射線治療政策與程序指引七參考資料

5 一鼻咽癌鼻咽癌診療指引流程圖 WORK-UP CLINICAL STAGING Head and Neck Cancers Cancer of the Nasopharynx TREATMENT OF PRIMARY AND NECK 初版日期 :99.01 最後更新日 : * H&P including a complete head and neck exam; mirror and fiberoptic examination as clinically indicated * Nasopharyngeal exam and biopsy * Chest imaging * CT with contrast and/or MRI with contrast of primary and neck * PET-CT (option) * Dental evaluation as indicated * Nutrition, speech & swallowing evaluation * Bone Scan * Abdominal echo * Multidisciplinary consultation T1, N0, M0 T1, N1-3; T2-T4, any N Any T, any N, M1 CCRT Induction chemotherapy followed by R/T or chemo / RT Definitive RT to nasopharynx And elective RT to neck Platinum-based combination chemotherapy concurrent Chemo / RT Adjuvant C/T Neck: residual tumor Neck: complete clinical response Definitive RT to primary and neck or Chemo / RT Neck dissection Observe 1.physical exam : Year 1, every 1 3 month Year 2, every 2 4 month Years 3 5, every 4 6 month >5 years, every 6 12 month 2.Further reimaging as indicated based on signs/symptoms 3.Chest imaging as clinically indicated 4.Thyroidstimulating hormone (TSH) every 6-12 mo if neck irradiated 5.Speech/hearing and swallowing evaluation and rehabilitation as clinically indicated 6.Smoking cessation and alcohol counseling as clinically indicated 4

6 二診斷共識 Diagnosis and Pre-treatment evaluation of Nasopharynx Cancer 鼻咽癌之診斷及治療前評估 Workup (Pre-treatment evaluation) H&P Nasopharyngeal exam and biopsy Chest imaging CT with contrast and/or MRI with contrast of primary and neck PET-CT (option) Nutrition, speech and swallowing evaluation Dental evaluation as indicated Bone Scan Abdominal echo Multidisciplinary consultation as indicated 5

7 三治療共識鼻咽癌第一期原則上單獨使用放射治療, 即可達到不錯的局部控制及存活率, 局部晚期鼻咽癌第二三四期的治療方式同步性化學放射治療為主 (concurrent chemoradiation) 加輔助性化學治療 (adjuvant chemotherapy); 或是前導性化學治療 (Induction chemotherapy) 加同步性化學放射治療 (concurrent chemoradiation) 或放射治療 (radiotherapy) 鼻咽癌病患病遠端轉移時的主要治療為化學治療 (chemotherapy) 或是同步性化學放射治療 (concurrent chemoradiation) 6

8 四追蹤共識 Follow-up evaluation 治療後追蹤評估 1.Physical examination (1)Year 1 every 1-3 month (2)Year 2, every 2-6 month (3)Years 3-5, every 4-8 month (4)>5 years, every 12 month 2.Further reimaging as indicated based on signs/symptoms 3.Chest imaging as clinically indicated 4.Thyroid-stimulating hormone (TSH) every 6-12 mo if neck irradiated 5.Speech/hearing and swallowing evaluation and rehabilitation as clinically indicated 7

9 五鼻咽癌院內通用抗癌藥物處方 ( 一 ) 頭頸癌化療處方集說明 102 年 7 月 1. Cisplatin 60-75mg/m 2 + (5-FU 1000 mg/m 2 + Leucovorin (LV) mg) *4 days q3-4 wks 若病人不願住院, 只在門診化療室接受治療, 則上述 regimen 可修正為 : Cisplatin 60-75mg/m FU mg/m 2 + Leucovorin (LV) mg q3-4 wks 2. Cisplatin 60-75mg/m 2 + oral (UFUR mg/m 2 /d + LV 30 mg/d * 3 - ~4 - wks q3-4 wks 依據 : JCO 1992;10: R.R.:(CF:carboplatin + 5-FU) MTX (PF:Cisplatin + 5-FU) > MTX median response duration; median survival time similar in CF,PF, MTX 可見 MTX 於 HNSCC 角色相當重要 Eur J Cancer 1993; 29A(5):704-8 Epirubicin, MTX and bleomycin in the recur. HNSCC (R.R.:44%) Epirubicin, MTX, Bleomycin 亦為 active agents in HNSCC Annals of Oncology (2010) 21 (Supp7) Educational Book of the 35 th ESMO Congress Milan Oct.2010 * Of large number of conventional single agents in p ts with recur. /meta. HNSCC, the four most active and most extensively used agents are MTX, cisplatin, 5-FU and bleomycin. 由此, 亦可觀察到 Epirubicin, MTX, Bleomycin 於 HNSCC 角色相當重要將 Epirubicin, MTX, Bleomycin 納入 PF 之 backbone regimen, 且為避免門診化療給藥時間過長及 serious side effects 可採取 biweekly (A)<-> (B) regimen 8

10 3.(A) Cisplatin 60-75mg/ m 2 + Bleomycin 8(6-10) mg/ m 2 +5-FU mg/ m 2 + LV mg ( 同上 2., 亦可以 oral UFUR 與 oral LV 取代 v. 5-FU+LV) (B) Epirubicin 50 mg/ m 2 +MTX 60 mg/ m 2 (or mg/ m 2 for high grade, extensive, multiple foci, R1 resection ) +5-FU mg/ m 2 +LV mg) 同上 2., 亦可以 oral UFUR 與 oral LV 取代 v. 5-FU+LV * 增列 Taxotere: 又依據 : Ai Zheng 2003 Aug; 22(8) :877-9 TPF ( Taxotere + Cisplatin + 5-FU) in induction C/T for HNSCC C.R.: 24% P.R.: 48% (R.R.:72%) R.R. (oral cancer):63.6%; R.R.(others; tongue, larynx, hypopharynx, N-P):71.4% Medscape Oncology 2006; 9(2) In reur./meta. HNSCC: PFS: PF:8.2 months ; TPF: 11 months ORR: PF:6.4% ; TPF: 72% Educational Book of the 35th ESMO Congress Milan, Oct,2010 亦有提及 : ORR: Cisplatin + Taxol(27%) PF(26%) TPF(Taxotere, Cisplatin, 5-FU): 44% (median time to progression: 7.5 mothers ; median OS: 11 months) 可見 MTX( 前述 4 篇文章 ) 與 Taxotere, 除了 PF 之外, 於 HNSCC 相當重要 p.s. 依據本院至統計 104 位病人僅列 neoadjuvant, adjuvant & CCRT alone 三類典型治療模式中之代表疾病 ( 各個疾病治療之詳情為了節省篇幅不一一列出 ) *neoadjuvant C/T (13p ts, oral cavity cancers) C.R.+ P.R. :61.5%(8/13) (tumor resection rate) Tumor control rate : 92.3% (12/13) P.D.: 7.8% (1/13) * adjuvant C/T (median overall survival): oral cavity cancers (29 p ts ):1183 days oropharyngeal cancer (3p ts ):1529days * CCRT (NPC): C.R.:66.7% (12/18); P.R.:5.6% (1/18) S.D.:11.1%(2/18) P.D.:16.7%(3/18) 9

11 癌登資料庫 ( 年 ) NPC 本院全國 oropharynx 本院全國 5- yr survival of O-P 1- yr(%) yr(%) Stage 本院 AJCC 2- yr(%) yr(%) I 0.0% 72.6% 3- yr(%) yr(%) II 100% 58.0% 4- yr(%) yr(%) III 50% 45.0% 5- yr(%) yr(%) 沒有資料沒有資料 IV 0.0% 32.4% oral cavity cancers: 1- yr survival of rate(%) 2- yr survival of rate(%) 3- yr survival of rate(%) Stage 本院 AJCC Stage 本院 AJCC Stage 本院 AJCC I I I II II II III III III IV IV IV yr survival of rate(%) 5- yr survival of rate(%) Stage 本院 AJCC Stage 本院 AJCC I I II II III III IV IV NPC 及 oral cavity cancers 之 1-5 yr survival rate 與癌登全國資料庫相比, 高出些許, 而 oropharyngeal cancer 則相似, 由上述資料, 顯見 long- term survival of HNSCC 在全體同仁之盡心協力合作之下, 本院治療之效果些略高於全國或 global 平均資料, 但由於個案量不多, 尚未足以下結論健保條例 (from 100/1, for unresectable, locally advanced HNSCC) 4. Taxotere 60-75mg/ m 2 + Cisplatin 60-75mg/m 2 + (5-FU 1000 mg/m 2 + Leucovorin (LV) mg) *4 days q3-4 wks 5. Taxotere 60-75mg/ m 2 + Cisplatin 60-75mg/m 2 + oral (UFUR mg/m 2 /d + LV 30 mg/d * 3 - ~4 - wks q3-4 wks * 加入 MTX 保留 (4) or (5) backbone regimen, 但根據院內統計資料 (100/1-102/5), 治療效果與 TPF 大致類似 ( 統計資料說明見下頁 ), 故自 102/7 起,Taxotere- containing regimen 不再加入 MTX : 10

12 但為避免門診化療給藥時間過長及 serious side effects 可採取 biweekly (A)<-> (B) regimen 6.(A) Cisplatin 60-75mg/ m 2 + Taxotere mg/ m FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) (B) Taxotere 35-50mg/ m 2 +5-FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) 因應病情須要, 可考慮下列藥物 Avastin 5mg/kg/dose Erbitux 250mg/ m 2 / dose Etoposide mg/ m days ( 視 performance 而定 ) Ifosfamide g/ m 2 / d 3days q 4-6wks Gemzar mg/ m 2 / dose * 依據院內 Taxotere-containing regimen for HNSCC 統計資料 (100/1-102/5) 依據 (A) Cisplatin 60-75mg/ m 2 + Taxotere mg/ m 2 (B) Taxotere 35-50mg/ m 2 +MTX 60mg/ m 2 ( or mg/ m 2 )+5-FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) ( C) Taxotere 35-50mg/ m 2 +5-FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) Regimen(R/T 前 ) 之評估 : NPC (11 p ts) Stage II : C.R.(5/5, 100%); Stage IV : P.R.(1/1, 100%) Stage III : C.R.(2/5, 40%); P.R.(1/5, 20%) ; S.D.(2/5, 40%) ORR: C.R. + P.R. (9/11, 82%); S.D.(2/11, 18.2%)); tumor control rate:100% Oropharynx (12p ts): Stage III : C.R.(4/4, 100%); Stage IVA : P.R.(4/8, 50%); S.D.(3/8, 37.5%); P.D.(1/8, 12.5%) ORR: C.R. + P.R. (8/12, 66.7%); S.D.(3/12, 25%)); tumor control rate: 91.7%(P.D.: 8.3%) 11

13 NPC + oropharynx C.R.(11/23, 47.8%); P.R.(6/23, 26.1%); S.D.(5/23, 21.8%); tumor control rate: 95.7% P.D.: 4.3% Hypopharynx (12p ts): Stage II : C.R.(1/2, 50%); S.D.(1/2, 50%) Stage III : C.R.(3/4, 75%); S.D.(1/4, 25%) Stage IVA : C.R.(1/5, 20%); P.R.(2/5, 40%);S.D.(1/5, 20%);P.D.(1/5, 20%) Stage IVB :P.D.(1/1, 100%) ORR: C.R. + P.R. (7/12, 58.3%); S.D.(3/12, 25%)); tumor control rate:83.3%; P.D.(16.7%) 整體而言, 治療效果與 TPF 大致類似, 故自 102/7 起,Taxotere- containing regimen 不再加入 MTX 12

14 ( 二 ) 頭頸癌化療處方集最初出版日期 :95.03 最後更新日期 : 癌症類別 Neoadjuvant( 術前 ) Adjuvant( 術後 ) Palliative( 無法手術 ) 口腔癌口咽癌下咽癌鼻咽癌 1. Cisplatin 60-75mg/m 2 + (5-FU 1000 mg/m 2 + Leucovorin (LV) mg) *4 days q3-4 wks 若病人不願住院, 只在門診化療室接受治療, 則上述 regimen 可修正為 : Cisplatin 60-75mg/m FU mg/m 2 + Leucovorin (LV) mg q3-4 wks 2. Cisplatin 60-75mg/m 2 + oral (UFUR mg/m 2 /d + LV 30 mg/d * 3 - ~4 - wks q3-4 wks 3.(A) Cisplatin 60-75mg/ m 2 + Bleomycin 8(6-10) mg/ m 2 +5-FU mg/ m 2 + LV mg ( 同上 2., 亦可以 oral UFUR 與 oral LV 取代 v. 5-FU+LV) (B) Epirubicin 50 mg/ m 2 +MTX 60 mg/ m 2 (or mg/ m 2 for high grade, extensive, multiple foci, R1 resection ) +5-FU mg/ m 2 +LV mg) 同上 2., 亦可以 oral UFUR 與 oral LV 取代 v. 5-FU+LV 以下 Taxotere-containing regimen (4.5.6.),Taxotere 若使用於健保給付, 只能用於 unresectable,locally advanced HNSCC ( 自費者則不在此限 ) : 4. Taxotere 60-75mg/ m 2 + Cisplatin 60-75mg/m 2 + (5-FU 1000 mg/m 2 + Leucovorin (LV) mg) *4 days q3-4 wks 5. Taxotere 60-75mg/ m 2 + Cisplatin 60-75mg/m 2 + oral (UFUR mg/m 2 /d + LV 30 mg/d * 3 - ~4 - wks q3-4 wks * 加入 MTX 保留 (4) or (5) backbone regimen, 但根據院內統計資料 (100/1-102/5), 治療效果與 TPF 大致類似 ( 統計資料說明見下頁 ), 故自 102/7 起,Taxotere- containing regimen 不再加入 MTX : 但為避免門診化療給藥時間過長及 serious side effects 可採取 biweekly (A)<-> (B) regimen 6.(A) Cisplatin 60-75mg/ m 2 + Taxotere mg/ m FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) (B) Taxotere 35-50mg/ m 2 +5-FU mg/ m 2 +LV mg ( 亦可以 oral UFUR 與 oral LV 取代 ) 因應病情須要, 可考慮下列藥物 Avastin 5mg/kg/dose Erbitux 250mg/ m 2 / dose Etoposide mg/ m days ( 視 performance 而定 ) Ifosfamide g/ m 2 / d 3days q 4-6wks Gemzar mg/ m 2 / dose 13

15 六鼻咽癌放射線治療政策與程序指引癌症名稱鼻咽癌 NCCN Guidelines 劑量 Gy(2.0 Gy/fraction; daily) in 7 weeks Uninvolved nodal stations:44-64 Gy( Gy/fraction) 放射腫瘤科醫師劑量 2013 年制定每日劑量為 Gy/fraction 總劑量 :68-74 Gy 總治療時間 : 不超過 10 週 ; 放射治療次數 :35-41 次 14

16 七參考資料 ( 一 ) 診療指引參考文獻 1. NCCN Clinical Practice Guidelines in Oncology-Cancer of the Nasopharynx V 國家衛生研究院台灣癌症臨床研究合作組織 - 鼻咽癌臨床診療指引 (2011 年 12 月 ) ( 二 ) 抗癌藥物處方參考文獻 1. Laramore GE, Scott CB, al-sarraf M et al. Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: report on Intergroup Study Int J Radiat Oncol Biol Phys 1992;23(4): Chang PM, Chen PM, Chu PY et al. Effectiveness of pharmacokinetic modulating chemotherapy combined with cisplatin as induction chemotherapy in resectable locally advanced head and neck cancer: phase II study. Cancer Chemother Pharmacol 2008;63(1): Vermorken JB, Trigo J, Hitt R et al. Open-label, uncontrolled, multicenter phase II study to evaluate the efficacy and toxicity of cetuximab as a single agent in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck who failed to respond to platinum-based therapy. J Clin Oncol 2007;25(16): Taylor SG, McGuire WP, Hauck WW, Showel JL, Lad TE. A randomized comparison of high-dose infusion methotrexate versus standard-dose weekly therapy in head and neck squamous cancer. J Clin Oncol 1984;2(9): Woods RL, Fox RM, Tattersall MH. Methotrexate treatment of squamous-cell head and neck cancers: dose-response evaluation. Br Med J (Clin Res Ed) 1981;282(6264): Colevas AD. Chemotherapy options for patients with metastatic or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol 2006;24(17):

17 7. Forastiere AA, Shank D, Neuberg D, Taylor SG, DeConti RC, Adams G. Final report of a phase II evaluation of paclitaxel in patients with advanced squamous cell carcinoma of the head and neck: an Eastern Cooperative Oncology Group trial (PA390). Cancer 1998;82(11): Forastiere AA, Metch B, Schuller DE et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 1992;10(8): Kohno N, Ichikawa G, Nakazawa E, Kusunoki M, Nishiya M. Induction chemotherapy with cisplatin, etoposide, and mitomycin-c (PEM) regimen in advanced cases with cancer of pharynx and oral cavity. Auris Nasus Larynx 1995;22(1): Posner MR, Hershock DM, Blajman CR et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 2007;357(17): Pointreau Y, Garaud P, Chapet S et al. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst 2009;101(7): Vermorken JB, Remenar E, van HC et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 2007;357(17): Kish JA, Weaver A, Jacobs J, Cummings G, Al-Sarraf M. Cisplatin and 5-fluorouracil infusion in patients with recurrent and disseminated epidermoid cancer of the head and neck. Cancer 1984;53(9): Hainsworth JD, Spigel DR, Greco FA et al. Combined modality treatment with chemotherapy, radiation therapy, bevacizumab, and erlotinib in patients with locally advanced squamous carcinoma of the head and neck: a phase II trial of the Sarah Cannon oncology research consortium. Cancer J 2011;17(5): Kundu SK, Nestor M. Targeted therapy in head and neck cancer. Tumour Biol 2012;33(3): Morton RP, Rugman F, Dorman EB et al. Cisplatinum and bleomycin for advanced or recurrent squamous cell carcinoma of the head and neck: a randomised factorial phase III controlled trial. Cancer Chemother Pharmacol 1985;15(3):

18 17. Zhang L, Zhang Y, Huang PY, Xu F, Peng PJ, Guan ZZ. Phase II clinical study of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother Pharmacol 2008;61(1): Burtness B. Commentary: bevacizumab and erlotinib with chemoradiation for head and neck cancer. Cancer J 2011;17(5): Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV(> or = N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression-free survival. International Nasopharynx Cancer Study Group. VUMCA I trial. Int J Radiat Oncol Biol Phys 1996;35(3): Onat H, Basaran M, Esassolak M et al. High-dose epirubicin and cisplatin in locally advanced undifferentiated nasopharyngeal carcinoma. Clin Oncol (R Coll Radiol ) 2002;14(6): Shiu WC, Tsao SY. Etoposide (VP16-213) in the treatment of advanced nasopharyngeal carcinoma. Eur J Cancer Clin Oncol 1988;24(4): He XY, Hu CS, Ying HM, Wu YR, Zhu GP, Liu TF. Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2010;267(5): Wei WH, Cai XY, Xu T et al. Concurrent weekly docetaxel chemotherapy in combination with radiotherapy for stage III and IVA-B nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2012;13(3):

前言鼻咽癌, 乃中國人特有之癌症根據統計 106 年 12 月底國民健康署公布的癌症年報, 國人在民國 104 年, 鼻咽惡性腫瘤發生個案數, 初次診斷為鼻咽惡性腫瘤者共計 1,492 人, 占全部惡性腫瘤發生個案數的 1.42%, 當年死因為鼻咽惡性腫瘤者共計 747 人, 死亡人數占全部惡性

前言鼻咽癌, 乃中國人特有之癌症根據統計 106 年 12 月底國民健康署公布的癌症年報, 國人在民國 104 年, 鼻咽惡性腫瘤發生個案數, 初次診斷為鼻咽惡性腫瘤者共計 1,492 人, 占全部惡性腫瘤發生個案數的 1.42%, 當年死因為鼻咽惡性腫瘤者共計 747 人, 死亡人數占全部惡性鼻咽癌診療指引頭頸癌多專科團隊擬定 1 2010.01.27 初訂 2011.03.23 修訂 2012.03.28 修訂 2013.03.27 修訂 2014.03.19 修訂 2015.03.25 修訂 2016.03.23 修訂 2017.03.22 修訂 2018.03.28 修訂前言鼻咽癌, 乃中國人特有之癌症根據統計 106 年 12 月底國民健康署公布的癌症年報, 國人在民國