Background: Carcinoma of the nasopharynx is one of the most common 
cancers in the head and neck areas. Control of the disease at an early stage with 
radiotherapy alone is usually successful. However, in loco regionally advanced 
disease, concurrent chemo radiotherapy is the standard treatment
As regards the conventional 2dimensional radiotherapy, many studies have 
shown equivalent results to intensity modulated radiotherapy on the level of 
local, regional and distant disease control while others have reported that 
intensity modulated radiotherapy has improved both the overall survival and 
local disease control and decreased late toxicities compared to the conventional 
2 dimensional radiotherapy.
The aim of the study: Is to compare between intensity modulated radiotherapy 
and conventional 2D radiotherapy on the level of treatment outcome and 
treatment related morbidities in patients with non metastatic squamous cell 
carcinoma of the nasopharynx.
Patients and methods: Patients treated by radiotherapy +/- chemotherapy from 
January 2013 to January 2023 in Sohag University Hospital were retrospectively 
enrolled and analyzed. 
Results: Forty one patients were identified. Twenty one (51%) were treated 
with intensity modulated radiotherapy while 20 (49%) were treated with 
conventional 2D radiotherapy. Chemotherapy was given in 33 cases (80%). No 
significant differences were noticed between both arms on the level of acute and 
chronic treatment related toxicities.
The 5-y overall survival (OS), local progression free survival (LPFS) and distant 
progression free survival (DPFS) with conventional 2D radiotherapy and 
intensity modulated radiotherapy in the whole cohort were 72% versus 64%; p = 
0.218 & 63% versus 85%; p = 0.220 and 77% versus 88%; p = 0.449 
respectively. In univariate analysis, many significant findings were evident. Age 
> 51 y was associated with poorer OS in the whole cohort (p = 0.049) and also 
in the subgroup received chemotherapy (p = 0.047). Intensity modulated 
radiotherapy has significantly improved the 5-y DPFS in stage II disease 
(p=0.049). Chemotherapy significantly improved LPFS in advanced stages 
(p=0.012). Irradiation dose at 70 Gy has demonstrated significantly better OS 
and LPFS in advanced versus early stage (p = 0.041 and 0.012 respectively) and 
lastly male patients have shown significantly lower OS (p=0.041) compared to 
females in the older subgroup of patients. In multivariate analysis, younger age 
was associated with significantly better 5-y OS versus older age in the subgroup 
received concurrent chemo radiotherapy (HR: 0.123; 95% CI: 0.021 – 0.712 & p 
= 0.019).
Conclusions: Although this retrospective study has enrolled a small number of 
patients, we conclude that in early stage of cancer nasopharynx, intensity 
modulated radiotherapy alone is successful and preferable than conventional 
radiotherapy while in advanced stages both chemotherapy (preferably, both 
induction and concurrent) and high dose radiation therapy should be considered. 
Younger ages associated with better survival outcome and, more studies are 
needed to improve the outcome in elderly male patients.