Treatment Outcome And Prognostic Factors For Nasopharyngeal Carcinoma With Cranial Nerve Palsy Treated By Conventional Or Conformal Radiotherapy

Purpose/Objective(s)To evaluate the therapeutic outcome for nasopharyngeal carcinoma (NPC) with cranial nerve (CN) palsy treated by conventional or conformal radiotherapy (RT), and to analyze the associated prognostic factors.Materials/MethodsA total of 104 patients with NPC with CN palsy curatively treated by conventional (n = 44) or conformal (n = 60) RT from January 2000 to July 2007 were enrolled. Upper CN (II-VI) palsy was presented in 81 (78.9%) patients, lower CN (VII-XII) palsy in 4 (3.8%) patients, and both upper and lower in 19 (18.3%) patients. Sixty-three (60.6%) patients had CN palsy for more than 2 months before diagnosis. The median dose of RT was 73.9 Gy (range, 64.8 - 86.4 Gy). Concomitant cisplatin-based chemotherapy (C/T) was given to 78 (75%) patients.ResultsComplete recovery of CN palsy was observed in 74 patients (71.2 %). The interval of CN palsy more than 2 months before diagnosis was the independent adverse prognosticator for the CN recovery following treatment (43.9 % versus 88.9 %, p < 0.001). The actuarial 5-year loco-regional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 58.2 %, 62.2 % and 38.4 %, respectively. No significant prognosticator was found for LRC. On the contrast, we observed patients with age ≥ 60 years, histology of WHO type I, and without receiving C/T had poorer OS; those with histology of WHO type I had worse DMFS. We did not observe any significant difference in the CN recovery, LRC, DMFS, and OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by conformal technique. (odds ratio = 0.25, 95 % confidence interval = 0.10 - 0.61).ConclusionsThe recovery of CN palsy, LRC, and survival in NPC patients with CN palsy did not significantly change with the treatment evolution for conventional to conformal technique. Purpose/Objective(s)To evaluate the therapeutic outcome for nasopharyngeal carcinoma (NPC) with cranial nerve (CN) palsy treated by conventional or conformal radiotherapy (RT), and to analyze the associated prognostic factors. To evaluate the therapeutic outcome for nasopharyngeal carcinoma (NPC) with cranial nerve (CN) palsy treated by conventional or conformal radiotherapy (RT), and to analyze the associated prognostic factors. Materials/MethodsA total of 104 patients with NPC with CN palsy curatively treated by conventional (n = 44) or conformal (n = 60) RT from January 2000 to July 2007 were enrolled. Upper CN (II-VI) palsy was presented in 81 (78.9%) patients, lower CN (VII-XII) palsy in 4 (3.8%) patients, and both upper and lower in 19 (18.3%) patients. Sixty-three (60.6%) patients had CN palsy for more than 2 months before diagnosis. The median dose of RT was 73.9 Gy (range, 64.8 - 86.4 Gy). Concomitant cisplatin-based chemotherapy (C/T) was given to 78 (75%) patients. A total of 104 patients with NPC with CN palsy curatively treated by conventional (n = 44) or conformal (n = 60) RT from January 2000 to July 2007 were enrolled. Upper CN (II-VI) palsy was presented in 81 (78.9%) patients, lower CN (VII-XII) palsy in 4 (3.8%) patients, and both upper and lower in 19 (18.3%) patients. Sixty-three (60.6%) patients had CN palsy for more than 2 months before diagnosis. The median dose of RT was 73.9 Gy (range, 64.8 - 86.4 Gy). Concomitant cisplatin-based chemotherapy (C/T) was given to 78 (75%) patients. ResultsComplete recovery of CN palsy was observed in 74 patients (71.2 %). The interval of CN palsy more than 2 months before diagnosis was the independent adverse prognosticator for the CN recovery following treatment (43.9 % versus 88.9 %, p < 0.001). The actuarial 5-year loco-regional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 58.2 %, 62.2 % and 38.4 %, respectively. No significant prognosticator was found for LRC. On the contrast, we observed patients with age ≥ 60 years, histology of WHO type I, and without receiving C/T had poorer OS; those with histology of WHO type I had worse DMFS. We did not observe any significant difference in the CN recovery, LRC, DMFS, and OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by conformal technique. (odds ratio = 0.25, 95 % confidence interval = 0.10 - 0.61). Complete recovery of CN palsy was observed in 74 patients (71.2 %). The interval of CN palsy more than 2 months before diagnosis was the independent adverse prognosticator for the CN recovery following treatment (43.9 % versus 88.9 %, p < 0.001). The actuarial 5-year loco-regional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 58.2 %, 62.2 % and 38.4 %, respectively. No significant prognosticator was found for LRC. On the contrast, we observed patients with age ≥ 60 years, histology of WHO type I, and without receiving C/T had poorer OS; those with histology of WHO type I had worse DMFS. We did not observe any significant difference in the CN recovery, LRC, DMFS, and OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by conformal technique. (odds ratio = 0.25, 95 % confidence interval = 0.10 - 0.61). ConclusionsThe recovery of CN palsy, LRC, and survival in NPC patients with CN palsy did not significantly change with the treatment evolution for conventional to conformal technique. The recovery of CN palsy, LRC, and survival in NPC patients with CN palsy did not significantly change with the treatment evolution for conventional to conformal technique.