CRANIAL NERVE INVOLVEMENT IN NASOPHARYNGEAL CARCINOMA PATIENTS TREATED WITH INTENSITY-MODULATED RADIOTHERAPY: A SINGLE INSTITUTIONAL EXPERIENCE

併有腦神經侵犯之鼻咽癌患者接受強度調控放射線治療之分析--單一醫學中心之經驗

方本詞(Pen-Tzu Fang) ； 黃旼儀(Ming-Yii Huang) ； 鄭凱元(Kai-Yuan Cheng) ； 吳孟霓(Meng-Ni Wu) ； 黃志仁(Chih-Jen Huang)

《放射治療與腫瘤學》 23卷4期 (2016/12) Pp. 219-228

https://doi.org/10.6316/TRO/201623(4)219

摘要

Background : This study evaluated cranial nerve (CN) involvement and the outcomes of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT). Method : This study recruited 230 patients with histologically proven NPC without metastasis who were treated with IMRT at our institution between 2007 and 2013. Twenty-two patients had CN involvement. The primary tumor and involved lymph nodes were prescribed 69.96-70 Gy, the microscopic areas were prescribed 59.4-63 Gy, and clinically negative neck regions were prescribed 54.45-56 Gy in 33–35 fractions. Twenty-one patients with CN involvement received RT combined with chemotherapy. Result : The incidence of CN involvement was 9.6%. The most commonly involved CNs were the trigeminal (59.1%) and abducens nerves (45.5%), with the most commonly presenting symptoms being neuroophthalmic manifestations (68.2%), followed by facial numbness or pain (45.5%). The 3-year overall survival (OS), local relapse-free survival (LRFS), and disease-free survival (DFS) rates were 79.2%, 82.9%, and 50.0% respectively. Significant differences were observed in the 3-year OS rate (100% vs 43.7%, p = 0.016) and DFS (77.8% vs. 12.5%, p = 0.014) between patients with pretreatment neurological symptoms that presented for less than 3 months and more than 3 months. Patients with complete recovery of neurological symptoms after treatment tended to exhibit higher 3-year DFS (100% vs. 30.0%, p = 0.071). Single or multiple CN involvement and clinically or radiologically diagnosed CN involvement were not prognosticators for NPC patients with CN involvement. No temporal lobe necrosis was noted as the late effect. Conclusion : The pretreatment duration of neurological symptoms is a significant prognostic factor for the OS and DFS of NPC patients with CN palsy. Patients with a complete neurological response after treatment tend to exhibit higher DFS (p = 0.071). However, the outcome of NPC patients with CN palsy is not affected by the extensive involvement of CN lesions or the mode of diagnosis, either clinical or radiological.

關鍵字

Cranial nerve involvement ； Nasopharyngeal carcinoma (NPC) ； Intensity-modulated radiotherapy (IMRT)

並列摘要

目的：分析併有腦神經侵犯之鼻咽癌患者接受強度調控放射線治療後之預後。材料與方法：回溯性追蹤 2007 到 2013 年間，230 位鼻咽癌病人接受放射線治療，其中有腦神經侵犯之患者占 22 位，原發腫瘤及淋巴結陽性部位給予 69.96 至 70 Gy，顯微侵犯處給予 59.4至 63 Gy，無侵犯處則給予 54.45 至 56 Gy。二十二位有腦神經侵犯之患者有二十一位有接受化學治療。結果：有腦神經侵犯之患者占了 9.6%，最常影響到的腦神經為第五對（59.1%）及第六對（45.5%）。最普遍的症狀為眼睛的神經症狀（68.2%），第二為顏面麻痺痛（45.5%）。3 年的整體存活率（OS）、局部控制率（LRFS）及無疾病存活率（DFS）為 79.2%、82.9%及 50.0%。比較次分組的預後，治療前症狀小於三個月跟超過三個月比較有較佳的 OS（100% vs. 43.7%, p =0.016） 及 DFS（77.8% vs. 12.5%, p = 0.014）。治療後神經學症狀完全恢復在 DFS 上雖無顯著差異，但呈現略佳的趨勢（100.0% vs. 30.0%, p = 0.071）。臨床症狀診斷或影像診斷；及單一腦神經侵犯或多重腦神經侵犯對預後並無顯著的差異。治療後所有病人目前沒有發生腦壞死的副作用。結論：治療前症狀小於三個月跟超過三個月對於有腦神經侵犯之鼻咽癌患者 OS 及 DFS 是顯著的預後因子。治療後神經學症狀的完全恢復對於 DFS 雖不是顯著的預後因子，但有略佳的趨勢。但有 CN 侵犯的多寡及診斷方式（臨床或影像）對於腦神經侵犯之鼻咽癌患者的預後皆無顯著影響。

並列關鍵字

腦神經侵犯 ； 鼻咽癌 ； 強度調控放射線治療