Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone

doi:10.1016/j.ijrobp.2004.11.002

International Journal of Radiation OncologyBiologyPhysics

Volume 62, Issue 3, 1 July 2005, Pages 672-679

https://doi.org/10.1016/j.ijrobp.2004.11.002 Get rights and content

Purpose: The objective of this study was to describe the treatment outcomes and treatment-related complications of nasopharyngeal carcinoma (NPC) patients treated with radiotherapy alone.

Methods and Materials: Retrospective analysis was performed on 849 consecutive NPC patients treated between 1983 and 1998 in our institution. Potentially significant patient-related and treatment-related variables were analyzed. Radiation-related complications were recorded.

Results: The 5-year overall and disease-free survival rates of these patients were 59% and 52%, respectively. Advanced parapharyngeal space (PPS) invasion showed stronger prognostic value than PPS invasion. Multiple neck lymph node (LN) involvement was demonstrated to be one of the most powerful independent prognostic factors among all LN-related parameters. External beam radiation dose more than 72 Gy was associated with significantly higher incidence of hearing impairment, trismus, and temporal lobe necrosis.

Conclusions: We recommend that the extent of PPS should be clarified and stratified. Multiple neck LN involvement could be integrated into the N-classification in further revisions of the American Joint Committee on Cancer stage. Boost irradiation is not suggested for node-negative necks. For node-positive necks, boost irradiation is indicated and a longer interval between initial and boost irradiation would reduce the incidence of neck fibrosis without compromising the neck control rate.

Introduction

Nasopharyngeal carcinoma (NPC) is one of the leading malignancies in Taiwan, with incidence rates of as high as 10 per 100,000. Due to anatomic restrictions and the high degree of radiosensitivity, radiotherapy has provided the standard of care for NPC. Chemotherapy also plays a role in the treatment of NPC. Many articles reported that a combination of chemotherapy and radiotherapy was superior to radiotherapy alone for locally advanced NPC (1, 2, 3, 4). It is important to be certain that the improved outcomes from a combined modality therapy were not due to being compared with unusually poor outcomes from radiotherapy alone. To justify the exact role of combined chemotherapy, the treatment results and treatment-related complications of a combined modality therapy should be carefully compared with those of radiotherapy alone. This study was undertaken to investigate the long-term outcomes of patients treated with radiotherapy alone at a single institution with uniform techniques. Our results might be informative and add to the historical database of treatment results of radiotherapy alone.

Section snippets

Methods and materials

From October 1983 to September 1998, 1001 consecutive patients with histology-proven nonmetastatic NPC were registered at our department. Among them, 849 patients treated with radiotherapy alone were enrolled into this retrospective study. All were ethnic Chinese. There were 568 males and 281 females. Their age ranged from 20 to 82 years (median, 49 years). All patients had a pretreatment evaluation including complete history, physical examination, hematology and biochemistry profiles, chest

Overall and disease-free survival (DFS)

At the time of this retrospective review, 362 patients were still alive with a median follow-up of 112 months (range, 36–235 months) and 21 patients were alive with disease. The 5-year overall survival rate of the 849 patients was 59%. Multivariate analysis confirmed the independent prognostic significance of the following variables: gender, age, advanced PPS invasion, oropharynx invasion, multiple neck LN, AJCC stage, delayed primary remission, delayed neck LN remission, primary recurrence,

Discussion

The prognostic significance of PPS invasion is controversial. Some studies have reported a worse prognosis for patients with PPS invasion (14, 15, 16), but others have drawn the opposite conclusion (17, 18). Although PPS invasion is regarded as a component of T-classification, there is no consensus on the radiologic definition of PPS invasion. Some articles classified the PPS into two or three portions according to different criteria (16, 19, 20). Some authors even considered retropharyngeal LN

Conclusion

This study provides evidence that advanced PPS invasion and multiple neck LN involvement have strong prognostic significance and might be considered in the revised edition of AJCC stage. Delayed remission of primary tumor and neck LN should also be viewed as poor prognostic factors, and aggressive management rather than observation should be considered. Boost neck irradiation is not indicated for node-negative necks and should be applied to node-positive necks with an appropriately prolonged

References (43)

S.H. Cheng et al.
Prognostic features and treatment outcome in locoregionally advanced nasopharyngeal carcinoma following concurrent chemotherapy and radiotherapy
Int J Radiat Oncol Biol Phys
(1998)
A.D. King et al.
Parapharyngeal space involvement in nasopharyngeal cancerDetection by CT and MRI
Clin Oncol
(2000)
J.D. Cox et al.
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)
Int J Radiat Oncol Biol Phys
(1995)
P. Teo et al.
Prognostic factors in nasopharyngeal carcinoma investigated by computer tomography—an analysis of 659 patients
Radiother Oncol
(1992)
G.L. Xiao et al.
Prognostic influence of parapharyngeal space involvement in nasopharyngeal carcinoma
Int J Radiat Oncol Biol Phys
(2002)
J. Ma et al.
Is the 1997 AJCC staging system for nasopharyngeal carcinoma prognostically useful for Chinese patient populations?
Int J Radiat Oncol Biol Phys
(2001)
J.S. Sham et al.
Nasopharyngeal carcinomaOrderly neck node spread
Int J Radiat Oncol Biol Phys
(1990)
A.W. Lee et al.
Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976–1985Overall survival and pattern of failure
Int J Radiat Oncol Biol Phys
(1992)
J.H. Yan et al.
Management of local residual primary lesion of nasopharyngeal carcinoma (NPC)Are higher doses beneficial?
Int J Radiat Oncol Biol Phys
(1989)
P.M. Teo et al.
A retrospective study of the role of intracavitary brachytherapy and prognostic factors determining local tumour control after primary radical radiotherapy in 903 non-disseminated nasopharyngeal carcinoma patients
Clin Oncol
(1996)

K. Al Kourainy et al.

Excellent response to cisplatin-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma

Am J Clin Oncol

(1988)

Cited by (209)

Rehabilitation strategies for trismus post oral cancer treatment: Progress in the study of mouth opening exercises
2024, Journal of Stomatology, Oral and Maxillofacial Surgery
Oral cancer is a significant public health issue worldwide. Although its treatment methods effectively control tumor growth, they can lead to complications, including Trismus, severely affecting patients' quality of life. The practice standards for mouth opening exercises, a rehabilitative method to prevent and treat Trismus, are not yet clear. Therefore, this article aims to review the research progress of mouth opening exercises in the rehabilitation of Trismus post oral cancer treatment, providing a scientific and effective rehabilitation plan for oral cancer patients to improve their quality of life.
The application of 3-dimensional magnetic resonance imaging in nasopharyngeal carcinoma with pterygopalatine fossa invasion
2023, Magnetic Resonance Imaging
The pterygopalatine fossa (PPF) is a covert neurovascular pathway in the skull base and connects with numerous intracranial and extracranial spaces. The aim of this study was to explore the magnetic resonance imaging (MRI) features of PPF invasion in patients with nasopharyngeal carcinoma (NPC).
The medical records of 88 patients with stage T3 or T4 NPC were retrospectively analyzed. The 3-Dimensional (3D) volumetric images of MRI were reconstructed for the tiny connecting conduits of the invaded PPFs in the NPC patients. The infiltration incidence of conduits and connected further structures were calculated.
Forty-six PPFs from 37 patients were invaded by NPC. The proportions of stage T4 NPC and intracranial extension were higher in patients with PPF invasion than that without PPF invasion (P < 0.05). Each connecting conduit of the PPF had corresponding optimal reconstructed orientation based on 3D volumetric MRI images. The first three most common infiltrated conduits were palatovaginal canal, vidian canal and sphenopalatine foramen, which were adjacent to the nasopharynx. Among the conduits connecting with further structures, the most common infiltrated conduit was pterygomaxillary fissure, followed by foramen rotundum and inferior orbital fissure. Furthermore, The NPC lesions involved stage T4 structures via the conduits from 19.6% of the invaded PPFs.
The application of high-quality reconstruction images based on 3D sequence of MRI in NPC patients proved to be feasible and beneficial for the manifestation of the invaded PPFs and connecting conduits.
Dosimetric Analysis for Otitis Media With Effusion Due to Eustachian Tube Dysfunction After Carbon-ion Radiation Therapy for Head and Neck Cancers
2023, Advances in Radiation Oncology
Citation Excerpt :
Otitis media with effusion (OME) is a major concerning adverse event for patients with head and neck cancers treated with radiation therapy (RT), producing various clinical symptoms, such as earache, chronic purulent secretion, tinnitus, hearing loss, and reduced quality of life.1-3
This study aimed to clarify the predictive factors for otitis media with effusion (OME) due to Eustachian tube dysfunction in patients treated with carbon-ion radiation therapy (CIRT) for head and neck cancers.
We investigated patients with head and neck cancer whose Eustachian tube was irradiated by CIRT between October 2013 and December 2018 at our institution. OME severity was assessed by the proportion of mastoid cell opacification of magnetic resonance or computed tomography imaging (grade 0: <5% of volume of mastoid cell with opacification by fluid collection; grade 1: 6%-33%; grade 2: 34%-67%; and grade 3: 68%-100%). Clinical factors and dosimetric parameters affecting the development of grade 2 to 3 OME were analyzed using a log-rank test and Cox proportional hazards model.
In total, 141 patients were analyzed. The median follow-up period was 25.2 months. Grade 2 to 3 OME was observed in 65 patients, with a median incidence period of 6.5 months. According to the multivariate analysis, the mean dose of the cartilage part was a significant independent predictive parameter of grade 2 to 3 OME. The 2-year incidence rate of patients with a mean dose of the cartilage part of <40.59 Gy (relative biological effectiveness) and ≥40.59 Gy (relative biological effectiveness) was 24.2% (95% confidence interval, 15.1%-37.4%) and 66.4% (95% confidence interval, 54.5%-78.0%), respectively.
Our findings may be useful to predict the risk of grade 2 to 3 OME due to Eustachian tube dysfunction before CIRT.
Retrospective study on the predictive factors in chronic trismus
2022, British Journal of Oral and Maxillofacial Surgery
Trismus is one of the most debilitating and treatment-resistant complications resulting from head and neck oncological treatments. The objective of this study was to assess how primary tumour variables could assist in predicting chronic trismus. From a (retrospective) oncological database (Department of Oral and Maxillofacial Surgery, University Hospitals Leuven), tumour-related, surgical, and oral functional variables were reviewed. Contributing factors for chronic trismus, defined as a mouth opening of less than 35 mm, at least one year after treatment for oral squamous cell cancer, were assessed via logistic regression. A mediational analysis was conducted on the significant predictive variables. Thirteen out of 52 patients were observed to have chronic trismus. A significantly higher prevalence of trismus was found for increasing clinical T classification (p < 0.01), tumours based in the maxilla or the retromolar trigone (p = 0.04), after adjuvant radiotherapy (p = 0.04), and/or with masticatory muscle tumour invasion (p ≤ 0.02). Furthermore, radiotherapy significantly impacted T classification in chronic trismus, while T classification was significantly related to masticatory muscle invasion. Although radiotherapy and clinical T classification are well-established risk factors for postoperative trismus, masticatory muscle invasion should be considered as one of the main predictive factors.
Improvement in Swallowing Function in Patients with Previous Irradiation for Nasopharyngeal Carcinoma by Expiratory Muscle Strength Training
2024, Dysphagia
Nutritional status and its correlation to prognosis of nasopharyngeal carcinoma patients in different ages in China: a multicenter cohort study
2023, Supportive Care in Cancer

View all citing articles on Scopus

View full text

Clinical investigationHead and neckTreatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone

Introduction

Section snippets

Methods and materials

Overall and disease-free survival (DFS)

Discussion

Conclusion

Int J Radiat Oncol Biol Phys

Clin Oncol

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Clin Oncol

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

J Am Dent Assoc

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Eur J Cancer Part B, Oral Oncol

Radiother Oncol

Radiother Oncol

Excellent response to cisplatin-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma

Am J Clin Oncol

Clinical investigation
Head and neck
Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone