Li Jian-Cheng, Mayr Nina A, Yuh William T C, Wang Jian Z, Jiang Guo-Liang
Department of Radiation Oncology, Affiliated Cancer Hospital, Fudan University, Shanghai, People's Republic of China.
Ann Otol Rhinol Laryngol. 2006 May;115(5):340-5. doi: 10.1177/000348940611500504.
To evaluate the cranial nerve (CN) palsy associated with nasopharyngeal carcinoma (NPC), we studied factors that influenced the neurologic outcome of radiotherapy (RT), and the patterns and time course of neurologic recovery of CN palsy.
Between July 1987 and July 1989, 93 patients who presented with CN palsy at the time of diagnosis of NPC were studied. All patients underwent external-beam RT with either cobalt-60 or 6-MV photon beams to a dose of 69 to 84 Gy at 2 Gy per fraction. The time course and pattern of neurologic recovery (complete, partial, or none) from CN palsy were evaluated. Age, sex, stage, histology, incidence and distribution of types of CNs involved, duration of CN palsy, and time course of tumor response during RT were correlated with the patterns and the time course of neurologic CN recovery by univariate and multivariate analyses.
The cases of CN palsy most commonly involved CN V (38%), CN VI (26%), and CN XII (11%), which accounted for the majority of the cases (75%). The time course of CN recovery was variable and protracted. Most patients showed significant improvement upon completion of RT (51%, 19%, and 30% complete, partial, and no recovery, respectively) and further improvement 6 months after RT (58%, 17%, and 25%, respectively). Cranial nerves V, VI, and XII accounted for 75% of cases with no recovery. Recovery was best for CNs II, IX, and XI and the sympathetic nerve (100%, 87%, 100%, and 100%, respectively) and worst for CNs IV, VII, and XII (67%, 60%, and 40%, respectively, with no recovery). Neurologic CN recovery correlated significantly with the pretherapy duration (<3 months versus > or =3 months) of CN palsy (88% versus 62%; p = .002, multivariate analysis), the time course of clinical tumor regression, and neurologic symptom improvement during RT. Age, sex, T stage, N stage, histology, anterior versus posterior CN palsies, and base of skull involvement were not significant.
According to our limited data, most patients with CN palsy respond well to RT. That the time course of neurologic recovery is variable and can be protracted indicates a need for continuous and close neurologic surveillance. The poorer neurologic outcome associated with a longer duration of CN symptoms may be related to a more severe longterm CN compression that results in irreversible damage. Timely diagnosis of NPC and fast institution of therapy are therefore critical to improving the neurologic outcome.
为评估与鼻咽癌（NPC）相关的颅神经（CN）麻痹，我们研究了影响放射治疗（RT）神经学结果的因素，以及CN麻痹的神经学恢复模式和时间进程。
在1987年7月至1989年7月期间，对93例在NPC诊断时出现CN麻痹的患者进行了研究。所有患者均接受了钴-60或6兆伏光子束的外照射放疗，剂量为69至84戈瑞，每次分割剂量为2戈瑞。评估了CN麻痹神经学恢复的时间进程和模式（完全恢复、部分恢复或无恢复）。通过单因素和多因素分析，将年龄、性别、分期、组织学、受累CN类型的发生率和分布、CN麻痹持续时间以及放疗期间肿瘤反应的时间进程与CN神经学恢复的模式和时间进程进行了关联。
CN麻痹病例最常累及CN V（38%）、CN VI（26%）和CN XII（11%），这些占病例的大多数（75%）。CN恢复的时间进程是可变的且持续时间长。大多数患者在放疗结束时显示出显著改善（完全恢复、部分恢复和无恢复的分别为51%、19%和30%），放疗后6个月进一步改善（分别为58%、17%和25%）。CN V、VI和XII占无恢复病例的75%。CN II、IX、XI和交感神经的恢复情况最好（分别为100%、87%、100%和100%），而CN IV、VII和XII最差（无恢复的分别为67%、60%和40%）。CN神经学恢复与CN麻痹的治疗前持续时间（<3个月与≥3个月）（多因素分析中分别为88%与62%；p = 0.002）、临床肿瘤消退的时间进程以及放疗期间神经症状改善显著相关。年龄、性别、T分期、N分期、组织学、前部与后部CN麻痹以及颅底受累情况均无显著意义。
根据我们有限的数据，大多数CN麻痹患者对放疗反应良好。神经学恢复的时间进程是可变的且可能持续时间长，这表明需要持续和密切的神经学监测。与较长时间的CN症状相关的较差神经学结果可能与更严重的长期CN压迫导致不可逆损伤有关。因此，NPC的及时诊断和快速开始治疗对于改善神经学结果至关重要。
