Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
Radiother Oncol. 2021 Oct;163:221-228. doi: 10.1016/j.radonc.2021.08.022. Epub 2021 Sep 8.
Cranial neuropathy is a common presenting symptom of advanced T4 nasopharyngeal carcinoma (NPC). Data on neurological outcomes after modern intensity-modulated radiotherapy (IMRT) and chemotherapy are scarce.
Case records of consecutive T4 NPC patients who received definitive IMRT in two tertiary oncology centers in 2004-2019 were reviewed. Patterns of cranial neuropathies at disease presentation were recorded. Time to neurological recovery and the rate of subsequent re-palsy were estimated by the Kaplan-Meier method. Clinical predictors were analyzed using multivariable Cox regression.
During the study period, 257 T4 NPC patients presented with 504 individual cranial neuropathies. The median time from neuropathy onset to NPC diagnosis was two months (IQR, 1-4 months). Cranial nerves (CN) VI (56.4%), V2 (47.9%), and V3 (29.2%) were most frequently involved. At a median follow-up of 6.4 years, the crude partial and full recovery rates of neuropathies were 111 (22%) and 289 (57.3%), respectively. CN III, IV, and VI had the highest 5-year full recovery rate (72.7%), followed by CN V1-3 (60.3%), XII (48.6%), and II (18.2%) (p < 0.001). Positive smoking history, optic nerve involvement, and longer duration of neuropathy were independent negative predictors for neurological recovery. After full recovery, re-palsy was observed in 6.9% (20/289) of the nerves, 60% of which co-occurred with local NPC recurrences.
Durable recovery of most cranial neuropathies in advanced T4 NPC was observed in the era of modern IMRT and effective systemic chemotherapy. Both patient and disease factors affected the chance of neurological recovery. Re-palsy of recovered nerves should prompt careful evaluation for local recurrence.
颅神经病变是晚期 T4 期鼻咽癌（NPC）的常见表现症状。关于现代调强放疗（IMRT）和化疗后神经学结局的数据较为缺乏。
回顾了 2004 年至 2019 年在两个三级肿瘤中心接受根治性 IMRT 的连续 T4 NPC 患者的病历。记录疾病发作时颅神经病的模式。通过 Kaplan-Meier 法估计神经恢复的时间和随后再麻痹的发生率。使用多变量 Cox 回归分析临床预测因子。
在研究期间，257 例 T4 NPC 患者出现 504 例单独的颅神经病。从神经病发作到 NPC 诊断的中位时间为 2 个月（IQR，1-4 个月）。最常受累的颅神经（CN）VI（56.4%）、V2（47.9%）和 V3（29.2%）。中位随访 6.4 年后，神经病变的粗略部分和完全恢复率分别为 111 例（22%）和 289 例（57.3%）。CN III、IV 和 VI 的 5 年完全恢复率最高（72.7%），其次是 CN V1-3（60.3%）、XII（48.6%）和 II（18.2%）（p<0.001）。阳性吸烟史、视神经受累和较长的神经病持续时间是神经恢复的独立负预测因子。在完全恢复后，289 例恢复神经中有 6.9%（20/289）出现再麻痹，其中 60%与局部 NPC 复发同时发生。
在现代 IMRT 和有效全身化疗时代，晚期 T4 NPC 的大多数颅神经病都能持久恢复。患者和疾病因素都影响神经恢复的机会。恢复神经的再麻痹应提示仔细评估局部复发。
