Nasopharyngeal carcinoma with cranial nerve palsy: the importance of MRI for radiotherapy
Nasopharyngeal carcinoma with cranial nerve palsy: the importance of MRI for radiotherapy
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DOI：
10.1016/j.ijrobp.2005.05.042
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发表时间：
2005-12-01
影响因子：
7
通讯作者：
Liao, CT
中科院分区：
文献类型：
--
作者：
Chang, JTC;Lin, CY;Liao, CT
目的：评估鼻咽癌（NPC）伴颅神经（CN）麻痹患者的各种预后因素以及影像学检查方法对肿瘤控制的影响。
材料与方法：1979年9月至2000年12月期间，长庚纪念医院林口院区采用常规对穿技术对330例鼻咽癌伴颅神经麻痹患者进行了根治性放疗（RT）。在此期间使用的影像学方法各异，其中47例患者使用了常规断层扫描（Tm），195例使用了计算机断层扫描（CT），88例使用了磁共振成像（MRI）。268例患者出现上颅神经（II - VI）麻痹，13例出现下颅神经（IX - XII）麻痹，49例患者上下颅神经均受累。最常受累的颅神经是V或VI或两者皆有（分别为23%、12%和16%）。所有患者的身体状况良好（世界卫生组织评分＜2）。外照射的中位剂量为70.2 Gy（范围为63 - 77.5 Gy）。除了外照射，156例患者还接受了近距离放疗，采用遥控后装高剂量率技术。共有139例患者接受了以顺铂为基础的化疗，其中115例作为新辅助或辅助化疗，24例与放疗同时进行。放疗期间或放疗后，171例患者的颅神经麻痹得到恢复。死因不明的患者被视为死于疾病未控。
结果：3年、5年和10年总生存率分别为47.1%、34.4%和22.2%。3年、5年和10年疾病特异性生存率（DSS）分别为50.4%、37.8%和25.9%。采用MRI、CT和Tm分期的患者5年DSS分别为46.9%、36.7%和21.9%（p = 0.016）。MRI和CT之间的差异具有显著性（p = 0.015）。3年和5年局部控制率分别为62%和53%。如果排除死因不明的患者，5年局部控制率为68.2%。接受MRI检查的患者肿瘤控制率明显优于接受CT或Tm检查的患者，局部肿瘤控制和生存率提高了15 - 30%。广泛颅神经麻痹患者的生存率比仅下颅神经或上颅神经受累的患者差（5年DSS分别为20.4%对比43.2%和40.4%；p＜0.001）。颅神经麻痹恢复的患者生存率比未恢复的患者好（47%对比26%，p＜0.001）。近距离放疗与较差的局部控制相关，而外照射总剂量超过70 Gy可改善局部肿瘤控制并略微提高DSS。对CT和MRI患者组进行亚组分析，DSS或总生存率（OS）与影像学检查方法、N分期、颅神经麻痹的部位或缓解情况显著相关。
结论：使用MRI与鼻咽癌致颅神经麻痹患者的肿瘤控制和生存率提高相关。颅神经麻痹恢复的患者生存率更高。外照射给予更高的辐射剂量可能比近距离放疗实现更好的肿瘤控制。（c）2005爱思唯尔公司
Purpose: To evaluate various prognostic factors and the impact of imaging modalities on tumor control in patients with nasopharyngeal cancer (NPC) with cranial nerve (CN) palsy.Material and Methods: Between September 1979 and December 2000, 330 NPC patients with CN palsy received radical radiotherapy (RT) by the conventional opposing technique at Chang Gung Memorial Hospital-Linkou. Imaging methods used varied over that period, and included conventional tomography (Tm) for 47 patients, computerized tomography (CT) for 195 patients, and magnetic resonance image (MRI) for 88 patients. Upper CN (II-VI) palsy was found in 268 patients, lower CN (IX-XII) in 13, and 49 patients had both. The most commonly involved CN were V or VI or both (23%, 12%, and 16%, respectively). All patients had good performance status (World Health Organization < 2). The median external RT dose was 70.2 Gy (range, 63-77.5 Gy). Brachytherapy was also given to 156 patients in addition to external RT, delivered by the remote after-loading, high-dose-rate technique. A total of 139 patients received cisplatin-based chemotherapy, in 115 received as neoadjuvant or adjuvant chemotherapy and in 24 concomitant with RT. Recovery from CN palsy occurred in 171 patients during or after radiotherapy. Patients who died without a specific cause identified were regarded as having died with persistent disease.Results: The 3-year, 5-year, and 10-year overall survival was 47.1%, 34.4%, and 22.2%. The 3-year, 5-year, and 10-year disease-specific survival (DSS) rates were 50.4%, 37.8%, and 25.9%. The 5-year DSS for patients staged with MRI, CT, and Tm were 46.9%, 36.7%, and 21.9%, respectively (p = 0.016). The difference between MRI and CT was significant (p = 0.015). The 3-year and 5-year local control rates were 62% and 53%, respectively. The 5-year local control was 68.2% if excluding patients who died without a specific cause. Patients who had an MRI had a significantly better tumor control rate than those evaluated with CT or Tm, with a 15-30% improvement in local tumor control and survival. Patients with extensive CN palsy had worse survival than those with only lower CN or upper CN involvement (5-year DSS 20.4% vs. 43.2% and 40.4%, respectively; p < 0.001). Patients who recovered from CN palsy had better survival than those who did not (47% vs. 26%, p < 0.001). Brachytherapy was associated with poorer local control, whereas a total external dose of more than 70 Gy improved local tumor control and marginally improved DSS. Subgroup analysis in CT and MRI patients group, either DSS or OS was significantly associated with imaging modality, N stage, or location of or remission of CN palsy.Conclusion: The use of MRI was associated with improved tumor control and survival of patients with NPC causing CN palsy. Patients recovering from CN palsy had better survival. A higher radiation dose delivered by external beam may achieve better tumor control than brachytherapy. (c) 2005 Elsevier Inc.