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Radiation-induced cranial neuropathy in patients with nasopharyngeal carcinoma

A follow-up study

Strahleninduzierte Hirnnervenschädigung bei Patienten mit Nasopharyngealkarzinom

Eine Follow-up-Studie

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Abstract

Goal

The purpose of the current study was to investigate the long-term characteristics of radiation-induced cranial nerve injury in nasopharyngeal carcinoma (NPC) patients.

Patients and methods

We studied cranial nerve palsy (CNP) in 328 NPC patients who received radiotherapy between 1994 and 2006. Follow-up was 93.6% complete as of December 2009. A total of 72 patients with CNP were recruited for analysis (56 men and 16 women). Patients with evidence of residual or recurrent tumor accompanied by CNP were excluded. The characteristics of CNP and the relationship with the radiation fields as well as re-radiotherapy were evaluated.

Results

After a mean follow-up of 11.2 years, 72 patients were found to have developed CNP. The latency of palsy ranged from 0.6–16.0 years. For the 67 patients with first course radiation, the glossopharyngeal and vagus nerves were the most vulnerable combination, occurring in 57 patients (85.1%). Patients with facial–cervical field radiation had a significantly longer latency comparing with that of patients with facial–cervical split fields (p = 0.021). In the first 5 years, 49.3% of patients developed CNP, while 40.3% presented CNP in the second 5-year period. In patients with first course radiation, 61 patients had more than one CNP. With regard to the 5 patients with re-radiation, most of them had multiple upper cranial nerve injuries.

Conclusion

Radiation therapy of NPC patients may lead to cranial neuropathy. Patients with facial–cervical radiation fields had a longer latency for the manifestation of CNP compared with those patients who were treated with split fields. In patients with re-radiotherapy, the frequency of upper cranial nerve injury increased greatly.

Zusammenfassung

Ziel

Follow-up-Untersuchung von Charakteristika der strahleninduzierten Hirnnervenschädigungen bei Patienten mit Nasopharyngealkarzinom (NPC).

Patienten und Methoden

Von 1994 bis 2006 untersuchten wir Hirnnervenparalysen (CNP) bei 328 NPC-Patienten, die eine Strahlentherapie erhielten. Bis Dezember 2009 waren 93,6% des Follow-up abgeschlossen. Insgesamt 72 CNP-Fälle (56 männlich, 16 weiblich) gingen in die Analyse ein. Nicht eingeschlossen waren CNP-Patienten mit Residual- oder Rezidivtumoren. Charakteristika der CNP wurden in Relation zu Bestrahlungsfeldern wie auch zu Re-Irradiation untersucht.

Ergebnisse

Nach einem Follow-up von im Mittel 11,2 Jahren traten bei 72 Patienten CNP auf. Die Latenzzeit der CNP lag bei 0,6–16 Jahren. Bei 67 CNP-Patienten waren nach „first line“-Strahlentherapie am häufigsten – in 57 Fällen (85,1%) – Glossopharyngeus und Vagus betroffenen. Nach Anwendung war, verglichen mit fazial-zervikaler „split field“-Bestrahlung, die CNP-Latenzzeit signifikant länger (p = 0,021). Bei 49,3% der Patienten traten CNP innerhalb der ersten 5 Jahre nach Strahlentherapie auf, bei 40,3% der Patienten erst innerhalb der folgenden 5 Jahre. Von den Patienten, die eine „first line“-Strahlentherapie erhalten hatten, hatten 61 mehr als eine CNP. Die 5 Patienten nach Re-Irradiation hatten multiple höhere Hirnnervenschädigungen.

Schlussfolgerungen

Die Strahlentherapie von Nasopharyngealkarzinomen kann zu Hirnnervenschädigungen führen. Nach Anwendung fazial-zervikaler Bestrahlungsfelder ist die CNP-Latenzzeit länger als nach Einsatz mehrerer fazial-zervikaler aneinander gesetzter Bestrahlungsfelder. Nach Re-Bestrahlung sind höhere Hirnnervenschädigungen deutlich häufiger.

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References

  1. Shin HR, Masuyer E, Ferlay J, Curado MP (2010) Cancer in Asia – incidence rates based on data in cancer incidence in five continents IX (1998–2002). Asian Pac J Cancer Prev 11(Suppl 2):11–16

    PubMed  Google Scholar 

  2. Yee D, Hanson J, Lau H et al (2006) Treatment of nasopharyngeal carcinoma in the modern era: analysis of outcomes and toxicity from a single center in a nonendemic area. Cancer J 12(2):147–154

    PubMed  Google Scholar 

  3. Selzer E, Liederer S, Lemaire C et al (2011) Incidence of dermatitis in head and neck cancer patients treated with primary radiotherapy and cetuximab. Strahlenther Onkol 187(6):373–377

    Article  PubMed  Google Scholar 

  4. Behin A, Delattre JY (2004) Complications of radiation therapy on the brain and spinal cord. Semin Neurol 24(4):405–417

    Article  PubMed  Google Scholar 

  5. Kong L, Lu JJ, Liss AL et al (2011) Radiation-induced cranial nerve palsy: a cross-sectional study of nasopharyngeal cancer patients after definitive radiotherapy. Int J Radiat Oncol Biol Phys 79(5):1421–1427

    Article  PubMed  Google Scholar 

  6. Matuschek C, Bolke E, Nawatny J et al (2011) Bevacizumab as a treatment option for radiation-induced cerebral necrosis. Strahlenther Onkol 187(2):135–139

    Article  PubMed  Google Scholar 

  7. Qin DX, Hu YH, Yan JH et al (1988) Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation. Cancer 61(6):1117–1124

    Article  PubMed  CAS  Google Scholar 

  8. Lee AW, Law SC, Ng SH et al (1992) Retrospective analysis of nasopharyngeal carcinoma treated during 1976–1985: late complications following megavoltage irradiation. Br J Radiol 65(778):918–928

    Article  PubMed  CAS  Google Scholar 

  9. Huang S, Chu G (1981) Nasopharyngeal cancer: study II. Int J Radiat Oncol Biol Phys 7(6):713–716

    Article  PubMed  CAS  Google Scholar 

  10. Takahashi T, Hondo M, Nishimura K et al (2008) Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy. Radiat Med 26(7):396–401

    Article  PubMed  Google Scholar 

  11. Lee PW, Kwan TT, Kwong DL et al (2007) A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients. Cancer 109(7):1344–1354

    Article  PubMed  Google Scholar 

  12. Lin YS, Jen YM, Lin JC (2002) Radiation-related cranial nerve palsy in patients with nasopharyngeal carcinoma. Cancer 95(2):404–409

    Article  PubMed  Google Scholar 

  13. Teo PM, Leung SF, Chan AT et al (2000) Final report of a randomized trial on altered-fractionated radiotherapy in nasopharyngeal carcinoma prematurely terminated by significant increase in neurologic complications. Int J Radiat Oncol Biol Phys 48(5):1311–1322

    Article  PubMed  CAS  Google Scholar 

  14. Johansson S, Svensson H, Denekamp J (2000) Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. Int J Radiat Oncol Biol Phys 48(3):745–750

    Article  PubMed  CAS  Google Scholar 

  15. Berger PS, Bataini JP (1977) Radiation-induced cranial nerve palsy. Cancer 40(1):152–155

    Article  PubMed  CAS  Google Scholar 

  16. Asao C, Korogi Y, Kitajima M et al (2005) Diffusion-weighted imaging of radiation-induced brain injury for differentiation from tumor recurrence. Am J Neuroradiol 26(6):1455–1460

    PubMed  Google Scholar 

  17. Al SA, Buckley R, McHenery C et al (2010) Distinguishing recurrent primary brain tumor from radiation injury: a preliminary study using a susceptibility-weighted MR imaging-guided apparent diffusion coefficient analysis strategy. Am J Neuroradiol 31(6):1049–1054

    Article  Google Scholar 

  18. Chang JT, Lin CY, Chen TM et al (2005) Nasopharyngeal carcinoma with cranial nerve palsy: the importance of MRI for radiotherapy. Int J Radiat Oncol Biol Phys 63(5):1354–1360

    Article  PubMed  Google Scholar 

  19. Danesh-Meyer HV (2008) Radiation-induced optic neuropathy. J Clin Neurosci 15(2):95–100

    Article  PubMed  Google Scholar 

  20. Levy RL, Miller NR (2006) Hyperbaric oxygen therapy for radiation-induced optic neuropathy. Ann Acad Med Singapore 35(3):151–157

    PubMed  Google Scholar 

  21. Parsons JT, Bova FJ, Fitzgerald CR et al (1994) Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys 30(4):755–763

    Article  PubMed  CAS  Google Scholar 

  22. Stafford SL, Pollock BE, Leavitt JA et al (2003) A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 55(5):1177–1181

    Article  PubMed  Google Scholar 

  23. Hasegawa T, Kobayashi T, Kida Y (2010) Tolerance of the optic apparatus in single-fraction irradiation using stereotactic radiosurgery: evaluation in 100 patients with craniopharyngioma. Neurosurgery 66(4):688–694, discussion 694–695

    Article  PubMed  Google Scholar 

  24. Platteaux N, Dirix P, Vanstraelen B, Nuyts S (2011) Outcome after re-irradiation of head and neck cancer patients. Strahlenther Onkol 187(1):23–31

    Article  PubMed  Google Scholar 

  25. Tang Y, Zhang Y, Guo L et al (2008) Relationship between individual radiosensitivity and radiation encephalopathy of nasopharyngeal carcinoma after radiotherapy. Strahlenther Onkol 184(10):510–514

    Article  PubMed  Google Scholar 

  26. Hsiung CY, Yorke ED, Chui CS et al (2002) Intensity-modulated radiotherapy versus conventional three-dimensional conformal radiotherapy for boost or salvage treatment of nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 53(3):638–647

    Article  PubMed  Google Scholar 

  27. Lai SZ, Li WF, Chen L et al (2011) How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys 80(3):661–668

    Article  PubMed  Google Scholar 

  28. Peponi E, Glanzmann C, Kunz G et al (2010) Simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) in nasopharyngeal cancer. Strahlenther Onkol 186(3):135–142

    Article  PubMed  Google Scholar 

  29. Fua TF, Corry J, Milner AD et al (2007) Intensity-modulated radiotherapy for nasopharyngeal carcinoma: clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat Oncol Biol Phys 67(4):976–981

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by the National Natural Science Foundation of China (No. 30600164 and No. 81072242), the Natural Science Foundation of Guangdong Province (No. S2011010004708), and the Fundamental Research Funds for the Central Universities to Y. Tang.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Number 107, Yan Jiang Xi Road, 510120, Guangzhou, Guangdong Province, China

    X. Rong, Y. Tang, K. Lu & Y. Peng

  2. Department of Nasopharyngeal Carcinoma, Cancer Center of Sun Yat-sen University, Guangzhou, China

    M. Chen

Authors
  1. X. Rong
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  2. Y. Tang
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  3. M. Chen
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  4. K. Lu
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  5. Y. Peng
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Corresponding author

Correspondence to Y. Tang.

Additional information

The first two authors contributed equally to the study.

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Rong, X., Tang, Y., Chen, M. et al. Radiation-induced cranial neuropathy in patients with nasopharyngeal carcinoma. Strahlenther Onkol 188, 282–286 (2012). https://doi.org/10.1007/s00066-011-0047-2

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  • DOI: https://doi.org/10.1007/s00066-011-0047-2

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