Clinical significance of cranial nerve deficit in the therapy of nasopharyngeal carcinoma

Abstract

The results of radiation treatment of nasopharyngeal carcinoma (NPC) have recently been improved, but the prognosis remains relatively poor in cases with cranial nerve (CN) involvement. A total of 109 cases with histologically-proven NPC and cranial nerve involvement treated during 1979-1985 were reviewed and analysed. Definitive radiotherapy (RT) was given to patients with a high upper margin of the RT field at 2.5 cm above the base of the skull to a total dose of 70.2 Gy/39 fractions/8 weeks, with two applications of intranasopharyngeal brachytherapy. There were 37 cases (34%) in Group I (upward invasion only) and 72 cases (66%) in Group II (bidirectional invasion). Abducens, trigeminal, oculomotor and facial were the commonly involved nerves. Headache was the major symptom at diagnosis and was present in 82.6% of the patients, significantly higher than in general NPC cases (p less than 0.005). Fifty per cent (31/62) achieved complete response to definitive RT, but it did not correlate well with survival rate. The residual neurological deficit of each CN ranged from 31 to 57%. The actuarial 5-year survival rates of Groups I and II were similar in spite of neck lymph node metastasis in Group II (33% (I) compared with 24% (II); p greater than 0.05). Cases with single CN deficit did not show better results than those with multiple CN involvements. Five-year survivors were seen only in those who received a complete course of definitive RT.

T4‐Locally Advanced Nasopharyngeal Carcinoma: Prognostic Influence of Cranial Nerve Involvement in Different Radiotherapy Techniques

“…This is because nasopharyngeal neoplasm may hide all nasal and aural symptoms and present nonspecific signs such as diplopia, facial numbness, or headache as the initial manifestation [2, 19]. Eleven to 29% patients showed cranial nerve involvement at disease presentation [7, 13, 14]. Cranial nerve involvement was observed in 65.1% of our nonmetastatic T4 NPC patients.…”

“…Destruction of the skull base resulting in intracranial extension with cranial nerve involvement is not unusual because the cranial nerve is located adjacent to the skull base and the tumor is infiltrating in nature. It has been shown in previous studies that 11–29% patients had cranial nerve involvement at disease presentation [7, 13, 14]. The majority of cases with cranial nerve involvement are caused by superior invasion through the skull base into the cavernous sinus.…”

Headache as the Sole Symptom of Nasopharyngeal Carcinoma and Its Clinical Implications

“…The ascending-type NPC extends directly toward the base of skull with frequent involvement of cranial nerves [9]. However, there is no cervical lymphadenopathy in this entity.…”

Hypoglossal nerve palsy in nasopharyngeal carcinoma

“…[1][2][3] The majority of cranial nerve palsies on presentation are caused by superior invasion of the tumor into the skull base in the region of the cavernous sinus. This results in the abducens and trigeminal nerves being the most frequently affected, 4,5 whereas palsy of the lower cranial nerves including the hypoglossal nerve are less frequently seen. The purpose of the present study was to use magnetic resonance (MR) imaging to identify the cause and the sites of involvement of the nerve in NPC patients with hypoglossal nerve palsy when they were first seen and at postradiation therapy follow-up.…”