Clinical outcomes of 174 nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis

被引：60

作者：

Lam, Tai-Chung ^{[1
]}

Wong, Frank C.S. ^{[1
]}

Leung, To-Wai ^{[2
]}

Ng, S.H. ^{[3
]}

Tung, Stewart Y. ^{[1
]}

机构：

[1] Department of Clinical Oncology, Tuen Mun Hospital, 15 Tsing Chung Koon Road, Tuen Mun, Hong Kong

[2] Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong

[3] Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong

来源：

International Journal of Radiation Oncology Biology Physics | 2012年 / 82卷 / 01期

关键词：

Risk assessment - Diagnosis - Multivariant analysis - Patient monitoring - Salvaging - Neurosurgery - Lipids;

D O I：

10.1016/j.ijrobp.2010.11.070

中图分类号：

学科分类号：

摘要：

Purpose: To retrospectively study the clinical outcomes of nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis (TLN) treated with steroids, surgery, or observation only. Methods and Patients: We performed a retrospective analysis of 174 consecutive patients diagnosed with TLN between 1990 and 2008. Before 1998, symptomatic patients were treated with oral steroids, while asymptomatic patients were treated conservatively. After 1998, most symptomatic and asymptomatic patients with a large volume of necrosis were treated by intravenously pulsed-steroid therapy with a standardized protocol. We examined factors affecting grade 4 complication-free survival and overall survival. Outcomes of the three treatment groups, those receiving conservative treatment, those receiving oral steroid, and those receiving intravenous pulse steroid, were compared. Results: The mean follow-up time was 115 months. Rates of grade 4 complication-free survival at 2 years and at 5 years after diagnosis of TLN were 72.2% and 54.1%, respectively. The 2-year and 5-year overall survival rates were 57.5% and 35.4%, respectively. Multivariate analysis revealed that being symptomatic at diagnosis (relative risk [RR], 4.5; p = 0.0001), re-irradiation of the nasopharynx (NP) (RR, 1.56; p = 0.008), salvage brachytherapy to the NP (RR, 1.75; p = 0.012), and a short latency period before the diagnosis of TLN (RR, 0.96, p

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