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

TitleClinical outcomes of 174 nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis
Authors
KeywordsNeurosurgery
Temporal lobe necrosis
Radiotherapy
Pulsed steroid
Nasopharyngeal carcinoma
Issue Date2012
Citation
International Journal of Radiation Oncology - Biology - Physics, 2012, v. 82, n. 1, p. e57-e65 How to Cite?
AbstractPurpose: 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 < 0.0001) were independent prognosticators of poor grade 4 complication-free survival. Patients with all four factors had a 100% risk of developing grade 4 complications within 5 years; whereas if no factor was present, the risk was 12.5%. Intravenous pulse steroid therapy was associated with a higher clinical response rate compared with conventional steroid therapy (p < 0.0001); however, it did not affect complication-free survival in multivariate analysis. Conclusions: TLN patients with good prognosticators could be observed without active treatment. Although treatment with intravenously pulsed steroid was associated with better clinical response than conventional steroid delivery, it did not affect the complication-free survival rate of TLN patients. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/223108
ISSN
2015 Impact Factor: 4.495
2015 SCImago Journal Rankings: 2.274

 

DC FieldValueLanguage
dc.contributor.authorLam, Tai Chung-
dc.contributor.authorWong, Frank C S-
dc.contributor.authorLeung, To Wai-
dc.contributor.authorNg, S. H.-
dc.contributor.authorTung, Stewart Y.-
dc.date.accessioned2016-02-19T02:37:45Z-
dc.date.available2016-02-19T02:37:45Z-
dc.date.issued2012-
dc.identifier.citationInternational Journal of Radiation Oncology - Biology - Physics, 2012, v. 82, n. 1, p. e57-e65-
dc.identifier.issn0360-3016-
dc.identifier.urihttp://hdl.handle.net/10722/223108-
dc.description.abstractPurpose: 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 < 0.0001) were independent prognosticators of poor grade 4 complication-free survival. Patients with all four factors had a 100% risk of developing grade 4 complications within 5 years; whereas if no factor was present, the risk was 12.5%. Intravenous pulse steroid therapy was associated with a higher clinical response rate compared with conventional steroid therapy (p < 0.0001); however, it did not affect complication-free survival in multivariate analysis. Conclusions: TLN patients with good prognosticators could be observed without active treatment. Although treatment with intravenously pulsed steroid was associated with better clinical response than conventional steroid delivery, it did not affect the complication-free survival rate of TLN patients. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.-
dc.languageeng-
dc.relation.ispartofInternational Journal of Radiation Oncology - Biology - Physics-
dc.subjectNeurosurgery-
dc.subjectTemporal lobe necrosis-
dc.subjectRadiotherapy-
dc.subjectPulsed steroid-
dc.subjectNasopharyngeal carcinoma-
dc.titleClinical outcomes of 174 nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ijrobp.2010.11.070-
dc.identifier.pmid21300460-
dc.identifier.scopuseid_2-s2.0-83955161772-
dc.identifier.volume82-
dc.identifier.issue1-
dc.identifier.spagee57-
dc.identifier.epagee65-
dc.identifier.eissn1879-355X-

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