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Comparative Study
. 2014 May 27;110(11):2633-9.
doi: 10.1038/bjc.2014.243. Epub 2014 May 8.

Comparison of radiological and clinical features of temporal lobe necrosis in nasopharyngeal carcinoma patients treated with 2D radiotherapy or intensity-modulated radiotherapy

Y-P Mao  1 , G-Q Zhou  1 , L-Z Liu  2 , R Guo  1 , Y Sun  1 , L Li  2 , A-H Lin  3 , M-S Zeng  4 , T-B Kang  4 , W-H Jia  4 , J-Y Shao  5 , H-Q Mai  6 , J Ma  1
Affiliations
Comparative Study

Comparison of radiological and clinical features of temporal lobe necrosis in nasopharyngeal carcinoma patients treated with 2D radiotherapy or intensity-modulated radiotherapy

Y-P Mao et al. Br J Cancer. .

Abstract

Background: To compare the imaging and clinical features of temporal lobe necrosis (TLN) in nasopharyngeal carcinoma (NPC) patients treated with two-dimensional radiotherapy (2D-RT) or those with intensity-modulated radiotherapy (IMRT).

Methods: We retrospectively analysed NPC patients who underwent 2D-RT (72 patients, 128 temporal lobes) or IMRT (36 patients, 50 lobes) and developed radiation-induced, MRI-confirmed TLN.

Results: White-matter lesions (WMLs), contrast-enhanced lesions, cysts and local mass effects were present in 128 out of 128 vs 48 out of 50 (P=0.078), 123 out of 128 vs 47 out of 50 (P=0.688), 10 out of 128 vs 1 out of 50 (P=0.185) and 57 out of 128 vs 13 out of 50 (P=0.023) temporal lobes, respectively, in the 2D-RT and IMRT groups. The WMLs were more extensive in the 2D-RT group (P<0.001). The maximum diameter of contrast-enhanced lesions was greater in the 2D-RT group (P<0.001), and these lesions tended to extend far away from the nasopharynx. The WMLs and enhancement had no impact on cyst development (both P=1). Local mass effects were always accompanied with contrast-enhanced lesions (P=0.024) but were not correlated with WMLs or cysts (P=0.523 and 0.341, respectively). There were no between-group differences in clinical features (all P-values>0.05), whereas the difference in the incidence of severe debility was of marginal significance (18.1% vs 5.6%, P=0.077).

Conclusions: The IMRT-induced TLN was less extensive and milder than 2D-RT-induced TLN, but both had similar clinical features.

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Figures

Figure 1
Figure 1
Post-contrast, T1-weighted magnetic resonance images show the extent of contrast-enhanced lesions in both the mediolateral and superoinferior directions. (A) Contrast-enhanced lesions (rightward arrow) within the medial 1/3 of the ipsilateral temporal lobe in an axial image. (B) Contrast-enhanced lesions (leftward arrow) extending beyond the medial 1/3 but not reaching the lateral 1/3 of the ipsilateral temporal lobe in an axial image. (C) Contrast-enhanced lesions (downward arrow) reaching the lateral 1/3 of the ipsilateral temporal lobe in an axial image. (D) Contrast-enhanced lesions (rightward arrow) within the inferior 1/3 of the ipsilateral temporal lobe in a coronal image. (E) Contrast-enhanced lesions (leftward arrow) extending beyond the inferior 1/3 but not reaching the superior 1/3 of the ipsilateral temporal lobe in a coronal image. (F) Contrast-enhanced lesions (downward arrow) reaching the superior 1/3 of the ipsilateral temporal lobe in a coronal image.
Figure 2
Figure 2
Axial T2-weighted magnetic resonance images showing the severity of local mass effects. (A) Mild local mass effect affecting only the sulci of the temporal lobe (white arrow). (B) Moderate local mass effect affecting the sulci and ventricle (white arrow). (C) Severe local mass effect affecting the midline (white arrow).
Figure 3
Figure 3
Representative axial T2-weighted magnetic resonance images in patients with multiple cysts in the temporal lobe.
See this image and copyright information in PMC

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