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. 2021 Jun 27;16(1):118.
doi: 10.1186/s13014-021-01846-x.

Detailed analysis of recovery process of cranial nerve palsy after IMRT-based comprehensive treatment in nasopharyngeal carcinoma

Jian Zang #  1 , Yan Li #  1 , Shanquan Luo  1 , Jianhua Wang  1 , Bingxin Hou  1 , Min Yao  2 , Lina Zhao  3 , Mei Shi  4
Affiliations

Detailed analysis of recovery process of cranial nerve palsy after IMRT-based comprehensive treatment in nasopharyngeal carcinoma

Jian Zang et al. Radiat Oncol. .

Abstract

Background: Cranial nerve (CN) palsy due to cancer involvement has been considered as an unfavorable prognostic factor for patients with nasopharyngeal carcinoma (NPC). We assessed the role of IMRT based treatment on the recovery of CN palsy and investigated the prognostic value of complete recovery of CN palsy.

Methods: A total of 115 NPC patients with cancer-related CN palsy were included in the study. We referred CTCAE version 5.0 to evaluate the grade of CN palsy.

Results: All patients with grade 1 CN palsy recovered completely during the 2 years of follow-up after definite treatment. Most grade 2 palsy could change gradually to grade 1 palsy or complete recovery during 2 years of follow-up. Patients with more than 2 symptoms of CN palsy had poor 3-year disease-free survival (DFS) than these with 1 or 2 symptoms (60.3% vs. 84.9%, HR 0.25, 95% CI 0.07-0.89, P = 0.001). There were no significant differences for PFS, OS, DMFS and LRFS between patients with complete recovery and non-complete recovery from CN palsy after receiving IMRT based comprehensive treatment.

Conclusions: IMRT based comprehensive treatment could effectively promote the recovery of tumor-related CN palsy for NPC patient. More than 2 symptoms of CN palsy was a poor prognostic factor for DFS of NPC patients. The prognostic role of complete recovery of CN palsy was not identified in our study.

Keywords: Comprehensive treatment; Cranial nerve palsy; IMRT; Nasopharyngeal carcinoma; Recovery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between grade and symptom duration of cranial palsy. TN, trigeminal nerve (a); AN, abducens nerve (b); ON, oculomotor nerve (c)
Fig. 2
Fig. 2
Grade changing of cranial palsy after completion of treatment. TN, trigeminal nerve (a, d); AN, abducens nerve (b, e); ON, oculomotor nerve (c, f)
Fig. 3
Fig. 3
Impact of treatment-related factors on recovery of cranial nerve palsy. a–c Impact of radiation dose on recovery of cranial nerve palsy. Median radiation dose was used as dichotomy; d–f impact of treatment modalities on recovery of cranial nerve palsy. TN, trigeminal nerve; AN, abducens nerve; ON, oculomotor nerve
Fig. 4
Fig. 4
Survival analysis between patients with 1 or 2 symptoms of cranial palsy and patients with more than 2 symptoms of cranial palsy. DFS (a), disease-free survival; OS (b), overall survival; DMFS (c), distant metastasis-free survival; LRFS, locoregional recurrence-free survival (d)
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