Abstract
Radiotherapy (RT) or concurrent chemoradiation therapy (CCRT) is not only effective at patients’ survival rates, but also produces undesirable late complications. The purpose of this study is to investigate the post-treatment late complications in nasopharyngeal carcinoma (NPC) patients, and to analyze the individual impact factors. We enrolled 188 newly diagnosed NPC patients who had received complete treatments and at least 3 years’ follow-up between March 1984 and March 2010. Late complications were modified from the Toxicity Criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. Of 188 patients, 132 were male and 56 were female. Eighty-eight patients received CCRT and the other 100 patients received RT alone. The median follow-up duration was 7.34 years (range 3.30–26.54). Only 5.3% of patients reported no complication during post-treatment follow-up. The most common major and minor complications were osteoradionecrosis (10.1%) and xerostomia (56.4%), respectively. There was no impact factor for age, underlying disease, and cancer staging. However, there was a negative impact factor for xerostomia and limb numbness in the CCRT group compared with the RT group. Besides, re-radiation for recurrent patients could increase the risk of major complications. Fortunately, these major complications were reduced after the introduction of intensity-modulated radiotherapy in 2003. The improvement of treatment modality decreased the risk of major complications. Physicians should pay more attentions and improve patients’ quality of life during follow-up.
Similar content being viewed by others
References
Bureau of Health Promotion (2008) Cancer Registry annual report, 2008. Bureau of Health Promotion, Department of Health, The Executive Yuan, Taiwan, pp 28–29
Le QT, Tate D, Koong A, Gibbs IC, Chang SD, Adler JR, Pinto HA, Terris DJ, Fee WE, Goffinet DR (2003) Improved local control with stereotactic radiosurgical boost in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 56(4):1046–1054
Yeh SA, Tang Y, Lui CC, Huang YJ, Huang EY (2005) Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 62(3):672–679
Lee AW, Poon YF, Foo W, Law SC, Cheung FK, Chan DK, Tung SY, Thaw M, Ho JH (1992) Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976–1985: overall survival and patterns of failure. Int J Radiat Oncol Biol Phys 23(2):261–270
Hughes PJ, Scott PM, Kew J, Cheung DM, Leung SF, Ahuja AT, van Hasselt CA (2000) Dysphagia in treated nasopharyngeal cancer. Head Neck 22(4):393–397
Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P (2001) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck 23(5):389–398
Shanmugaratnam K, Sobin LH (1991) International histological classification of tumors: histological typing of upper respiratory tract tumors and ear, 2nd edn. World Health Organization, Geneva, pp 32–33
Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346
Cooper JS (2000) Concurrent chemotherapy and radiation therapy for advanced stage carcinoma of the nasopharynx. Int J Radiat Oncol Biol Phys 48(5):1277–1279
Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, Siu L, Sze WM, Leung TW, Sham JS, Ngan RK, Law SC, Yau TK, Au JS, O’Sullivan B, Pang ES, O SK, Au GK, Lau JT (2005) Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 23(28):6966–6975
Greenspan A, Treat J (1988) Peripheral neuropathy and low dose cisplatin. Am J Clin Oncol 11(6):660–662
Koom WS, Kim TH, Shin KH, Pyo HR, Kim JY, Kim DY, Yoon M, Park SY, Lee DH, Ryu JS, Jung YS, Lee SH, Cho KH (2008) SMART (simultaneous modulated accelerated radiotherapy) for locally advanced nasopharyngeal carcinomas. Head Neck 30(2):159–169
Sumitsawan Y, Chaiyasate S, Chitapanarux I, Anansuthiwara M, Roongrotwattanasiri K, Vaseenon V, Tooncam H (2009) Late complications of radiotherapy for nasopharyngeal carcinoma. Auris Nasus Larynx 36(2):205–209
Yeh SA, Huang YJ (2007) Dose escalation for patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone. Am J Clin Oncol 30(4):401–405
Leung TW, Tung SY, Sze WK, Sze WM, Wong VY, Wong CS, O SK (2000) Salvage radiation therapy for locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 48(5):1331–1338
Pryzant RM, Wendt CD, Delclos L, Peters LJ (1992) Re-treatment of nasopharyngeal carcinoma in 53 patients. Int J Radiat Oncol Biol Phys 22(5):941–947
Hao SP, Tsang NM, Chang KP, Hsu YS, Chen CK, Fang KH (2008) Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 53 patients and prognostic factors. Acta Otolaryngol 128(4):473–481
August M, Dodson TB, Nastri A, Chuang SK (2001) Nasopharyngeal carcinoma: clinical assessment and review of 176 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(2):205–214
Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66(4):981–991
Kwong DL, Pow EH, Sham JS, McMillan AS, Leung LH, Leung WK, Chua DT, Cheng AC, Wu PM, Au GK (2004) Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function. Cancer 101(7):1584–1593
Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Akazawa P, Weinberg V, Fu KK (2002) Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53(1):12–22
Huang XM, Zheng YQ, Zhang XM, Mai HQ, Zeng L, Liu X, Liu W, Zou H, Xu G (2006) Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope 116(9):1626–1631
Lin YS, Jen YM, Lin JC (2002) Radiation-related cranial nerve palsy in patients with nasopharyngeal carcinoma. Cancer 95:404–409
Tsui EYK, Chan JHM, Ramsey RG, Leung TW, Cheung YK, Luk SH, Lai KF, Wong KPC, Fong D, Yuen MK (2001) Late temporal lobe necrosis in patients with nasopharyngeal carcinoma: evaluation with combined multi-section diffusion weighted and perfusion weighted MR imaging. Eur J Radiol 39:133–138
Qin DX, Hu YH, Yan JH, Xu GZ, Cai WM, Wu XL, Cao DX, Gu XZ (1988) Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation. Cancer 61:1117–1124
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, CC., Ho, CY. Post-treatment late complications of nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 269, 2401–2409 (2012). https://doi.org/10.1007/s00405-011-1922-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-011-1922-2