Clinical analysis of 60 cases with radiative nasopharyngeal necrosis in nasopharyngeal carcinoma
10.3760/cma.j.issn.1673-0860.2012.03.003
- VernacularTitle:鼻咽癌放射治疗后鼻咽坏死60例临床分析
- Author:
WUJun-xin
1
;
Lu-Ying XU
;
Bai-Hua YANG
;
Shao-Jun LIN
;
Chun ZHANG
;
Feng-Jie LIN
;
Qiao-Juan GUO
;
Lu HAN
;
Jian-Ji PAN
Author Information
1. 福建医科大学福建省肿瘤医院
- Keywords:
Nasopharyngeal neoplasms;
Radiotherapy;
Necrosis;
Hemorrhage
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2012;47(3):185-190
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the clinical characteristics,diagnosis,treatment and prognostic factors of patients with postradiation nasopharyngeal necrosis(PRNN) in nasopharyngeal carcinoma(NPC).Methods Sixty patients with PRNN were studied retrospectively,50 males and 10 females,age ranging from 30-70 years of (median 51.5 years). All patients were treated with endoscopic debridement and systemic or local anti-inflammatory treatment. Kruskal-Wallis H test was used to assess the interval time between irradiation completion and necrosis onset and related factors of treatment outcome.Multivariate Cox proportional hazards regression survival analysis was performed to analyze risk factors.Results The latent period between the last irradiation and the onset of the symptom ranged from 1 to 156 months,with a median of 5 months.The median interval time was 7.0 months in 1 course group and 4.5 months in ≥ 2 courses group ( x2 =5.527,P =0.031 ),and 7.5 months in T2 group and 5.0 months in ≥T3 group ( X2 =4.330,P =O.037 ),respectively.Forty-one patients of them had nasopharyngeal infection,and the difference in curative effect between infection group and non-infection group was sigmficantly(x 2 =14.775,P ＜ 0.001 ).Symptoms were alleviated in all patients after endoscopic debridement and systemic or local anti-inflammatory treatment.Follow-up for all patients ranged from 2 to 46 months (median 12.5 months).Seven patients with internal carotid artery exposure died of sudden nasopharyngeal massive bleeding and fifteen patients died of tumor or systemic exhaustion; five cases were lost,and the rest were all in survival. Inter carotid artery erosion was an independent prognostic risk factor according to multivariate Cox proportional hazards regression survival analysis ( P ＜ 0.05 ). Conclusions Endoscopic debridement is effective in treating irradiation-related nasopharyngeal necrosis. The occurrence of nasopharyngeal necrosis is related to infection,irradiation dose and course,and T stage.Internal carotid artery erosion is a severe situation and also an independent prognostic factor for the patients.The most common causes of death were nasopharyngeal bleeding and systemic exhaustion.
