Clinical And Prognostic Factors Analysis Of Cavernous Sinus Invasion In Nasopharyngeal Carcinoma:78Cases Report

Objective:To investigate the clinical features and related prognostic factors of nasopharyngeal carcinoma infilatrating the carvernous sinus, by retrospectively analyzing the clinical data of78patients of cavernous sinus invasion in nasopharyngeal carcinoma.Methods:From August2005to December2006,78cases, pathologically proved and diagnosed as infilatrating the carvernous sinus NPC patients who hospitalized to affiliated tumor hospital of Guang Xi Medical university, were collected.And all of them were performed detailed medical examination, MRI and/or CT scan of nasopharynx and neck, nasopharynx fiberscopes inspection, nasopharynx tumor biopsies and pathological examination and other relevant examinations before treatment.The radiological data were read.The patients were treated with radiotherapy and chemotherapy, who has been follow-uping to January2012.The clinical and radiological features were investigated. The incidence, overall response rate, survival rate, distant metastatic rate and prognostic factors were analysed.Results:1. The number of cases of which screening diagnosis was cavernous sinus invasion was98among547cases of patients with nasopharyngeal carcinoma.The incidence of nasopharyngeal carcinoma infilatrating the carvernous sinus was17.9%.2. Headache occurred as an initial symptom in78.21%(61/78),and all localized in same unilateral position in CSI.The cranial nerves(Ⅱ、Ⅲ、Ⅳ、Ⅴ、 Ⅵ)、the bone of the skull base both were simultaneously affected in approximately70%patients having headache. Invasion of the bones of the skull base was present in92.31%of CSI cases, and62.50%of these cases,which has the most common sites of bone destruction, had over three sites of extensive bone infiltration as "windowing" In our series of SCI,49cases (62.82%) showed lesions of cranial nerve (Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ).3. The most common MRI features were enlargement of cavernous sinus with unconventional enhancement (28/64,43.75%),even with formation of mass inside the sinus (22/64,34.38%).The other MRI image features were local or diffuse dura mater thickening of cavernous sinus and presence of obscure structure as intra-sinus blurs and hazies inside.4. Among the group of all patients, the survival rates of1year、3years、5years were respectively81%、51%、24%.The overall response rate (RR) was34.62%. The distant metastatic rate was19.23%.5. Univariate and multivariate analysis showed that the number of articles of cranial nerve injury, radiotherapy dose, with or without invasion of paranasal sinus affect the patient’s OS (Overall Survival Rate) of the independent prognostic factors (P<0.05). Conclusion1. The incidence of nasopharyngeal carcinoma infilatrating the carvernous sinus of the group was17.9%, lower than that of other reported in the literature at home and abroad.2. The cranial nerves(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ)、the bone of the skull base both were simultaneously affected in approximately70%patients having headache. This clinical features contributed to the detection of CSI.3. The number of articles of cranial nerve injury, radiotherapy dose, with or without invasion of paranasal sinus are the independent prognostic factors for the patients of nasopharyngeal carcinoma infilatrating the carvernous sinus.