Central nervous system infection in patients with postirradiated nasopharyngeal carcinoma: a case-controlled study.
BACKGROUND
It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection.


OBJECTIVE
The purpose of this study was to better understand this clinical entity.


METHODS
From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated.


RESULTS
The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001).


CONCLUSIONS
Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.
Liang
Kai-Li
KL
Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan. kellyliang1107@gmail.com
Jiang
Rong-San
RS
Lin
Jin-Ching
JC
Chiu
Yu-Jung
YJ
Shiao
Jiun-Yih
JY
Su
Mao-Chang
MC
Hsin
Chung-Han
CH
D000328:Adult; D000368:Aged; D001706:Biopsy; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D002490:Central Nervous System / Q000528:radiation effects*; D002494:Central Nervous System Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004307:Dose-Response Relationship, Radiation; D004724:Endoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed