title: Impact of intracranial extension on survival in stage IV nasopharyngeal carcinoma: identification of a subset of patients with better prognosis.
abstract: OBJECTIVE
  T-stage is an imperfect prognostic indicator for patients with nasopharyngeal carcinoma. We evaluated the effect of extent of intracranial involvement on survival after conventional radiotherapy in patients with Stage T4 nasopharyngeal carcinoma.
  
  
  METHODS
  We conducted a retrospective analysis of the results of computed tomography, magnetic resonance imaging and treatment outcomes in 84 consecutive patients with Stage T4 nasopharyngeal carcinoma during the period September 1993 to December 2002 in Taiwan. The patients were subcategorized into those who had limited intracranial involvement (primary nasopharyngeal tumors with involvement of the unilateral cavernous sinus or the parasellar region only) or extensive involvement (extension of the tumors to the bilateral cavernous sinus or the parasellar region, into the orbit and the ethmoid sinus anteriorly, or to the prepontine region and the posterior cranial fossa).
  
  
  RESULTS
  Extensive intracranial involvement was found in 51.2% of the patients. Among these patients, the 5-year rate of overall survival after conventional radiotherapy was only 3.4%. In contrast, the 5-year survival among patients with limited intracranial involvement was 42.9%. This difference was significant (P < 0.001). In the multivariate analysis, extensive intracranial involvement, advanced age and a nodal status of N3 correlated with poor overall survival (all P < 0.05).
  
  
  CONCLUSIONS
  Among patients with T4 nasopharyngeal carcinoma, better treatment outcomes were associated with limited intracranial involvement. We conclude that a subdivision of Stage T4 nasopharyngeal carcinoma disease based on the extent of intracranial involvement would provide better prognostic information.
authors.affiliation: Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Hu
authors.forename: Ching-Hsiung
authors.initials: CH
authors.lastname: Chang
authors.forename: Chien-Hsun
authors.initials: CH
authors.lastname: Chen
authors.forename: Luo-Ping
authors.initials: LP
authors.lastname: Ger
authors.forename: Wen-Shan
authors.initials: WS
authors.lastname: Liu
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lin
authors.forename: Chung-Man
authors.initials: CM
authors.lastname: Leung
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D002426:Cavernous Sinus / Q000473:pathology; D005005:Ethmoid Sinus / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D009918:Orbital Neoplasms / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012658:Sella Turcica; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome