Introduction: Nasopharyngeal carcinoma (NPC) invasive of the skull base remains a clinical challenge. Stereotactic radiosurgery (SRS) is a surgical method that delivers single session conformal radiation and may provide greater therapeutic benefit than fractionated radiotherapy.
Methods: We reviewed records from 22 consecutive patients (13 males) who underwent SRS for NPC. The median patient age was 51 years. The median interval between initial diagnosis and SRS was 81 months and three patients underwent prior fractionated radiotherapy for their intracranial lesions. The most common intracranial site was the cavernous sinus (n=11), and the most common presenting symptom was facial numbness or pain (n=6). Nine patients underwent prior chemotherapy with carboplatin. Two patients underwent prior radiosurgery, and no patient underwent prior whole brain radiation. The median tumor volume was 11.9 cc (range 1.6-29.6 cc) and the median margin dose was 15 Gy (range, 10-18 Gy). Six patients were lost to follow up and the median follow-up time after SRS for the remaining 16 patients was 23 months (range 4-128 months).
Results: The actuarial overall survival after SRS was 71%, 36%, 26% and 10% at 1, 3, 5 and 10 years, respectively (median survival =23 months). The only factor associated with longer survival was older age (p=0.006). The tumor control rates for the entire series were 55%, 27%, and 27% at 1, 3, and 5 years, respectively. There were no factors associated with longer progression free survival. Overall, 70% of patients improved or remained neurologically stable. Four patients developed subsequent cranial neuropathies following SRS and no other adverse radiation effects were noted.
Conclusions: Stereotactic radiosurgery may be a therapeutic option for older patients suffering from nasopharyngeal carcinoma invasive of the skull base.
Patient Care: This research provides further insight into the use of stereotactic radiosurgery for patients with nasopharyngeal carcinoma invading the skull base.
Learning Objectives: By the conclusion of this session, participants should be able to understand the role of stereotactic radiosurgery (SRS) in the management of nasopharyngeal carcinoma invading the skull base.