Clinical characteristics and changes in living quality of patients with radiation encephalopathy induced by radiation therapy for treating nasopharyngeal carcinoma*

Abstract

Background Radiation encephalopathy (RE) caused by radiation therapy of nasopharyngeal carcinoma severely influences patients' quality of life (QOL). The factors, which influence such patients' QOL, have not been confirmed. Objective To observe the clinical and imageological characteristics of patients with radiation therapy of nasopharyngeal carcinoma-induced RE and the changes in QOL, and analyze QOL influencing factors. Design Retrospective case analysis. Setting Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University. Participants Eighty-nine inpatients or outpatients with RE induced by radiation therapy of nasopharyngeal carcinoma admitted to Sun Yat-sen University Cancer Center and Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University from March 1994 to August 2004 were involved in this experiment. They all met the diagnosis criteria of RE from MERRITT'S neurology (10 th edition). Thirty-three involved patients were randomly chosen as RE group. Another 34 concurrent inpatients or outpatients with nasopharyngeal carcinoma who received radiation therapy but without RE were chosen as control group. Informed consents of detected items were obtained from all the involved subjects. Methods ▪ Patients were evaluated when they were followed up. The World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF) was used for on-the-spot evaluation. High points of WHOQOL-BREF indicated better QOL. The Late Effects on Normal Tissues - Subjective, Objective, Management and Analytic (LENT-SOMA) scale for evaluating radiation injury was used to evaluate headache and neurologic disorder of patients with RE induced by radiation therapy of nasopharyngeal carcinoma. The evaluation was graded into 5 degrees. High degrees indicted severer clinical symptoms. ▪ Disease latency ( i.e. time interval from symptoms and body signs appearing or radiation therapy ending to onset), initial symptoms, common symptoms, imageological characteristics, QOL and other related factors of patients were recorded. ▪ Statistical management was carried out with SPSS 10.0 software. Main outcome measures QOL and clinical characteristics of patients with RE induced by radiation therapy of nasopharyngeal carcinoma as well as QOL influencing factors. Results All the involved subjects participated in the final analysis. ▪ Disease latency of patients with RE ranged from 0 to 24 years, and 95% confidence interval was 0 to 15 years. There were significant differences in amount of invaded cases between 6 months after one radiation therapy and 6 months after two or more radiation therapies (χ 2=36.76, P < 0.01). ▪ The common initial symptom of patients with RE was glossopharyngeal paralysis (33 cases, 37%). ▪ The first 3 common symptoms of patients with RE were glossopharyngeal paralysis (52 cases, 58%), limb inertia and sensory disorder (25 cases, 28%) and headache (25 cases, 28%). ▪Imageology of patients with RE was characterized by long T 1 and T 2 signal shadow on magnetic resonance. ▪Total scores of health, of daily life and of social relationship, measured with WHOQOL-BREF, of patients in RE group were significantly lower than those in the control group, respectively [(2.06±0.86)points vs. (2.59±0.66)points; (2.45±0.75)points vs. (2.91±0.75)points; (51.67±15.24) points vs. (59.22±13.03)points, P < 0.05]. Patients undergoing two or more radiation therapies were inferior to those undergoing one radiation therapy in total scores of health, and of daily life, scores of physiology, and of psychology ( P < 0.05). ▪Glossopharyngeal paralysis was negatively correlated with scores of psychology, total scores of daily life and of health in WHOQOL-BREF ( P < 0.05); Head was negatively correlated with scores of psychology in WHOQOL-BREF ( P < 0.05); Neurologic deficit was negatively correlated with scores of psychology, and total scores of health in WHOQOL-BREF ( P < 0.05). Conclusion ▪ The latency of RE of patients undergoing two or more radiation therapies is remarkably shortened, and QOL is decreased, but there is no difference in QOL between two genders. ▪ Brain edema is common in imageology of RE after radiation therapy. The first 3 ones of initial symptoms and common symptoms both are glossopharyngeal paralysis, neurologic deficit and headache, which greatly negatively influence QOL of patients.