鼻咽癌放疗后MRI表现评价

本文报道了３８例鼻咽癌放疗后的ＭＲＩ表现。鼻咽壁变光整２４例，增厚变形１４例。咽旁间隙消失１１例，翼肌模糊３例，翼腭窝不清２例，颞下窝不清１例。颈动脉鞘受累１５例，颈深淋巴结肿大５例。破裂孔破坏８例，斜坡破坏６例，卵圆孔破坏５例，颈静脉孔破坏４例，颅中窝广泛破坏８例。蝶窦和海绵窦侵犯７例，眶尖受累４例。放射性脑病５例，脑转移瘤１例。继发鼻副窦炎２０例。结合文献，对鼻咽癌放疗后的病理改变及其ＭＲＩ表现特点，进行了评价。认为采用ＭＲＩ来评估鼻咽癌疗效、发现复发瘤和并发症等，具有很好价值。     

鼻咽癌放疗后MRI表现评价

本文报道了３８例鼻咽癌放疗后的ＭＲＩ表现。鼻咽壁变光整２４例，增厚变形１４例。咽旁间隙消失１１例，翼肌模糊３例，翼腭窝不清２例，颞下窝不清１例，颈动脉鞘受累１５列，颈深淋巴结肿大５例。破裂孔破坏８例。斜坡破坏６例，卵圆孔破坏５例，颈脉孔破坏４例，颅中窝广泛破坏８例。蝶窦和少绵窦侵犯７例，眶尖受累４例，放射性脑病５例，脑转移瘤１例，继发鼻副窦炎２０例。结合文献，对鼻咽癌放疗后的病理改变及其ＭＲＩ表现     

鼻咽癌放射性脑病147例MR表现特点分析

目的:探讨鼻咽癌放射性脑病(REP)147例的MR表现特征。方法:回顾性分析147例鼻咽癌REP患者MR常规加增强扫描的影像学特点。结果:147例鼻咽癌REP中颞叶损伤122例(83.0%),脑干损伤13例(8.8%),颞叶+脑干混合损伤12例(8.2%),共检出224侧颞叶及25例脑干REP病灶。颞叶型REP:形态多样,水肿(96.9%)及强化(94.7%)常见,30.8%有占位效应。脑干型REP:多数为单发(22/25),体积较小(≤2.0 cm),多均匀强化,水肿及占位效应较轻,动态观察可见病灶消失(7/25),明显缩小(4/25)。结论:鼻咽癌REP的MR表现具有特征性及动态变化的特点。颞叶仅1侧病灶消失;脑干REP经治后部分病灶可缩小或消失,并伴有脑干萎缩。     

鼻咽癌2008分期的临床应用研究

目的:从鼻咽癌2008分期临床应用的角度探讨其合理性,指出不足,完善分期.方法:收集我科收治的经病理确诊、无远处转移的初诊鼻咽癌患者100例,按各个分期标准中提及的所有解剖结构进行阅片,按2008分期、2002年UICC及'92分期的标准分别进行分期.结果:斜坡受侵比例最高为85%(85/100),翼内肌为37%(37/100),鼻腔为16%(16/100),口咽为3%(3/100).淋巴结最大径＞3 cm11例,仅依据淋巴结＞3 cm而诊断为N2的只有1例.3种分期中T3及N0、N2数量有一定差别,但临床总分期基本一致.结论:鼻腔、口咽等解剖结构的定义过于局限,蝶骨大翼的定义及跨区淋巴结的归属需明确,颅神经受侵的MR诊断部位和标准需要完善,翼内肌的合理性有待研究,可制定出锁骨上区的影像学边界,淋巴结大小作为N参数可保留.     

CT/MRI配准对圆孔、卵圆孔、棘孔、舌下神经管及舌下神经的显示

背景与目的:不同学者对MR I与CT在鼻咽癌颅底区域的影像显示的看法存在分歧。为明确MR I对鼻咽癌颅底区域靶区显示的情况,分析无颅神经侵犯鼻咽癌患者的CT、MR I,比较圆孔、卵圆孔、棘孔、舌下神经管及舌下神经CT、MR I的显示情况和影像表现,探讨圆孔、卵圆孔及棘孔、舌下神经管及舌下神经在鼻咽癌放射治疗靶区勾画的意义。方法:研究我院2005年3—4月未经治疗的无颅神经侵犯20例鼻咽癌患者CT、MR I。在P innac le3 7.0工作站上采用互信息法配准后分析圆孔、卵圆孔、棘孔及舌下神经管在CT/MR I图像上显示特点。记录CT、MR I横断面显示情况;测量舌下神经管两侧纵径、内径及两侧纵径分别与矢状面的角度,并进行数据统计学分析。结果:在CT骨窗上圆孔显示为低密度的管状结构,卵圆孔及棘孔显示为低密度的孔状结构。7例(35%)圆孔在CT上为双侧显示,5例(25%)为单侧显示,8例(40%)未见显示。全部患者卵圆孔、棘孔在CT上均为双侧显示,卵圆孔两侧对称者13例(65%),不对称者7例(35%)。卵圆孔呈圆形8例(20%),呈椭圆形32例(80%)。棘孔两侧对称3例(15%),两侧不对称者17例(85%)。全部病例圆孔在MR I各个序列上均未见显示,卵圆孔及棘孔在T1W I、T2W I上均未见显示,在增强T1W I上表现为高信号血管影。全部患者卵圆孔及棘孔在增强T1W I上为双侧显示,卵圆孔两侧对称13例(65%),两侧不对称7例(35%);呈圆形8例(20%),呈椭圆形32例(80%)。增强CT未见圆孔、卵圆孔及棘孔内血管显示。全部舌下神经管在CT上显示,各项指标如下:左管径3.9~8.5mm,平均(6.17±1.3)mm、左管长5.8~10.1mm,平均(6.5±2.0)mm、左管倾角44.2°±0.6°(42°~58°)、右管径4.2~9.7 mm,平均(5.78±1.2)mm、右管长5.6~10.6mm,平均(6.8±1.9)mm、右管倾角44.5°±1.7°(41°~66°)。两侧管径比较t=1.202P>0.05,两侧管长比较t=-1.216P>0.05,两侧管倾角比较t=0.252P>0.05。在MR I上均为全管双侧显示各项指标显示如下:双侧100%;左管径4.2~8.7 mm,平均(6.3±1.3)mm、左管长5.6~10.2 mm,平均(6.6±1.8)mm、左管倾角平均44.1°±0.7°(41°~59°)、右管径4.8~9.7mm,平均(5.9±0.9)mm、右管长5.7~10.5mm,平均(6.9±1.7)mm、右管倾角平均44.3°±1.7°(41°~68°)。两侧管径比较t=1.11,P>0.05,两侧管长比较t=-0.984,P>0.05,两侧管倾角比较t=0.532,P>0.05。舌下神经CT未能显示,舌下神经池内段、管内段在MR I上亦可显示,但是管外段未见显示。结论:在MR I上对圆孔的识别还有很大困难,但是MR I可以显示正常卵圆孔及棘孔,为今后直接在MR I勾画鼻咽癌靶区(卵圆孔)制定放疗计划提供了影像解剖及靶区确定的依据。在舌下神经管和舌下神经显示及影像诊断上MR I较CT有明显优势。MR I较CT具有同时显示舌下神经管及舌下神经的优势,特别是对舌下神经麻痹的患者,可以很好判断病灶,有助于制定治疗计划。在临床上对于鼻咽癌我们推荐MR I检查以便更确切地评价病灶。     

鼻咽癌的CT表现(附142例报告)

目的分析鼻咽癌的CT表现,探讨鼻咽癌的生长浸润方式以及CT在鼻咽癌诊断治疗中的价值.方法经活检病理证实鼻咽癌142例,全部病例作鼻咽轴位CT平扫,层厚、层距6mm～8mm,部分病例同时作冠状扫描.结果CT能显示早期鼻咽癌患侧咽隐窝变钝、闭塞,腭帆提肌增厚及其它黏膜下浸润.鼻咽癌可广泛侵犯其周围组织,包括咽旁间隙,颞下窝,颈动脉鞘区,口咽,翼腭窝,副鼻窦等.颈动脉鞘区受累与颈部淋巴结转移有相关性.颅底骨质破坏的部位和范围与鼻咽癌原发灶部位和侵犯程度有关.结论颈动脉鞘区受累与颈部淋巴结转移有密切关系;CT能清晰地显示肿瘤生长部位,病变范围及浸润深度,在鼻咽癌诊断治疗中起重要作用.     

电子鼻咽镜和MRI对鼻咽癌颈淋巴结转移的诊断价值

目的探讨鼻咽镜和MRJ检查诊断鼻咽癌颈部淋巴结转移的价值。方法对185例鼻咽癌患者的临床资料进行回顾性分析。结果185例鼻咽癌患者中有131例出现颈部肿块,占70．81％。颈部肿块位于单侧102例,占55．13％,双侧20例,占15．68％,电子鼻咽镜及MRI检查鼻咽灶分布和咽旁间隙受累与颈淋巴结转移有关,双侧咽旁间隙受累比单侧咽旁间隙受累其双侧颈淋巴结转移率高P〈0．005。以颈部淋巴结的影像学分区为标准：Ⅰ-Ⅵ区和咽后区的转移率分别为2．4％、95．42％、51．15％、11．45％、19．84％、0％和75．57％。结论鼻咽癌患者大多数会出现颈淋巴结转移,鼻咽灶分布与颈淋巴结转移率、大小及在颈部分区之间存在着密切相关性,鼻咽镜检查及MRI在鼻咽癌的诊断中起重要作用。     

眼眶淋巴瘤的CT和MR影像特点

目的:探讨眼眶淋巴瘤的CT和MR影像特点,为临床提供更多有价值的影像学信息。方法:　回顾性分析9例（共10眶）经病理诊断明确的眼眶淋巴瘤的CT及MR影像学表现,包括病变的位置、形态、密度及信号,强化方式及其与邻近结构的关系。 结果:　纳入10眶病例的临床表现主要以眼球突出、眼睑肿物为主;纳入10眶病变中跨越2个区域或以上的有7眶;7眶为弥漫型,3眶为局限型;CT密度以同层面眼外肌密度为参照均为均质稍高密度,增强扫描呈均质（1眶）或不均质（3眶）中等强化;MR同样以同层面眼外肌为参照,病变为均质T1WI呈等、稍低信号,T2WI呈稍高信号;眼外肌有两个或以上受累者有6眶。结论:　眼眶淋巴瘤影像学表现有一定的特征性,好发于眶隔前区及泪腺区,病变密度及信号均匀,增强扫描呈轻至中度强化,可以为临床诊断及治疗提供重要的参考价值。     

鼻咽癌2008分期和第7版UICC分期的比较研究

目的:通过对鼻咽癌2008分期和第7版UICC分期的比较,探讨其合理性,为2008分期的修订完善提供参考.方法:收集广西医科大学第一附属医院放疗科收治的经病理证实、无远处转移的初诊鼻咽癌患者100例,按各个分期标准中提及的所有解剖结构进行MRI阅片,结合患者就诊时的临床体检资料(如脑神经麻痹、淋巴结大小等),按鼻咽癌两种临床分期标准进行分期.结果:解剖结构定义不同的鼻腔受侵16例(第7版UICC 27例)、口咽受侵犯3例(第7版UICC 11例),两种分期中T1、T2例数完全相同.T3、T4例数有一定差别,这与第7版UICC分期中将鼻窦受侵归为T3有关.N0例数完全相同,N1例数相差最大,未出现淋巴结最大径>6cm的病例,临床总分期基本一致.Ⅲ+Ⅳ期病例分别为97例和95例,晚期病例占绝大多数.结论:两种分期鼻咽和口咽、鼻腔的分界不同,口咽和鼻腔受侵的T分期归属不同,但第7版UICC分期中鼻腔和口咽受侵均全部合并更高期别的T因素,所以未造成两种分期T1、T2例数的差别.2008分期中,翼内肌受侵(37%),100%合并同期别和更高期别T因素,故翼内肌的合理性有待研究.2008分期中副鼻窦受侵归为T4、咽后淋巴结归转移为N1a、N分期采用3cm的标准是合理的.可对RTOG(2006年版)颈部淋巴结影像学分区做适当调整,制定出锁骨上区的影像学边界,以便与UICC分期接轨.两种分期的脑神经受累的MRI诊断标准需要完善.     

鼻咽癌颈部淋巴结转移与鼻咽病灶的关系

收集了鼻咽癌伴颈部淋巴结转移者２５４例，探讨其咽旁间隙和／或“茎内”受累与颈淋巴结的关系。结果表明：咽旁间隙或“茎内”受累与颈淋巴结转移有关，但与其大小无关；当鼻咽癌仅累及鼻咽一侧时，其颈部淋巴结转移率与受累的鼻咽部位多少无关；双侧“茎内”伴双侧咽旁间隙受累比伴单侧受累更易发生双侧颈淋巴结转移；仅双侧“茎内”受累与同时伴单侧或双侧咽旁间隙受累，两者颈淋巴结转移率无差别；鼻咽双侧受累较单侧受累，其双侧颈淋巴结转移率要高。     

鼻咽癌颅底骨质侵犯的MRI评价

目的:评价MRI检查对鼻咽癌侵犯骨质的诊断价值及其对肿瘤分期的影响.方法:回顾性分析本院350例初诊鼻咽癌患者的MRI影像资料,其中有颅底骨质侵犯196例,病理类型以鳞癌为主180例.134例采用PhilipsT5-Ⅱ型超导磁共振成像仪,场强0.5T.62例采用Philips intera型超导磁共振成像仪,场强1.5T.8例单纯平扫,188例平扫后增强,造影剂为Gd-DTPA,剂量为0.1mmol/kg体重,经前臂静脉注射.结果:196例有骨质侵犯的初诊鼻咽癌中,单部位侵犯65例(33.16%),多部位侵犯131例(66.83%).单侧侵犯178例(90.81%),双侧侵犯18例(9.19%).累计骨质破坏部位698个,骨质侵犯类型:骨质硬化型13个部位(1.86%),骨髓浸润型120个部位(17.19%),溶骨性破坏565个部位(80.95%).结论:MRI可作为评价鼻咽癌颅底骨质侵犯首选检查方法,尤其在评价鼻咽癌早期骨髓侵犯方面MRI比CT敏感,MRI检查可增加鼻咽癌分期的准确性.     

Nasopharyngeal cancer: A review of 1605 patients treated radically with cobalt 60

A retrospective study was performed on 1605 patients with histologically proven and radically treated nasopharyngeal carcinoma. All were followed for a minimum of five years; 833 patients had a minimum follow-up period of ten years Treatment results were reviewed according to: 1) size of primary tumor; 2) base of skull invasion; 3) cranial nerve involvement; 4) cervical node metastases; and 5) distant spread. An appropriate staging system was developed that reflected these prognostic factors. The evidence presented indicates that in this series of patients, base of skull involvement was less ominous than cranial nerve involvement. Unilateral lymph node involvement carried a better prognosis than bilateral neck nodes, this was the poorest sign of all since it predicted distant metastases. The average 5-year survival rate for 1605 patients in all stages, was 529/1605 (32.1 %); the 10-year survival rate for 833 patients in all stages was 20.2 %.     

Prognostic value of magnetic resonance imaging-detected cranial nerve invasion in nasopharyngeal carcinoma

Background:

We previously reported that magnetic resonance imaging evidence of cranial nerve invasion was an unfavourable prognostic factor in nasopharyngeal carcinoma. However, the prognostic value of this evidence in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy remains unknown.

Methods:

We retrospectively analysed 749 nasopharyngeal carcinoma patients who underwent intensity-modulated radiotherapy.

Results:

Cranial nerve invasion was observed in 299 (39.9%) patients with T3–4 disease. In T3–4 nasopharyngeal carcinoma, magnetic resonance imaging-detected cranial nerve invasion was associated with inferior 5-year overall survival, distant metastasis-free survival, and locoregional relapse-free survival (P=0.002, 0.003, and 0.012, respectively). Multivariate analyses confirmed that cranial nerve invasion was an independent prognostic factor for distant metastasis-free survival (hazard ratio, 1.927; P=0.019) and locoregional relapse-free survival (hazard ratio, 2.605; P=0.032). Furthermore, the receiver-operating characteristic curves verified that the predictive validity of T classifications was significantly improved when combined with magnetic resonance imaging-detected cranial nerve invasion in terms of death, distant metastasis, and locoregional recurrence (P=0.015, 0.021 and 0.008, respectively).

Conclusions:

Magnetic resonance imaging-detected cranial nerve invasion is an independent adverse prognostic factor in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.     

THE RELATIONSHIP BETWEEN THE INVASION OF PARAPHARYNGEAL SPACES AND THE INVOLVEMENT OF CERVICAL NODES AND POSTERIOR GROUP CRANIAL NERVES IN NASOPHARYNGEAL CARCINOMA

Two hundred cates of nasopharyngeal carcinoma (NPC) admitted to this department from Feb. 1985 to May. 1988 were analysed according to the CT scanning and clinical findings of the primary lesions prior to radiotherapy. The results showed that involvement of parapharyngeal space was very common in NPC, about 80% (160/200 cases) ; particularly unilateral or bilateral retro-styloid spaces, about 69.5% (139/200 cases). It was proposed that patients with NPC had a high Incidence of ipsilateral cervical node metastasis. Contralateral cervical node metastasis was rare. The development of cervical node metastasto in NPC has two modes: one Is direct Infiltration of the retro-stylold space by the lesion; the other Is along the nasopharyngeal lymphatic rete. The data also showed that patients with NPC who presented symptoms of Ⅸ- Ⅲ cranial nerve paralyses always had ipsilateral or bilateral retro- styloid space Infiltrations.     

长链非编码RNA ZFAS1在鼻咽癌组织中的表达及临床意义

目的 探讨长链非编码RNA ZFAS1在鼻咽癌组织中的表达及其临床意义。方法 收集2014年1月至2016年12月鼻咽癌组织标本及配对癌旁组织94例,采用实时荧光定量聚合酶链反应（QPCR）检测癌组织及癌旁组织中ZFAS1的表达情况,分析ZFAS1表达与鼻咽癌临床病理特征（年龄、T分期、N分期、TNM分期、颅底侵犯、颅神经麻痹及EB病毒VCA IgA水平）的关系,采用受试者工作特征曲线（ROC）评价组织ZFAS1水平在鼻咽癌早期诊断中的效能。结果 94例鼻咽癌组织中ZFAS1的表达水平为5.388±0.446,中位数和四分位数间距为3.933（2.107,7.339）;癌旁组织的ZFAS1表达水平为1.091±0.045,中位数和四分位数间距为1.092（0.799,1.297）。鼻咽癌组织的ZFAS1表达水平高于癌旁组织,差异有统计学意义（P＜0.05）。ZFAS1表达与T分期、N分期、TNM分期、EB病毒VCA-IgA滴度及颅底侵犯有关（P＜0.05）;与颅神经麻痹和年龄无关（P＞0.05）。组织ZFAS1水平诊断鼻咽癌的曲线下面积为0.924（95％CI：0.882～0.965）,最佳截断值为3.472,该截断值的灵敏度和特异度分别为83.4％和77.0％。结论 ZFAS1在鼻咽癌中高表达,且与临床分期、颅底侵犯及EB病毒感染有关,对鼻咽癌的早期诊断有较好价值,可用于鼻咽癌的辅助诊断和病情评估。     

Sphenoid Sinus Mucocoele and Cranial Nerve Palsies in a Patient with a History of Nasopharyngeal Carcinoma: May Mimic Local Recurrence

We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.     

SPECT和CT检测鼻咽癌颅底受侵的临床价值

目的:探讨SPECT和CT对鼻咽癌颅底骨侵犯的检测能力及临床价值。方法:对50例初治鼻咽癌患者放疗前同期进行前瞻性SPECT和CT检测,比较两者的检出率及与临床症状、体征、T、N分期的相关性。结果:SPECT和CT对鼻咽癌颅底骨侵犯的阳性检出率在全部患者中分别为60%和36%;在头痛、颅神经损害及两者并存患者中分别为83.3%、25%;100%、0;94.4%、77.8%。在T1+T2及T3+T4的患者中分别为18.2%、0;92.9%、64.3%。在N0+N1及N2+N3的患者中分别为67.7%、45.5%;41.2%、17.6%。在Ⅰ+Ⅱ及Ⅲ+Ⅳ期的患者中分别为20%、0;70%、45%。SPECT的阳性检出率明显高于CT,差异有统计学意义,P<0.05。Binarry Logistic回归分析显示,头痛及T分期是SPECT阳性检出的危险因素(OR头痛=11.92,ORT分期=15.43);颅神经损伤是CT阳性检出的危险因素(OR颅神经损伤=7.50)。结论:结合患者头痛、颅神经损害症状、T、N分期,综合SPECT和CT检测结果,提高鼻咽癌患者早期颅底骨受侵犯的检出率和诊断的准确性是可行且有实际意义的。     

Cranial nerve involvement and base of the skull erosion in nasopharyngeal carcinoma

In a prospective study of 262 consecutive patients with nasopharyngeal carcinoma (NPC), using computed tomography (CT) as their baseline evaluation, erosion of the base of the skull and intracranial extension into the middle cranial fossa were found in 31.3% and 12.2% of patients, respectively. Thirty-four of these patients had cranial nerve involvement at presentation; 30 of them had involvement of one or more of the third to sixth cranial nerves. Most cases of intracranial extension of tumor were accompanied by erosion of the base of the skull, but the reverse was not true. All patients with cranial nerve palsy involving the third to sixth cranial nerves had associated erosion of the ipsilateral base of the skull. The CT evaluation of patients with cranial nerve involvement who are believed to harbor NPC should include thin cuts of the base of the skull for detection of subtle bone erosion. This may be the only clue to the presence of a small NPC. The prognostic significance of cranial nerve involvement, base of the skull erosion, and intracranial extension of the tumor on the survival of the group of 84 patients who had T4 tumors was evaluated with regression analysis using the Cox model. Only cranial nerve involvement was found to be a significant factor influencing survival.     

612例鼻咽癌放射治疗预后因素分析

 目的 1973年1月至1987年12月我院共放射治疗鼻咽癌612例,本文对其结果 及影响预后的因素予以分析。全组总的5年生存率42．2％。性别、年龄对预后无明显影响,病期、原发肿瘤超胜,预淋巴结转移、颅神经受损和照射剂量是主要的预后因素。随着病期变晚,5年生存率逐渐下降,Ⅰ、Ⅱ期的5年生存率明显高于Ⅲ、Ⅳ期（P＜0．01）。肿瘤局限于鼻咽腔者的预后明显好于超腔者（P＜0．01）。前后组颅神经同时受累预后最差。预淋巴结转移的大小、单双侧、部位、活动或固定对预后有不同的影响。放疗剂量应以65－75Gy／6．5－7．5周为宜。本组资料证明,鼻咽癌放疗失败的主要原因是远处转移与局部复发。     

Important prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after radiotherapy

PURPOSE: To evaluate the long-term outcome and prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after initial radiotherapy (RT). METHODS AND MATERIALS: From January 1985 to December 1986, 100 patients (71 males, 29 females) with a diagnosis of nasopharyngeal carcinoma were found on computed tomography (CT) to have skull base erosion. The mean age was 41 years (range 16-66). Ninety-six patients had World Health Organization type III undifferentiated carcinoma, and 4 had type I. The metastatic workup, including chest radiography, liver ultrasound scanning, and liver function test was negative. All patients underwent external beam RT (EBRT) alone to 66-80 Gy during 6-8 weeks. A daily fraction size of 2 Gy was delivered using 60Co or a linear accelerator. No patient received chemotherapy. All patients were followed at regular intervals after irradiation. The median follow-up was 22.3 months (range 2-174). Survival of the cohort was computed by the Kaplan-Meier method. The potential prognostic factors of survival were examined. Multivariate analyses were performed using the Cox regression model. RESULTS: The 1, 2, 5, and 10-year overall survival rate for the cohort was 79%, 41%, 27%, and 13%, respectively. However, the subgroup of patients with both anterior cranial nerve (I-VIII) and posterior cranial nerve (IX-XII) involvement had a 5-year survival of only 7.7%. A difference in the time course of local recurrence and distant metastasis was observed. Both local recurrence and distant metastasis often occurred within the first 2 years after RT. However, local relapse continued to occur after 5 years. In contrast, no additional distant metastases were found after 5 years. The causes of death included local recurrence (n = 59), distant metastasis (n = 21), both local recurrence and distant metastasis (n = 1), and unrelated causes (n = 5). After multivariate analysis, complete recovery of cranial nerve involvement, cranial nerve palsy, and headache after irradiation were found to be independent prognostic factors in this cohort. CONCLUSIONS: We present one of the longest follow-ups of patients with nasopharyngeal carcinoma invading the skull base. Our results demonstrate the importance of cranial nerve involvement, recovery of headache, and cranial nerve palsy. These factors should be carefully evaluated from the history, physical examination, and imaging studies. A subgroup of patients with skull base involvement had long-term survival after RT alone. The findings of this study are important as a yardstick against which more aggressive strategies, such as combined radiochemotherapy and altered fractionation RT can be compared.