The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

Oral Oncol. 2019 Mar;90:48-53. doi: 10.1016/j.oraloncology.2019.01.013. Epub 2019 Feb 1.

Abstract

Objectives: Nasopharyngeal carcinoma (NPC) and its treatment can lead to cervical spine pathologies such as metastases, osteoradionecrosis (ORN) and infection. However, the occurrence rate and relationship between timing of diagnosis and outcomes of the ever-advancing technology of radiation therapy is largely unknown. Hence, the aim of this study is to determine the prevalence and impact of cervical spine pathologies in patients with NPC.

Materials and methods: This was a cross-sectional study of all newly diagnosed cases of NPC from 2007 to 2016 at a tertiary referral oncology and spine centre with minimum 1-year post-treatment follow-up. All cervical spine pathologies, their treatment and outcomes were determined. Presentation, onset time and correlations of the cervical spine pathologies with mortality and risk factors were also analysed.

Results: Out of 605 cases of verified cases of NPC, cervical spine pathologies were seen in 8.9% of patients. New onset neck pain was seen in 5.3%, symptomatic cervical spondylosis in 4.8%, cervical spine metastases in 2.5%, local tumour invasion in 0.8%, cervical ORN in 0.7%, osteomyelitis in 0.7%, radiculopathy in 0.3%, and myelopathy in 0.3%. Cervical spine pathologies were associated with an increased risk (odds ratio: 2.73) in overall mortality. Cervical spine metastases, invasion, ORN and infection were associated with significantly higher risk of mortality (p = 0.01-0.02).

Conclusion: Cervical spine pathologies in patients with NPC are heterogenous but not uncommon. Neck pain is prevalent but is often benign. ORN and osteomyelitis of the cervical spine is uncommon but have large clinical implications including higher mortality with subtle presentations.

Keywords: Cervical spine pathology; Nasopharyngeal carcinoma; Neck pain; Prevalence.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Mortality
  • Nasopharyngeal Carcinoma / pathology
  • Nasopharyngeal Carcinoma / radiotherapy*
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Neck Pain / epidemiology*
  • Neck Pain / etiology
  • Osteomyelitis / epidemiology*
  • Osteomyelitis / etiology
  • Osteomyelitis / mortality*
  • Osteoradionecrosis / epidemiology*
  • Osteoradionecrosis / etiology
  • Osteoradionecrosis / mortality*
  • Prevalence
  • Prospective Studies
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Spondylosis / epidemiology*
  • Spondylosis / etiology
  • Young Adult