Brain dead.

Don’t worry, we’re just talking about part of the brain. Temporal lobe necrosis is a dreaded complication of definitive radiation for locally-advanced nasopharyngeal cancer. The problem lies in the simple fact that dose-escalation does great things for local tumor control and not great things to the immediately adjacent temporal lobe. This Taiwanese retrospective study aims to arm us with some predictive biomarkers. Among 71 patients with cT3 tumors and 73 with cT4 tumors treated with definitive dose-escalated chemoradiation, the local control rates were an impressive 95-97% at 5 years. Unfortunately the rates of temporal lobe necrosis were impressive, too, at 3% for cT3 tumors and a whopping 30% for cT4. As hypothesized, inflammatory markers such as serum neutrophil to lymphocyte ratio (NLR) both before (>3) or after (>4) treatment as well as tumor infiltration of T-cell receptor-β (TCR-β) were highly predictive of late temporal lobe necrosis as diagnosed per MRI-criteria. TBL: Patient and tumor inflammatory markers may help inform the best risk/benefit ratio when deciding how far to dose-escalate locally-advanced nasopharyngeal cancers. | Wu, Int J Radiat Biol Phys 2019