Nasopharyngeal carcinoma with orbital invasion

To review the clinical profiles of patients having nasopharyngeal carcinoma (NPC) with orbital invasion, which occurs more frequently in patients with Chinese and south-east Asian racial backgrounds. Although this disease frequently spreads superiorly to the skull base and intracranium, it rarely invades the orbit and we wish to examine some cases in which it has.

In this observational case series, we examined 406 patients, who were diagnosed with orbital tumour at Taipei Veterans General Hospital between January 1974 and December 2001. In all, 13 of the patients (11 males, two females) were found to have NPC with orbital invasion. Neuroimaging studies, pathologic reports, and clinical courses of these 13 patients were then reviewed retrospectively and survival analysis was carried out using a Kaplan-Meier estimate.

One patient presented with eyelid tumour and three other patients presented with proptosis as the initial manifestation of NPC. The other nine cases, already diagnosed to have NPC, visited our department with a variety of ocular symptoms and signs, such as proptosis, diplopia, visual impairment, and orbital pain. Palliative treatment with radiotherapy alone or in combination with chemotherapy was given in 12 cases. During the follow-up period ranging from 4 to 64 months, six patients died, one was lost during follow-up, and six were still alive.

Although orbital invasion in NPC is rare, we found a 5-year survival rate of 28% in our patients, indicating that orbital invasion with NPC confers a particularly poor prognosis.