The Symptom Burden of Treatment-Naive Patients with Infratemporal Fossa Malignant Tumors

Background: The infratemporal fossa (ITF) is a complex space that acts as a conduit for many neurovascular structures that travel between the cranial cavity and the neck. The treatment of skull base tumors may cause substantial local and systemic symptomatic morbidities; however, many patients are symptomatic due to direct tumor effects (e.g., compression, neural invasion, intracranial extension). The current study aimed to characterize the disease-related symptom status in treatment-naive patients with ITF tumors.

Methods: This study investigated all patients with ITF tumors treated between 1985 and 2016 in MD Anderson Cancer Center. We retrospectively analyzed symptoms, pre and postoperative performance status, and neurological status of patients with ITF tumors who were naive to any treatment. Symptoms were explored by anatomical extent and disease factors were correlated with symptom burden and performance status. A clustering algorithm was used to identify a subset of highly symptomatic patients, and the effects of histology, disease site, tumor stage, and demographic variables on membership in this high-symptom group were examined.

Results: A total of 113 patients with malignant tumors involving the ITF were identified. Forty one patients were treatment-naive (36%) with a median age of 47 years. Sarcoma was the most common pathology (13/32, 41%) followed by squamous cell carcinoma (12/32, 37%). One-third the patients (11/32) had a high pretreatment symptom burden defined as more than 4 cranial nerves disturbances. Pain, visual disturbances, numbness, speech impairment and unsteady gait were the most severe symptoms reported, regardless of tumor stage or site. Patients with high symptoms burden had significantly lower performance status compared with those with moderate or mild symptoms burden (Karnofsky performance status mean ± SD were 76 ± 3.6, 95% CI: 69.3–82.67, 86 ± 3.2, 95% CI: 80.41–93.33 and 89 ± 2.5, 95% CI: 84.4–94.76, respectively). Symptom burden was found to be higher among older patients with more advanced disease. Predictors of a high symptom burden included age ≥ 55 years (RR: 2.2; CI: 1.3–4.56), having a metastatic tumor (RR: 4.8; CI: 3.4–9.87) and intracranial extension (RR: 3.6; CI: 2.71–7.62). Perineural invasion and tumor histology were not significant predictors for symptom burden.

Conclusion: The high prevalence of moderate to severe symptoms found in the current study demonstrates the importance of assessing patient-reported symptoms routinely before treatment is initiated. Targeted symptom assessment can guide symptom management in parallel with disease treatment. Baseline characterization of symptom status should be incorporated into clinical trials that may affect symptom burden.