Tumor fever in patients with nasopharyngeal carcinoma: Clinical experience of 67 patients

From 1982 through 1996, 67 patients with nasopharyngeal carcinoma (NPC) proven to have tumor fever (TF) were analyzed. All were in metastatic stage when TF occurred. Forty-five patients (67%) had recurrent disease. Thirty- eight (57%) had fever before metastatic lesions were detected. The metastatic sites were: 84% in bone, 69% in liver, and 19% in lung. Multiple-organ metastases were found in 64% of the patients. Nine patients (13%) had bone- marrow invasion. When TF was present, 22 (33%) patients had other paraneoplastic syndromes, of which leukemoid reaction (LR) was seen most frequently. After the initiation of naproxen or indomethacin, most patients had complete lysis of the fever within 48 hours. Of the six patients receiving chemotherapy as the initial therapy, all of their temperatures returned to normal range after the treatment. Some patients, particularly those with tumor progression, developed TF again when antipyretic drugs were discontinued. The median survival time was 5 months. In conclusion, TF in NPC is usually a manifestation of metastatic disease. Tumor fever often associates with other paraneoplastic syndromes. Naproxen, indomethacin, and systemic chemotherapy all had effectiveness in ameliorating TF. Systemic metastases should be suspected in NPC patients with fever of unknown origin.