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Guo F, Chen D, Zong Z, Wu W, Mo C, Zheng Z, Li J, Zhang X, Xiong D. Comprehensive analysis of aberrantly expressed circRNAs, mRNAs and lncRNAs in patients with nasopharyngeal carcinoma. J Clin Lab Anal 2023; 37:e24836. [PMID: 36597889 PMCID: PMC9937882 DOI: 10.1002/jcla.24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The location of nasopharyngeal cancer is hidden, so it is difficult to diagnose at an early stage. In this study, we aimed to investigate the expression profiles of circRNAs, mRNAs and IncRNAs and to provide some basis for further studies. METHODS Expression profiles of circRNAs, mRNAs, and lncRNAs were analyzed using microarray techniques. The differentially expressed ncRNA was calculated by bioinformatics. RESULTS A total of 3048 circRNAs, 2179 lncRNAs, and 2015 mRNAs were detected to be significantly differentially expressed in NPC. The most upregulated circRNAs, lncRNAs, and mRNAs were hsa-circ-0067562, NONHSAT232922.1, and HOXB13, respectively. And, the most downregulated circRNAs, lncRNAs, and mRNAs were hsa_circ_0078837, lnc-TTC8-4:3, and LTF, respectively. The number of upregulated DE lncRNAs was more than twice than those downregulated. Our data showed that 80.44% of pairs of lncRNAs and cis-mRNAs demonstrated positive correlations. For lncRNAs and trans-mRNAs pairs, 53.7% of pairs showed positive correlation. LncRNA-mediated cis regulation is a prevalent regulatory mode in the development of nasopharyngeal carcinoma. CR1, LRMP and SORBS2 are predicted to be mediated not only by cis-acting lncRNA modes of action, but also by trans-acting lncRNA mechanisms. Additionally, we constructed a diagnostic prediction model with a high sensitivity and specificity. CONCLUSION Our study characterized the landscape of circRNAs, mRNAs and lncRNAs in NPC tissue and provided novel insights into the molecular mechanisms of NPC.
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Affiliation(s)
- Feifan Guo
- School of MedicineAnhui University of Science and TechnologyHuainanChina,Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Dayang Chen
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Zengyan Zong
- School of MedicineAnhui University of Science and TechnologyHuainanChina,Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Wei Wu
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Chan Mo
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Zhou Zheng
- Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Jian Li
- Department of Otolaryngology, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangzhou Key Laboratory of OtorhinolaryngologyGuangzhouChina
| | - Xiuming Zhang
- School of MedicineAnhui University of Science and TechnologyHuainanChina,Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Dan Xiong
- School of MedicineAnhui University of Science and TechnologyHuainanChina,Medical Laboratory of the Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
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Chen X, Yi J, Liu S, Chen W, Guan J, Pan C. Yin-Yang tongue sign: An imaging clue of lesions involving the skull base segment in the hypoglossal pathway. Dentomaxillofac Radiol 2023; 52:20220201. [PMID: 36168971 PMCID: PMC9793452 DOI: 10.1259/dmfr.20220201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic value of the Yin-Yang tongue sign in patients with tongue deviation. METHODS According to the presence of the Yin-Yang tongue sign on CT/MR, 107 patients with tongue deviation were divided into a positive group and a negative group. The involvement categories of the hypoglossal canal (HC) in the positive group were evaluated and classified as HC dilation and HC erosion. The correlations between HC involvement categories and the presence of the sign were analysed. RESULTS There were 55 cases (55/107, 51.4%) in the positive group and 52 cases (52/107, 48.6%) in the negative group. Hypoglossal nerve (HN) involvement mainly occurred in the skull base (61.8%), skull base and carotid space (10.9%), and carotid space segment (12.7%). Neurogenic (50.9%), squamous cell carcinoma (14.5%), and metastases (12.7%) were the predominant aetiologies. The sensitivity, specificity, and accuracy of this sign for suggesting skull base lesions around HC were 72.4%, 80.8%, and 76.6%, respectively. In the positive group, HC dilation was seen in 21 patients (21/55, 38.2%) and 21 cases were all benign. HC erosion were noted in 19 patients (19/55, 34.5%), of whom 12 cases were malignant. CONCLUSION The Yin-Yang tongue sign is formed by unilateral tongue atrophy and fat infiltration caused by lesions in the HN pathway, especially compressive or invasive lesions involving the skull base segment.
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Affiliation(s)
| | - Jingru Yi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Application of hypoglossal nerve constraint in definitive radiotherapy for nasopharyngeal carcinoma: A dosimetric feasibility study. Med Dosim 2020; 46:39-44. [PMID: 32768273 DOI: 10.1016/j.meddos.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE Radiation-induced hypoglossal nerve palsy is an infrequent but debilitating late complication after definitive radiotherapy for head and neck cancers. D1cc < 74 Gy (equivalent dose in 2 Gy fractions, EQD2) has been proposed as a potential dose constraint that limits 8-year palsy risk to < 5%. This study sets to perform detailed dosimetric assessments on the applicability of this novel dose constraint in advanced nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS This is a retrospective single-institution dosimetry study. NPC radiotherapy plans were identified from an institutional database, with an aim to select 10 eligible cases. Bilateral hypoglossal nerves were retrospectively contoured following a standard atlas. Cases with either one, or both, hypoglossal nerves D1cc exceeded 74 Gy EQD2 were included. Dosimetry of hypoglossal nerves, planning target volumes (PTV) and normal structures before and after application of the new hypoglossal nerve constraint were compared and analyzed. RESULTS Ten NPC cases were replanned. All hypoglossal nerve contours overlapped with high-dose PTV, predominantly at regions of gross nodal diseases. D1cc in 15 out of 20 hypoglossal nerves exceeded 74G y EQD2 at initial plans. All nerves fulfilled the pre-specified constraint of 74Gy EQD2 after re-plan. Median hypoglossal nerve D1cc reduced from 74.8Gy (range, 74.1 to 77.4Gy) to 73.5Gy (range, 72.4 to 74.0Gy) (p < 0.001), corresponded to a projected reduction in 8-year palsy risk from 5%-14% to 3%-5%. PTV V100 was maintained above 95% in all cases. Dose increments in near-maximum (D2) and decrements in near-minimum (D98) were < 1 Gy. Safety dosimetric parameters of standard head and neck organs-at-risk showed no significant changes. CONCLUSIONS Hypoglossal nerve D1cc < 74 Gy EQD2 is a dosimetrically feasible constraint in definitive radiotherapy for NPC. Tumor target coverage and normal organ dosimetry were not compromised with its usage. Its routine application should be considered in definitive radiotherapy for head and neck cancers.
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Geng C, Lu Z, Xuan L, Yin H, Yang X, Yang L, Xia X, Chu W. Hypoglossal Nerve Lesions: The Role of a 3D IR-Prepped Fast SPGR High-Resolution 3T MRI Sequence. J Neuroimaging 2020; 31:180-185. [PMID: 32730672 DOI: 10.1111/jon.12762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE To assess a 3D high-resolution IR-prepped fast SPGR high-resolution MRI sequence for evaluating hypoglossal nerve lesions. METHODS The clinical data of 8 patients with hypoglossal nerve lesions admitted from December 2011 to February 2016 were retrospectively analyzed. MRI included contrast-enhanced conventional sequences and a 3D IR-prepped fast SPGR high-resolution T1-weighted (BRAVO) MRI sequence at 3T. RESULTS Eight patients had hypoglossal lesions detected by MRI. Conventional enhanced scanning could not clearly display the hypoglossal nerve and canal, while the enhanced 3D high-resolution sequence could. In addition, multiple planar reconstruction clearly displayed the hypoglossal nerve, hypoglossal canal, and lesions in multiple planes. CONCLUSIONS Compared with conventional MRI, we show superior results from an advanced sequence to improve image quality in characterizing hypoglossal nerve lesions.
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Affiliation(s)
- Chengjun Geng
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Zehua Lu
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Lulu Xuan
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Huikang Yin
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Xiaoliang Yang
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Liyue Yang
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Xiaoliang Xia
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, Wuxi, Jiangsu, China
| | - Wei Chu
- Department of Radiology, Wuxi Huishan People's Hospital, Wuxi, Jiangsu, China
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Incidence and outcomes of radiation-induced late cranial neuropathy in 10-year survivors of head and neck cancer. Oral Oncol 2019; 95:59-64. [PMID: 31345395 DOI: 10.1016/j.oraloncology.2019.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterize the late cranial neuropathy among 10-year survivors of head and neck cancer treatment. MATERIALS AND METHODS We retrospectively evaluated patients treated with curative-intent radiation for HNC between 1990 and 2005 at a single institution with systematic multidisciplinary follow-up ≥ 10 years. New findings of CNP were considered radiation-induced when examination, imaging and/or biopsy did not demonstrate a structural or malignant cause. Cox proportional hazards modeling was used for univariable analysis (UVA) and multivariable analysis (MVA) for time to CNP after completion of radiation. RESULTS We identified 112 patients with no evidence of disease and follow-up ≥ 10 years (median 12.2). Sixteen (14%) patients developed at least one CNP. The median time to CNP was 7.7 years (range 0.6-10.6 years). Most common was CN XII deficit in eight patients (7%), followed by CN X deficit in seven patients (6%). Others included CN V deficit in three, and CN XI deficit in two. Eight of the thirteen patients with a CN X and/or CN XII deficit required a permanent gastrostomy tube. On UVA, site of primary disease, post-radiation neck dissection, chemotherapy, and radiation dose were significantly associated with increased risk of CNP. CONCLUSION Iatrogenic CNP may develop years after head and neck cancer treatment and often leads to swallowing dysfunction. Long-term follow up is essential for these patients receiving head and neck radiation.
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Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. Radiographics 2018; 38:1498-1513. [DOI: 10.1148/rg.2018170194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Hutcheson KA, Yuk M, Hubbard R, Gunn GB, Fuller CD, Lai SY, Lin H, Garden AS, Rosenthal DI, Hanna EY, Kies MS, Lewin JS. Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review. Head Neck 2017; 39:1516-1523. [PMID: 28452175 DOI: 10.1002/hed.24789] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine swallowing-related lower cranial nerve palsy (LCNP) in oropharyngeal cancer (OPC) survivors after intensity-modulated radiotherapy (IMRT). METHODS Patients treated with definitive IMRT (66-72 Gy) were pooled from institutional trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre-IMRT, 6 months post-IMRT, 12 months post-IMRT, and 24 months post-IMRT. Time-to-event and incidence of LCNP was estimated with competing risk methods. Literature review (1977-2015) summarized published LCNP outcomes. RESULTS Three of 59 oropharyngeal cancer survivors with a minimum 2-year follow-up developed hypoglossal palsy ipsilateral to the index tumor (median latency 6.7 years; range 4.6-7.6 years). At a median of 5.7 years, cumulative incidence of LCNP was 5%. LCNP preceded progressive dysphagia in all cases. Published studies found median incidence of radiation-associated LCNP was 10.5% after NPC, but no OPC cancer-specific estimate. CONCLUSION Although uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long-term functional surveillance in OPC survivorship.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maggie Yuk
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel Hubbard
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill S Kies
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Janssen S, Glanzmann C, Yousefi B, Loewenich K, Huber G, Schmid S, Studer G. Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma. Mol Clin Oncol 2015; 3:811-816. [PMID: 26171186 DOI: 10.3892/mco.2015.558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/12/2015] [Indexed: 11/06/2022] Open
Abstract
Radiation-induced cranial nerve palsy (RICNP) is a severe long-term complication in patients with head and neck cancer following high-dose radiation therapy (RT). We present the case report of a patient with bilateral RICNP of the hypoglossal and vagus cranial nerves (XII/X) following postoperative RT in the era prior to the introduction of intensity-modulated RT (IMRT), and an analysis of our IMRT patient cohort at risk including the case of a XII RICNP. A total of 201 patients whose glosso-pharyngeal (IX), X and XII cranial nerves had been exposed to >65 Gy definitive IMRT in our institution between January, 2002 and December, 2012 with or without systemic therapy, were retrospectively identified. A total of 151 patients out of 201 fulfilling the following criteria were included in the analysis: Locoregionally controlled disease, with a follow-up (FU) of >24 months and >65 Gy exposure of the nerves of interest. So far, one of the assessed 151 IMRT patients at risk exhibited symptoms of RICNP after 6 years. The mean/median FU of the entire cohort was 71/68 months (range, 27-145). The results were compared with literature reports. In conclusion, RICNP appears to be a rare complication. However, a longer FU and a larger sample size are required to draw reliable conclusions on the incidence of RICNP in the era of IMRT.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland ; Department of Radiation Oncology, University of Lübeck, 23562 Lübeck, Germany
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Bita Yousefi
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Karl Loewenich
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Stephan Schmid
- Department of Otorhinolaryngology, Bethanien Hospital, 8044 Zurich, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
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Awan MJ, Mohamed ASR, Lewin JS, Baron CA, Gunn GB, Rosenthal DI, Holsinger FC, Schwartz DL, Fuller CD, Hutcheson KA. Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol 2014; 50:746-52. [PMID: 24906528 PMCID: PMC4158823 DOI: 10.1016/j.oraloncology.2014.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/13/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. MATERIALS AND METHODS An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. RESULTS Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5-11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. CONCLUSIONS SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.
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Affiliation(s)
- Musaddiq J Awan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States; Department of Radiation Oncology, Case Western Reserve University Hospitals, Cleveland, OH 44106, United States.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States; Department of Clinical Oncology, Faculty of Medicine, The University of Alexandria, Alexandria, Egypt.
| | - Jan S Lewin
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States.
| | - Charles A Baron
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - F Christopher Holsinger
- Department of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Stanford, CA 94305, United States.
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas Southwestern, Dallas, TX, United States.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - Katherine A Hutcheson
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States.
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Mourad WF, Young BM, Young R, Blakaj DM, Ohri N, Shourbaji RA, Manolidis S, Gámez M, Kumar M, Khorsandi A, Khan MA, Shasha D, Blakaj A, Glanzman J, Garg MK, Hu KS, Kalnicki S, Harrison LB. Clinical validation and applications for CT-based atlas for contouring the lower cranial nerves for head and neck cancer radiation therapy. Oral Oncol 2013; 49:956-963. [PMID: 23623404 DOI: 10.1016/j.oraloncology.2013.03.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Radiation induced cranial nerve palsy (RICNP) involving the lower cranial nerves (CNs) is a serious complication of head and neck radiotherapy (RT). Recommendations for delineating the lower CNs on RT planning studies do not exist. The aim of the current study is to develop a standardized methodology for contouring CNs IX-XII, which would help in establishing RT limiting doses for organs at risk (OAR). METHODS Using anatomic texts, radiologic data, and guidance from experts in head and neck anatomy, we developed step-by-step instructions for delineating CNs IX-XII on computed tomography (CT) imaging. These structures were then contoured on five consecutive patients who underwent definitive RT for locally-advanced head and neck cancer (LAHNC). RT doses delivered to the lower CNs were calculated. RESULTS We successfully developed a contouring atlas for CNs IX-XII. The median total dose to the planning target volume (PTV) was 70Gy (range: 66-70Gy). The median CN (IX-XI) and (XII) volumes were 10c.c (range: 8-12c.c) and 8c.c (range: 7-10c.c), respectively. The median V50, V60, V66, and V70 of the CN (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The median maximal dose to the CN (IX-XI) and (XII) were 72Gy (range: 66-77) and 71Gy (range: 64-78), respectively. CONCLUSIONS We have generated simple instructions for delineating the lower CNs on RT planning imaging. Further analyses to explore the relationship between lower CN dosing and the risk of RICNP are recommended in order to establish limiting doses for these OARs.
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Affiliation(s)
- Waleed F Mourad
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States; Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.
| | - Brett M Young
- Department of Neuroradiology, Duke University Medical Center, Durham, NC, United States
| | - Rebekah Young
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Rania A Shourbaji
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
| | - Spiros Manolidis
- Department of Otolaryngology, Beth Israel Medical Center, New York, NY, United States
| | - Mauricio Gámez
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
| | - Mahesh Kumar
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
| | - Azita Khorsandi
- Department of Neuroradiology, Beth Israel Medical Center, New York, NY, United States
| | - Majid A Khan
- Department of Neuroradiology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Daniel Shasha
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
| | - Adriana Blakaj
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Jonathan Glanzman
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Kenneth S Hu
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Louis B Harrison
- Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, United States
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11
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Tuan JKL, Ha TC, Ong WS, Siow TR, Tham IWK, Yap SP, Tan TWK, Chua ET, Fong KW, Wee JTS. Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma. Radiother Oncol 2012; 104:305-11. [PMID: 22280806 DOI: 10.1016/j.radonc.2011.12.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/16/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE We sought to evaluate the nature and frequency of late toxicities in a cohort of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy alone. METHODS AND MATERIALS Seven-hundred and ninety-six consecutive NPC patients treated using conventional radiotherapy at a single center from 1992 to 1995 were retrospectively analyzed. Patients with histology proven, completely staged, Stage I-IVB World Health Organization Type I-III NPC and completed radical radiotherapy were included. Patients with incomplete staging investigations, distant metastases at diagnosis, previous treatment, and incomplete radiotherapy were excluded. Radiotherapy-related complications were categorized using the RTOG Late Radiation Morbidity Scoring Criteria. RESULTS Median follow-up was 7.2 years. The 5-year overall survival and disease free survival were 69% and 56%, respectively, and the corresponding 10-year rates were 52% and 44%. Among 771 patients with at least 3 months of follow-up post treatment, 565 (73%) developed RT-related complications. Diagnosed neurological complications were cranial nerve palsies (n=70; 9%), temporal lobe necrosis (n=37; 5%), Lhermitte's syndrome (n=7; 1%), and brachial plexopathy (n=2; 0.3%). Non-neurological complications included xerostomia (n=353; 46%), neck fibrosis (n=169; 22%), hypo-pituitarism (n=48; 6%), hearing loss (n=120; 16%), dysphagia (n=116; 15%), otorrhea (n=101; 13%), tinnitus (n=94; 12%), permanent tube feeding (n=61; 8%), trismus (n=45; 6%), second malignancies within treatment field (n=17; 2%), and osteo-radionecrosis (n=13; 2%). CONCLUSIONS While radiotherapy is curative in NPC, many patients suffer significant late treatment morbidities with conventional radiotherapy techniques.
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Radiation-Induced Cranial Nerve Palsy: A Cross-Sectional Study of Nasopharyngeal Cancer Patients After Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79:1421-7. [DOI: 10.1016/j.ijrobp.2010.01.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 01/03/2010] [Accepted: 01/06/2010] [Indexed: 11/18/2022]
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Cui C, Liu L, Ma J, Liang S, Tian L, Tang L, Li L. Trigeminal nerve palsy in nasopharyngeal carcinoma: correlation between clinical findings and magnetic resonance imaging. Head Neck 2009; 31:822-8. [PMID: 19373779 DOI: 10.1002/hed.21101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Our aim was to document the relationship between clinical and MRI evidence of trigeminal nerve involvement. METHODS The MRI and medical records of 924 consecutive patients with newly diagnosed nasopharyngeal carcinoma (NPC) were reviewed retrospectively. RESULTS A total of 92 divisions of palsied trigeminal nerves were found clinically in 46 patients (5.0%). The involved trigeminal nerve was ophthalmic nerve (V1; n = 21), the maxillary division (V2; n = 41), and the mandibular division (V3; n = 30). Of the 316 patients with MRI-demonstrated trigeminal nerve involvements, the symptoms were lacking in 270 patients (85.4%). Of the 92 clinical palsied trigeminal nerve divisions, 91 nerves (98.9%) showed MRI evidence of 1 or more trigeminal nerve involvements. Of the 91 palsied trigeminal nerve with MRI evidence, 85 divisions (93.4%) were found with intracranial or orbital segment involvement, 6 (6.6%) divisions were found only basicranial evidence, and 83 (91.2%) divisions were found with cavernous sinus invasion. CONCLUSION The incidence of MRI-evidenced trigeminal nerve involvement is high and often asymptomatic in NPC. Almost all patients with clinical trigeminal nerve palsies had MRI evidence of trigeminal nerve involvement in intracranial or orbital segment, especially in cavernous sinus.
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Affiliation(s)
- Chunyan Cui
- Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, People's Republic of China
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Abstract
NPC represents 0.2% of malignant disease in the white population but is more common in southern China, among Chinese in East Asia and the United [figure: see text] States, and in North Africa, including Saudi Arabia. NPC in these ethnic groups tends to manifest at a younger age. Undifferentiated carcinoma is the most common histopathologic type and is associated with EBV. The tumor is optimally assessed with CT and MR imaging for staging; PET scanning provides optimal assessment of recurrent tumor or small lymph node metastases. The primary tumor in the nasopharynx may be small and infiltrating, causing no or only a small mass effect in the nasopharynx. In these cases, obliteration of fat planes and loss of muscle boundaries are important diagnostic findings, which are best evaluated with MR imaging including, Gd-DTPA with fat suppression. The size of the NPC varies from 1 to 2 cm to large tumors that extend to the oropharynx, PPS, nasal cavities, paranasal sinuses, and orbits. Skull base erosion is independent of the size of the nasopharyngeal tumor and ranges from slight erosion to extensive destruction. A concomitant finding is intracranial invasion, predominantly to the basal cisterns and cavernous sinuses associated with cranial nerve palsies. Intracranial invasion should be assessed with contrast MR imaging. Lymph node metastases in the neck are present in 90% of cases and are bilateral in 50% of cases. In a small percentage of cases, extension of lymph node metastases to the mediastinum and hilar areas are encountered. Distant metastases involve the lungs, skeleton, and liver, and occasionally the choroid. They are usually present at the initial presentation [figure: see text] and increase in frequency in advanced disease and in recurrent tumors. In addition, the metastatic lymph nodes in the neck reveal no specific imaging features that would allow differentiation from other lymph node metastases. They may be discrete, often multiple, and large and bulky displaying a variable degree of necrosis and enhancement following introduction of contrast material. Local recurrence manifests commonly within the first 2 to 3 years posttherapy and is optimally evaluated by MR imaging and PET scanning.
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Affiliation(s)
- Alfred L Weber
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Kam MKM, Chau RMC, Suen J, Choi PHK, Teo PML. Intensity-modulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys 2003; 56:145-57. [PMID: 12694833 DOI: 10.1016/s0360-3016(03)00075-0] [Citation(s) in RCA: 244] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intensity-modulated radiotherapy (IMRT) with two-dimensional RT (2D-RT) and three-dimensional conformal radiotherapy (3D-CRT) treatment plans in different stages of nasopharyngeal carcinoma and to explore the feasibility of dose escalation in locally advanced disease. MATERIALS AND METHODS Three patients with different stages (T1N0M0, T2bN2M0 with retrostyloid extension, and T4N2M0) were selected, and 2D-RT, 3D-CRT, and IMRT treatment plans (66 Gy) were made for each of them and compared with respect to target coverage, normal tissue sparing, and tumor control probability/normal tissue complication probability values. In the Stage T2b and T4 patients, the IMRT 66-Gy plan was combined with a 3D-CRT 14-Gy boost plan using a 3-mm micromultileaf collimator, and the dose-volume histograms of the summed plans were compared with their corresponding 66-Gy 2D-RT plans. RESULTS In the dosimetric comparison of 2D-RT, 3D-CRT, and IMRT treatment plans, the T1N0M0 patient had better sparing of the parotid glands and temporomandibular joints with IMRT (dose to 50% parotid volume, 57 Gy, 50 Gy, and 31 Gy, respectively). In the T2bN2M0 patient, the dose to 95% volume of the planning target volume improved from 57.5 Gy in 2D-RT to 64.8 Gy in 3D-CRT and 68 Gy in IMRT. In the T4N2M0 patient, improvement in both target coverage and brainstem/temporal lobe sparing was seen with IMRT planning. In the dose-escalation study for locally advanced disease, IMRT 66 Gy plus 14 Gy 3D-CRT boost achieved an improvement in the therapeutic ratio by delivering a higher dose to the target while keeping the normal organs below the maximal tolerance dose. CONCLUSIONS IMRT is useful in treating all stages of nonmetastatic nasopharyngeal carcinoma because of its dosimetric advantages. In early-stage disease, it provides better parotid gland sparing. In locally advanced disease, IMRT offers better tumor coverage and normal organ sparing and allows room for dose escalation.
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Affiliation(s)
- Michael K M Kam
- Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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16
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Abstract
Nasopharyngeal carcinoma (NPC) is the most common epithelial tumor of the nasopharynx. Radiation therapy is the mainstay of treatment while surgery or chemotherapy is used in selected patients. NPC usually regresses after 3 months of radiation therapy. Nonetheless, a residual mass may be present following treatment and this does not necessarily indicate viable tumor. Imaging studies are often used in conjunction with clinical examination following treatment. While computed tomography (CT) is widely used due to its greater availability, less expensive, and less time consuming, MR imaging is now becoming the preferred modality. MR imaging is more capable than CT for identifying mature scarring, tumor recurrence and postradiation complications. However, MR imaging cannot reliably demonstrate mucosal recurrence or differentiate tumor recurrence from postradiation tissue changes. Familiarity with the imaging findings of various posttreatment changes, tumor recurrence and postradiation complications is essential for management of NPC. Comparison with previous images or imaging-guided biopsy facilitates definitive diagnosis.
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Affiliation(s)
- Shu Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, 222 Mai-Chin Road, Keelung, Taiwan.
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Timmers HJLM, Karemaker JM, Wieling W, Kaanders JHAM, Folgering HTM, Marres HAM, Lenders JWM. Arterial baroreflex and peripheral chemoreflex function after radiotherapy for laryngeal or pharyngeal cancer. Int J Radiat Oncol Biol Phys 2002; 53:1203-10. [PMID: 12128121 DOI: 10.1016/s0360-3016(02)02827-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Denervation of the carotid sinus causes baroreflex and chemoreflex failure, resulting in labile hypertension and loss of hypoxic responsiveness. We investigated whether radiation therapy for laryngeal or pharyngeal cancer affects baroreflex and chemoreflex function. METHODS AND MATERIALS Twelve patients were studied after radiation therapy for locally advanced laryngeal or pharyngeal cancer (11 male, 1 female, age: 56.0 +/- 7.9 years), 3.3 years (median; range 1.0-4.7) after radiotherapy and 15 healthy controls (11 male, 4 female, 53.4 +/- 9.2 years). We measured baroreflex sensitivity (phenylephrine), blood pressure level and variability (24-h Spacelabs and 5-h Portapres recordings), responses to cardiovascular reflex tests, and the ventilatory responses to normocapnic and hypercapnic hypoxia. RESULTS Baroreflex sensitivity was lower in patients (9.7 +/- 7.8 ms/mm Hg) than in controls (17.5 +/- 10.3 ms/mm Hg, p = 0.011). Mean office blood pressure was significantly higher in patients (141.5 +/- 27.8/89.2 +/- 10.6 mm Hg, 63.3 +/- 12.3 bpm) than in controls (117.3 +/- 10.1/75.1 +/- 6.8 mm Hg, 61.8 +/- 10.8 bpm). Blood pressure variability was not different between groups, nor were the responses to reflex tests. The normo/hypercapnic ventilatory response to hypoxia was similar in patients (0.21 +/- 0.10/1.37 +/- 0.60 L/min/%) and controls (0.22 +/- 0.16/1.19 +/- 0.78 L/min/%). CONCLUSIONS Radiation therapy for laryngeal or pharyngeal carcinoma does not affect chemoreflex function, but results in an attenuated baroreflex sensitivity. Clinically relevant blood pressure lability is absent however.
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Affiliation(s)
- Henri J L M Timmers
- Department of Internal Medicine, University Medical Center, Nijmegen, The Netherlands.
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Wong CS, Luk SH, Leung TW, Yuen KK, Sze WK, Tung SY. Sphenoid sinus mucocoele and cranial nerve palsies in a patient with a history of nasopharyngeal carcinoma: may mimic local recurrence. Clin Oncol (R Coll Radiol) 2002; 13:353-5. [PMID: 11716228 DOI: 10.1053/clon.2001.9288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
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Chew NK, Sim BF, Tan CT, Goh KJ, Ramli N, Umapathi P. Delayed post-irradiation bulbar palsy in nasopharyngeal carcinoma. Neurology 2001; 57:529-31. [PMID: 11502928 DOI: 10.1212/wnl.57.3.529] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In a hospital series of 70 patients on follow-up after radiotherapy for nasopharyngeal carcinoma, 14 patients (20%) developed delayed post-irradiation bulbar palsy 1 to 18 years after radiotherapy (mean 5.5 years). Functional disability was moderate to severe. Three patients had aspiration pneumonia with one mortality. Post-irradiation bulbar palsy was a common complication and probably resulted from direct neuronal damage.
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Affiliation(s)
- N K Chew
- Division of Neurology, University of Malaya, Kuala Lumpur, Malaysia
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