1
|
Henson C, Abou-Foul AK, Yu E, Glastonbury C, Huang SH, King AD, Lydiatt WM, McDowell L, Nagelschneider AA, Nankivell PC, O'Sullivan B, Rhys R, Xiao Y, Andrew D, Asmussen JT, Bidault F, Dankbaar JW, de Graaf P, Gebrim ES, Hu C, Ding J, Kanda T, Kim J, Kuno H, Medrano-Martorell S, Oikonomopoulos N, Goh JPN, Santos-Armentia E, Schafigh DG, Subramaniam RM, Wu XC, Yom SS, Mehanna H. Criteria for the diagnosis of extranodal extension detected on radiological imaging in head and neck cancer: Head and Neck Cancer International Group consensus recommendations. Lancet Oncol 2024; 25:e297-e307. [PMID: 38936388 DOI: 10.1016/s1470-2045(24)00066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 06/29/2024]
Abstract
Extranodal extension of tumour on histopathology is known to be a negative prognostic factor in head and neck cancer. Compelling evidence suggests that extranodal extension detected on radiological imaging is also a negative prognostic factor. Furthermore, if imaging detected extranodal extension could be identified reliably before the start of treatment, it could be used to guide treatment selection, as patients might be better managed with non-surgical approaches to avoid the toxicity and cost of trimodality therapy (surgery, chemotherapy, and radiotherapy together). There are many aspects of imaging detected extranodal extension that remain unresolved or are without consensus, such as the criteria to best diagnose them and the associated terminology. The Head and Neck Cancer International Group conducted a five-round modified Delphi process with a group of 18 international radiology experts, representing 14 national clinical research groups. We generated consensus recommendations on the terminology and diagnostic criteria for imaging detected extranodal extension to harmonise clinical practice and research. These recommendations have been endorsed by 19 national and international organisations, representing 34 countries. We propose a new classification system to aid diagnosis, which was supported by most of the participating experts over existing systems, and which will require validation in the future. Additionally, we have created an online educational resource for grading imaging detected extranodal extensions.
Collapse
Affiliation(s)
- Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Centre, Oklahoma City, OK, USA
| | - Ahmad K Abou-Foul
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Eugene Yu
- Neuroradiology and Head and Neck Imaging, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Christine Glastonbury
- Otolaryngology-Head & Neck Surgery and Radiation Oncology, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shao Hui Huang
- Department of Radiation Oncology and Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ann D King
- The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - William M Lydiatt
- Department of Surgery, Nebraska Methodist Hospital and Methodist Women's Hospital, Creighton University, Omaha, NE, USA
| | - Lachlan McDowell
- Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Alex A Nagelschneider
- Department of Radiology, Division of Neuroradiology, Mayo Clinic-Rochester, Rochester, MN, USA
| | - Paul C Nankivell
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Brian O'Sullivan
- Department of Radiation Oncology and Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rhian Rhys
- Radiology department, Royal Glamorgan Hospital, Caerdydd, Wales, UK
| | - Youping Xiao
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - David Andrew
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jon T Asmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Francois Bidault
- Department of Medical Imaging, Gustave Roussy Cancer Campus, and Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Villejuif, France
| | - Jan W Dankbaar
- Radiology department, University Medical Center, Utrecht, Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - Eloisa S Gebrim
- Department of Radiology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Shanghai, China
| | - Jianhui Ding
- Department of Radiology, Fudan University Shanghai Cancer, Shanghai, China
| | - Tomonori Kanda
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Jane Kim
- Radiology department, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Nikolaos Oikonomopoulos
- Second Department of radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | | | - Darius G Schafigh
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany
| | - Rathan M Subramaniam
- Department of Medicine, University of Otago Medical School, Dunedin, New Zealand; Department of Radiology, Duke University, Durham, NC, USA
| | - Xin Cynthia Wu
- Neuroradiology Division, University of California, San Francisco, CA, USA
| | - Sue S Yom
- Otolaryngology-Head & Neck Surgery and Radiation Oncology, University of California, San Francisco, CA, USA; Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
| |
Collapse
|
2
|
Chen Y, Huang Y, Chen X, Chen Z, Peng X, Lin S, Lin C, Zong J. Efficacy of salvage surgery versus re-irradiation for isolated regional lymph node recurrence in patients with nasopharyngeal carcinoma. BMC Cancer 2024; 24:483. [PMID: 38627711 PMCID: PMC11022380 DOI: 10.1186/s12885-024-12259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/15/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND To compare the clinical characteristics and prognoses of patients with isolated regional lymph node recurrent nasopharyngeal carcinoma (irrNPC) who underwent surgery or re-irradiation treatment. METHODS We retrospectively reviewed 124 irrNPC patients who underwent initial radiotherapy between January 2010 and December 2020. The staging of regional lymph node recurrence was as follows: 75.8% for rN1, 14.5% for rN2, and 9.7% for rN3. Fifty-five patients underwent regional lymph node surgery (Surgery group), and sixty-nine patients received salvage radiotherapy with or without chemotherapy (Re-irradiation group). The survival rate was compared using Kaplan‒Meier analysis and evaluated by the log-rank test. Cox proportional hazard models were used to analyze prognostic factors. RESULTS The median follow-up time was 70 months, the 5-year overall survival (OS) was 74%, and the median survival time was 60.8 months. There were no significant differences in 5-year OS (75.6% vs. 72.4%, P = 0.973), regional recurrence-free survival (RRFS, 62.7% vs. 71.1%, P = 0.330) or distant metastasis-free survival (DMFS, 4.2% vs.78.7%, P = 0.677) between the Surgery group and Re-irradiation group. Multivariate analysis revealed age at recurrence, radiologic extra-nodal extension (rENE) status, and recurrent lymph node (rN) classification as independent prognostic factors for OS. The rENE status was an independent prognostic factor for DMFS. Subgroup analysis of the Surgery group revealed that the rN3 classification was an adverse prognostic factor for OS. Age at recurrence ≥ 50 years, GTV-N dose, and induction chemotherapy were found to be independent prognostic factors for OS, RRFS, and DMFS, respectively, in the Re-irradiation group. CONCLUSIONS For NPC patients with isolated regional lymph node recurrence after initial radiotherapy, those who underwent surgery had survival prognosis similar to those who underwent re-radiotherapy with or without chemotherapy. A prospective study is needed to validate these findings.
Collapse
Affiliation(s)
- Yuebing Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Yiping Huang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Xiaoqiang Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zhiwei Chen
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Fuzhou Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Xiane Peng
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Shaojun Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Cheng Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.
| | - Jingfeng Zong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.
| |
Collapse
|
3
|
Ding J, Chen J, Lin Y, Hong J, Huang C, Fei Z, Chen C. Significance of radiologic extranodal extension in locoregionally advanced nasopharyngeal carcinoma with lymph node metastasis: a comprehensive nomogram. Braz J Otorhinolaryngol 2024; 90:101363. [PMID: 38101121 PMCID: PMC10727941 DOI: 10.1016/j.bjorl.2023.101363] [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: 10/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE We aimed to assess the significance of rENE and creat a predictive tool (nomogram) for estimating Overall Survival (OS) in locoregionally advanced Nasopharyngeal Carcinoma (NPC) patients with Lymph Node Metastasis (LNM) based on their clinical characteristics and Radiologic Extranodal Extension (rENE). METHODS Five hundred and sixty-nine NPC patients with LNM were randomly divided into training and validation groups. Significant factors were identified using univariate and multivariate analyses in the training cohort. Then, the nomogram based on the screening results was established to predict the Overall Survival (OS). Calibration curves and the Concordance index (C-index) gauged predictive accuracy and discrimination. Receiver Operating Characteristic (ROC) analysis assessed risk stratification, and clinical utility was measured using Decision Curve Analysis (DCA). The nomogram's performance was validated for discrimination and calibration in an independent validation cohort. RESULTS A total of 360 (63.2%) patients were present with radiologic extranodal extension at initial diagnosis. Patients with rENE had significantly lower OS than other patients. Multivariate analysis identified the five factors, including rENE, for the nomogram model. The C-index was 0.75 (0.71-0.78) in the training cohort and 0.76 (0.69-0.83) in the validation cohort. Notably, the nomogram outperformed the 8th TNM staging system, as evident from the higher AUC values (0.77 vs. 0.60 for 2year and 0.75 vs. 0.65 for 3year) and well-calibrated calibration curves. Decision curve analysis indicated improved Net Benefit (NB) with the nomogram for predicting OS. The log-rank test confirmed significant survival distinctions between risk groups in both training and validation cohorts. CONCLUSIONS We demonstrated the prognostic value of rENE in nasopharyngeal carcinoma and developed a nomogram based on rENE and other factors to provide individual prediction of OS for locoregionally advanced nasopharyngeal carcinoma with lymph node metastasis. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jianming Ding
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Jiawei Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Yuhao Lin
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Jiabiao Hong
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Chaoxiong Huang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Zhaodong Fei
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China
| | - Chuanben Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Department of Radiation Oncology, Fujian, PR China.
| |
Collapse
|
4
|
Ai QYH, King AD, Yuan H, Vardhanabhuti V, Mo FKF, Hung KF, Hui EP, Kwong DLW, Lee VHF, Ma BBY. Radiologic extranodal extension for nodal staging in nasopharyngeal carcinoma. Radiother Oncol 2024; 191:110050. [PMID: 38101457 DOI: 10.1016/j.radonc.2023.110050] [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: 05/03/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Extranodal extension (ENE) has the potential to add value to the current nodal staging system (N8th) for predicting outcome in nasopharyngeal carcinoma (NPC). This study aimed to incorporate ENE, as well as cervical nodal necrosis (CNN) to the current stage N3 and evaluated their impact on outcome prediction. The findings were validated on an external cohort. METHODS & MATERIALS Pre-treatment MRI of 750 patients from the internal cohort were retrospectively reviewed. Predictive values of six modified nodal staging systems that incorporated four patterns of ENE and two patterns of CNN to the current stage N3 for disease-free survival (DFS) were compared with that of N8th using multivariate cox-regression and concordance statistics in the internal cohort. Performance of stage N3 for predicting disease recurrence was calculated. An external cohort of 179 patients was used to validate the findings. RESULTS Incorporation of advanced ENE, which infiltrates into adjacent muscle/skin/salivary glands outperformed the other five modifications for predicting outcomes (p < 0.01) and achieved a significantly higher c-index for 5-year DFS (0.69 vs 0.72) (p < 0.01) when compared with that of N8th staging system. By adding advanced ENE to the current N3 increased the sensitivity for predicting disease recurrence from 22.4 % to 47.1 %. The finding was validated in the external cohort (5-year DFS 0.65 vs. 0.72, p < 0.01; sensitivity of stage N3 increased from 14.0 % to 41.9 % for disease recurrence). CONCLUSION Results from two centre cohorts confirmed that the radiological advanced ENE should be considered as a criterion for stage N3 disease in NPC.
Collapse
Affiliation(s)
- Qi Yong H Ai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
| | - Hui Yuan
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, PR China
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Frankie K F Mo
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Kuo Feng Hung
- Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edwin P Hui
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Dora Lai-Wan Kwong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Brigette B Y Ma
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| |
Collapse
|
5
|
Liu Y, Sun S, Zhang Y, Huang X, Wang K, Qu Y, Chen X, Wu R, Zhang J, Luo J, Li Y, Wang J, Yi J. Predictive function of tumor burden-incorporated machine-learning algorithms for overall survival and their value in guiding management decisions in patients with locally advanced nasopharyngeal carcinoma. JOURNAL OF THE NATIONAL CANCER CENTER 2023; 3:295-305. [PMID: 39036668 PMCID: PMC11256522 DOI: 10.1016/j.jncc.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 07/23/2024] Open
Abstract
Objective Accurate prognostic predictions and personalized decision-making on induction chemotherapy (IC) for individuals with locally advanced nasopharyngeal carcinoma (LA-NPC) remain challenging. This research examined the predictive function of tumor burden-incorporated machine-learning algorithms for overall survival (OS) and their value in guiding treatment in patients with LA-NPC. Methods Individuals with LA-NPC were reviewed retrospectively. Tumor burden signature-based OS prediction models were established using a nomogram and two machine-learning methods, the interpretable eXtreme Gradient Boosting (XGBoost) risk prediction model, and DeepHit time-to-event neural network. The models' prediction performances were compared using the concordance index (C-index) and the area under the curve (AUC). The patients were divided into two cohorts based on the risk predictions of the most successful model. The efficacy of IC combined with concurrent chemoradiotherapy was compared to that of chemoradiotherapy alone. Results The 1 221 eligible individuals, assigned to the training (n = 813) or validation (n = 408) set, showed significant respective differences in the C-indices of the XGBoost, DeepHit, and nomogram models (0.849 and 0.768, 0.811 and 0.767, 0.730 and 0.705). The training and validation sets had larger AUCs in the XGBoost and DeepHit models than the nomogram model in predicting OS (0.881 and 0.760, 0.845 and 0.776, and 0.764 and 0.729, P < 0.001). IC presented survival benefits in the XGBoost-derived high-risk but not low-risk group. Conclusion This research used machine-learning algorithms to create and verify a comprehensive model integrating tumor burden with clinical variables to predict OS and determine which patients will most likely gain from IC. This model could be valuable for delivering patient counseling and conducting clinical evaluations.
Collapse
Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shiran Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences (CAMS), Langfang 065001, China
| |
Collapse
|
6
|
Guo J, He Y, Lin C, Jiang Q, Xing HW, Zhang YC, Shen GZ, Lin HX, Guo L, Yang Q. Integrating pretreatment MRI-detected nodal features and Epstein-Barr virus DNA to identify optimal candidates for intensity-modulated radiotherapy alone in patients with stage II nasopharyngeal carcinoma. Oral Oncol 2023; 146:106574. [PMID: 37741017 DOI: 10.1016/j.oraloncology.2023.106574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES To develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein-Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient. METHODS This retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan-Meier curves with the log-rank test. RESULTS Independent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein-Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718-0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715-0.809]), nomogram A (0.619 [0.564-0.674]), and the TNM stage (0.560 [0.509-0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy. CONCLUSIONS The nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC.
Collapse
Affiliation(s)
- Jia Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Yun He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Chao Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Hong-Wei Xing
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China.
| | - Yu-Chen Zhang
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China
| | - Guan-Zhu Shen
- Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Qi Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| |
Collapse
|
7
|
Qu J, Su T, Pan B, Zhang T, Chen X, Zhu X, Chen Y, Zhang Z, Jin Z. Free-Breathing StarVIBE Sequence for the Detection of Extranodal Extension in Head and Neck Cancer: An Image Quality and Diagnostic Performance Study. Cancers (Basel) 2023; 15:4992. [PMID: 37894359 PMCID: PMC10605568 DOI: 10.3390/cancers15204992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: This study aims to evaluate the image quality of abnormal cervical lymph nodes in head and neck cancer and the diagnostic performance of detecting extranodal extension (ENE) using free-breathing StarVIBE. (2) Methods: In this retrospective analysis, 80 consecutive head and neck cancer patients underwent StarVIBE before neck dissection at an academic center. Image quality was compared with conventional VIBE available for 28 of these patients. A total of 73 suspicious metastatic lymph nodes from 40 patients were found based on morphology and enhancement pattern on StarVIBE. Sensitivity (SN), specificity (SP), and odds ratios were calculated for each MR feature from StarVIBE to predict pathologic ENE. (3) Results: StarVIBE showed significantly superior image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for enlarged lymph nodes compared to VIBE. The MR findings of "invading adjacent planes" (SN, 0.54; SP, 1.00) and "matted nodes" (SN, 0.72; SP, 0.89) emerged as notable observations. The highest diagnostic performance was attained by combining these two features (SN, 0.93; SP, 0.89). (4) Conclusions: This study confirms that StarVIBE offers superior image quality for abnormal lymph nodes compared to VIBE, and it can accurately diagnose ENE by utilizing a composite MR criterion in head and neck cancer.
Collapse
Affiliation(s)
- Jiangming Qu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Boju Pan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Xingming Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Xiaoli Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China
| |
Collapse
|
8
|
Henson CE, Abou-Foul AK, Morton DJ, McDowell L, Baliga S, Bates J, Lee A, Bonomo P, Szturz P, Nankivell P, Huang SH, Lydiatt WM, O’Sullivan B, Mehanna H. Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis. Front Oncol 2023; 13:1263347. [PMID: 37799466 PMCID: PMC10548228 DOI: 10.3389/fonc.2023.1263347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
Collapse
Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ahmad K. Abou-Foul
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel J. Morton
- Department of Pediatrics and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William M. Lydiatt
- Department of Surgery, Creighton University, and Nebraska Methodist Health System, Omaha, NE, United States
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
9
|
Xu YC, Chen KH, Liang ZG, Zhu XD. Long-term outcomes of chemoradiotherapy versus radiotherapy alone in patients with intermediate-risk nasopharyngeal carcinoma: a population-based analysis. Eur Arch Otorhinolaryngol 2023; 280:1793-1802. [PMID: 36335249 DOI: 10.1007/s00405-022-07726-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate the efficacy of chemotherapy among intermediate-risk (stage II/T3N0) nasopharyngeal carcinoma (NPC) patients receiving radiotherapy (RT). METHODS We identified stage II/T3N0 NPC patients who received radiotherapy with or without chemotherapy from the Surveillance, Epidemiology and End Results database (2004-2019). Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method with log-rank test and Cox proportional hazards models to evaluate the efficacy of chemotherapy. Subgroup analysis was also conducted based on the baseline characteristics. Propensity score matching (PSM) was performed to balance the intergroup covariates. RESULTS A total of 1623 patients were enrolled in the study, 1444 received chemoradiotherapy (CRT) and 179 received RT alone. CRT, compared to RT alone, was independently associated with a better OS (HR 0.57, 95% CI 0.45-0.71) and CSS (HR 0.55, 95% CI 0.39-0.79). After PSM, similar results were obtained, and CRT was superior to RT alone in terms of OS (HR 0.60, 95% CI 0.39-0.92) and CSS (HR 0.60, 95% CI 0.40-0.91). Subgroup analysis revealed that OS benefits from CRT were mainly observed in T0-2N1(HR 0.51, 95% CI 0.38-0.70) and T3N0 (HR 0.64, 95% CI 0.42-0.98) rather than T2N0 (HR 1.00, 95% CI 0.51-1.94). Interestingly, after PSM, OS benefits were still seen in T0-2N1 (HR 0.44, 95% CI 0.24-0.82), while not seen in T2N0 (HR 1.83, 95% CI 0.56-5.97) and T3N0 (HR 0.56, 95% CI 0.28-1.12). CONCLUSION For T0-2N1 NPC patients, CRT was superior to RT alone with better survival, whereas, for T2-3N0 patients, CRT was comparable to RT alone. Prospective large studies should be encouraged to verify the results.
Collapse
Affiliation(s)
- Yao-Can Xu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 He-di Road, Nanning, 530021, People's Republic of China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 He-di Road, Nanning, 530021, People's Republic of China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 He-di Road, Nanning, 530021, People's Republic of China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 He-di Road, Nanning, 530021, People's Republic of China. .,Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, People's Republic of China.
| |
Collapse
|
10
|
Masuoka S, Hiyama T, Kuno H, Sekiya K, Sakashita S, Kobayashi T. Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor. Radiographics 2023; 43:e220071. [PMID: 36795593 DOI: 10.1148/rg.220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Neck swelling due to lymph node (LN) metastasis is one of the initial symptoms of head and neck cancer, and in some cases, the primary tumor is not clinically evident. The purpose of imaging for LN metastasis from an unknown primary site is to identify the primary tumor or detect its absence, which leads to the correct diagnosis and optimal treatment. The authors discuss diagnostic imaging approaches for identifying the primary tumor in cases of unknown primary cervical LN metastases. The distribution and characteristics of LN metastases may help locate the primary site. Unknown primary LN metastasis often occurs at nodal levels II and III, and in recent reports, these were mostly related to human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx. Another characteristic imaging finding suggestive of metastasis from HPV-associated oropharyngeal cancer is a cystic change in LN metastases. Other characteristic imaging findings such as calcification may help predict the histologic type and locate the primary site. In cases of LN metastases at nodal levels IV and VB, a primary lesion located outside the head and neck region must also be considered. One clue for detecting the primary lesion at imaging is the disruption of anatomic structures, which can help in identifying small mucosal lesions or submucosal tumors at each subsite. Additionally, fluorine 18 fluorodeoxyglucose PET/CT may help identify a primary tumor. These imaging approaches for identifying primary tumors enable prompt identification of the primary site and assist clinicians in making the correct diagnosis. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Sota Masuoka
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Takashi Hiyama
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Hirofumi Kuno
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kotaro Sekiya
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Shingo Sakashita
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| |
Collapse
|
11
|
Caudal distribution pattern of metastatic neck lymph nodes in nasopharyngeal carcinoma and prognostic significance of nodal spread distances. Radiother Oncol 2023; 179:109443. [PMID: 36549339 DOI: 10.1016/j.radonc.2022.109443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/08/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the caudal distribution pattern of metastatic neck lymph nodes (LNs) in nasopharyngeal carcinoma (NPC) and the prognostic significance of nodal spread distances (SDs). MATERIALS AND METHODS NPC patients with neck metastatic LNs were enrolled. The most caudally located LNs were marked. SD was defined as the distance from marked LNs to the lateral process of the atlantoaxial spine (LPC1). Univariate and multivariate analyses were performed to assess association between MRI-identified nodal features and survival. Harrell's concordance index (C-index) and area under the curve (AUC) were used to compare AJCC (8th edition) N staging with the proposed N staging. Survival after induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) versus CCRT alone was compared between different SD groups. RESULTS A total of 1907 LNs (1164 patients) were contoured. SD > 7 cm was an independent predictor of overall survival (OS), distant metastasis-free survival (DMFS), and progression-free survival (PFS), with hazard ratios of 1.725, 1.553 and 1.414, respectively. When patients with SD > 7 cm were upgraded one N stage higher, the proposed N classification showed better stratification in OS, DMFS, and PFS between N1 and N2 stages. C-indices and AUCs of the proposed N staging were superior to AJCC N staging. IC + CCRT showed negative effect in N1-2 patients with SD ≤ 7 cm but improved OS in those with SD > 7 cm. CONCLUSION SD of metastatic LNs can predict survival in NPC. Integration of SD into AJCC N staging could improve its prognostic value and help identify patients requiring IC.
Collapse
|
12
|
Hu YJ, Lu TZ, Guo QJ, Zhang L, Xiao YP, Lin SJ, Zhou H, Zheng DC, Ding SR, Liu LZ, Gong XC, Li JG, Pan JJ, Xia YF. The role of radiologic extranodal extension in predicting prognosis and chemotherapy benefit for T1-2 N1 nasopharyngeal carcinoma: A multicenter retrospective study. Radiother Oncol 2023; 178:109436. [PMID: 36464180 DOI: 10.1016/j.radonc.2022.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE This multicenter retrospective study aimed to investigated the prognostic value of unequivocal radiologic extranodal extension (rENE) and the efficacy of chemotherapy for stage T1-2 N1 nasopharyngeal carcinoma (NPC) in the IMRT era. MATERIALS AND METHODS We included 1,082 patients treated in 2005-2017 from three centers. rENE was recorded as G1 (coalescent nodal mass comprising ≥ 2 inseparable nodes) or G2 (invading beyond perinodal fat to frankly infiltrate adjacent structures). Multivariable analysis (MVA) evaluated the prognostic value of rENE. The value of chemotherapy was assessed in rENE-positive (rENE + ) and rENE-negative (rENE - ) subset separately. RESULTS Centers 1, 2, and 3 had 139/515 (27.0 %), 100/365 (27.4 %), and 43/202 (21.3 %) cN + patients with rENE, respectively. Compared to rENE-, rENE + patients had a worse distant metastasis-free survival (DMFS) and overall survival (OS) (all p < 0.001). MVA confirmed the prognostic of both G1-rENE and G2-rENE for distant metastasis [G1: hazard ratio (HR): 2.933, G2: HR: 6.942, all p < 0.001] and death (G1: HR: 1.587, p = 0.040; G2: HR: 6.162, p < 0.001). There was no significant difference for DMFS and OS between chemo-radiotherapy and radiotherapy alone in rENE + and rENE - groups (all p > 0.1). However, rENE + patients with a cumulative cisplatin/nedaplatin dose (CCND) of > 160 mg/m2 had an improved DMFS (p = 0.033) but no OS (p = 0.197). CONCLUSION Unequivocal rENE is prognostic in patients with T1-2 N1 NPC. Addition of chemotherapy to radiotherapy did not affect DMFS and OS in rENE - patients. Chemotherapy with a CCND of > 160 mg/m2 improved DMFS in rENE + patients.
Collapse
Affiliation(s)
- Yu-Jun Hu
- Department of of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Tian-Zhu Lu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China; NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China; Jiangxi Key Laboratory of Translational Cancer Research, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Qiao-Juan Guo
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Lin Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China; NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China
| | - You-Ping Xiao
- Department of Radiology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Shao-Jun Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Han Zhou
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - De-Chun Zheng
- Department of Radiology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Shi-Rong Ding
- Department of of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Li-Zhi Liu
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiao-Chang Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China; NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China; Jiangxi Key Laboratory of Translational Cancer Research, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Jin-Gao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China; NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China; Jiangxi Key Laboratory of Translational Cancer Research, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China.
| | - Jian-Ji Pan
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
| | - Yun-Fei Xia
- Department of of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
| |
Collapse
|
13
|
MRI-identified multidimensional nodal features predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma. Radiol Oncol 2022; 56:479-487. [PMID: 36503717 PMCID: PMC9784368 DOI: 10.2478/raon-2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Reliable predictors are urgently needed to identify stage II nasopharyngeal carcinoma (NPC) patients who could benefit from concurrent chemoradiotherapy (CCRT). We aimed to develop a nomogram integrating MRI-identified multidimensional features of lymph nodes to predict survival and assist the decision-making of CCRT for stage II NPC. PATIENTS AND METHODS This retrospective study enrolled 242 stage II NPC patients treated from January 2007 to December 2017. Overall survival (OS) was the primary endpoint. Performance of nomogram was evaluated using calibration curves, Harrell Concordance Index (C-index), area under the curve (AUC) and decision curves analysis (DCA) and was compared with TNM staging. According to the individualized nomogram score, patients were classified into two risk cohorts and therapeutic efficacy of CCRT were evaluated in each cohort. RESULTS Three independent prognostic factors for OS: age, number and location of positive lymph nodes were included into the final nomogram. T stage was also incorporated due to its importance in clinical decision-making. Calibration plots demonstrated a good match between the predicted and our observed OS rates. C-index for nomogram was 0.726 compared with 0.537 for TNM staging (p < 0.001). DCAs confirmed the superior clinical utility of nomograms compared with TNM staging. CCRT compared to intensity-modulated radiotherapy (IMRT) delivered OS benefit to patients in the high-risk group (5-year: 89.9% vs. 72.1%; 10-year: 72.5% vs. 34.2%, p = 0.011), but not in the low-risk group. CONCLUSIONS This lymph node features-based nomogram demonstrated excellent discrimination and predictive accuracy for stage II patients and could identify patients who can benefit from CCRT.
Collapse
|
14
|
Xu YC, Chen KH, Liang ZG, Zhu XD. A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma. Front Oncol 2022; 12:843675. [PMID: 35903695 PMCID: PMC9317745 DOI: 10.3389/fonc.2022.843675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/31/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose The role of concurrent chemoradiotherapy (CCRT) in stage II nasopharyngeal carcinoma (NPC) is still controversial. Our objective is to evaluate the value of concurrent chemotherapy in stage II NPC receiving radiotherapy (RT). Methods We searched the PubMed, Embase, and Scopus databases for studies comparing CCRT versus RT alone in stage II NPC with survival outcomes and toxicities, including locoregional recurrence-free survival (LRFS), metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and grade 3–4 acute toxicities. The hazard ratios (HRs) of survival outcomes and risk ratios (RRs) of toxicities were extracted for meta-analysis. Subgroup analysis for stage N1 patients was performed to further explore whether these populations can earn benefits from concurrent chemotherapy. Results Nine eligible studies with a total of 4,092 patients were included. CCRT was associated with a better OS (HR = 0.61, 95% CI 0.44–0.82), LRFS (HR = 0.62, 95% CI 0.50–0.78), and PFS (HR = 0.65, 95% CI 0.54–0.79), but with similar DMFS (HR = 0.81, 95% CI = 0.46–1.45) compared with two-dimensional RT (2DRT) alone. However, CCRT showed no survival benefit in terms of OS (HR = 0.84, 95% CI 0.62–1.15), LRFS (HR = 0.85, 95% CI 0.54–1.34), DMFS (HR = 0.96, 95% CI 0.60–1.54), and PFS (HR = 0.96, 95% CI 0.66–1.37) compared with intensity-modulated RT (IMRT) alone. Subgroup analyses indicated that CCRT had similar OS (HR = 1.04, 95% CI 0.37–2.96), LRFS (HR = 0.70, 95% CI 0.34–1.45), DMFS (HR = 1.03, 95% CI 0.53–2.00), and PFS (HR = 1.04, 95% CI 0.58–1.88) in the stage N1 populations. Meanwhile, compared to RT alone, CCRT significantly increased the incidence of grade 3–4 leukopenia (RR = 4.00, 95% CI 2.29–6.97), mucositis (RR = 1.43, 95% CI 1.16–1.77), and gastrointestinal reactions (RR = 8.76, 95% CI 2.63–29.12). No significant differences of grade 3–4 toxicity in thrombocytopenia (RR = 3.45, 95% CI 0.85–13.94) was found between the two groups. Conclusion For unselected patients with stage II NPC, CCRT was superior to 2DRT alone with better LRFS, PFS, and OS, while adding concurrent chemotherapy to IMRT did not significantly improve survival but exacerbated acute toxicities. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022318253.
Collapse
Affiliation(s)
- Yao-Can Xu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
- Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Xiao-Dong Zhu,
| |
Collapse
|
15
|
Jiang Y, Yang S, Qi Y. Comment on: The prognostic value of radiologic extranodal extension in nasopharyngeal carcinoma: Systematic review and meta-analysis. Oral Oncol 2022; 130:105872. [PMID: 35550989 DOI: 10.1016/j.oraloncology.2022.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Yan Jiang
- Department of ENT, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou City 730050, Gansu, China
| | - Shaohua Yang
- Department of ENT, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou City 730050, Gansu, China
| | - Yinhui Qi
- Department of ENT, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou City 730050, Gansu, China.
| |
Collapse
|
16
|
Chin O, Alshafai L, O'Sullivan B, Su J, Hope A, Bartlett E, Hansen AR, Waldron J, Chepeha D, Xu W, Huang SH, Yu E. Inter-rater concordance and operating definitions of radiologic nodal feature assessment in human papillomavirus-positive oropharyngeal carcinoma. Oral Oncol 2022; 125:105716. [PMID: 35038657 DOI: 10.1016/j.oraloncology.2022.105716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE This study aims to evaluate the reliability of radiologic nodal feature assessment in clinical node-positive human papillomavirus-positive oropharyngeal carcinoma. MATERIALS AND METHODS Baseline CTs or MRIs of clinical node-positive human papillomavirus-positive oropharyngeal carcinoma diagnosed between 2012 and 2015 were reviewed independently by two neuroradiologists for seven nodal features: radiologic nodal involvement, cystic change, presence of necrosis, clustering, conglomeration, coalescence, and extranodal extension. Consensus operating definitions were derived after discussion. The features were re-reviewed in a randomly selected cohort. Levels of certainty (probability of presence: <25%, ∼50%, ∼75%, and >90%) were recorded. Interrater concordance was calculated using Cohen's kappa coefficient. RESULTS A total of 413 patients (826 necks) were eligible. At initial review, the inter-rater kappa values for: radiologic nodal involvement, cystic change, necrosis, clustering, conglomeration, coalescence, and extranodal extension were 0.92, 0.64, 0.48, 0.32, 0.32, 0.62, and 0.56, respectively. A re-review of 94 randomly selected cases (188 necks) after consolidation of operating definitions for nodal features showed that the inter-rater kappa values of these features were 0.83, 0.62, 0.58, 0.32, 0.18, 0.68, and 0.74 when considering ≥50% certainty as positive, and improved to 0.94, 0.66, 0.59, 0.33, 0.19, 0.76, and 0.86 when considering ≥75% certainty as positive. CONCLUSION Clearly defined nomenclature results in improved interrater reliability when assessing radiologic nodal features, especially for coalescent adenopathy and extranodal extension. Higher levels of certainty are associated with higher inter-rater agreement. Radiology reporting should include clear definitions of clinically relevant nodal features as well as levels of certainty to serve various needs in clinical care and research.
Collapse
Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Toronto, Canada
| | - Laila Alshafai
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jie Su
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Eric Bartlett
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Aaron R Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Douglas Chepeha
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
| |
Collapse
|
17
|
Yang SS, Wu YS, Pang YJ, Xiao SM, Zhang BY, Liu ZQ, Chen EN, Zhang X, OuYang PY, Xie FY. Development and validation of radiologic scores for guiding individualized induction chemotherapy in T3N1M0 nasopharyngeal carcinoma. Eur Radiol 2022; 32:3649-3660. [PMID: 34989842 PMCID: PMC9123027 DOI: 10.1007/s00330-021-08460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/08/2022]
Abstract
OBJECTIVES We aimed to develop and validate radiologic scores from [18F]FDG PET/CT and MRI to guide individualized induction chemotherapy (IC) for patients with T3N1M0 nasopharyngeal carcinoma (NPC). METHODS A total of 542 T3N1M0 patients who underwent pretreatment [18F]FDG PET/CT and MRI were enrolled in the training cohort. A total of 174 patients underwent biopsy of one or more cervical lymph nodes. Failure-free survival (FFS) was the primary endpoint. The radiologic score, which was calculated according to the number of risk factors from the multivariate model, was used for risk stratification. The survival difference of patients undergoing concurrent chemoradiotherapy (CCRT) with or without IC was then compared in risk-stratified subgroups. Another cohort from our prospective clinical trial (N = 353, NCT03003182) was applied for validation. RESULTS The sensitivity of [18F]FDG PET/CT was better than that of MRI (97.7% vs. 87.1%, p < 0.001) for diagnosing histologically proven metastatic cervical lymph nodes. Radiologic lymph node characteristics were independent risk factors for FFS (all p < 0.05). High-risk patients (n = 329) stratified by radiologic score benefited from IC (5-year FFS: IC + CCRT 83.5% vs. CCRT 70.5%; p = 0.0044), while low-risk patients (n = 213) did not. These results were verified again in the validation cohort. CONCLUSIONS T3N1M0 patients were accurately staged by both [18F]FDG PET/CT and MRI. The radiologic score can correctly identify high-risk patients who can gain additional survival benefit from IC and it can be used to guide individualized treatment of T3N1M0 NPC. KEY POINTS • [18F]FDG PET/CT was more accurate than MRI in diagnosing histologically proven cervical lymph nodes. • Radiologic lymph node characteristics were reliable independent risk factors for FFS in T3N1M0 nasopharyngeal carcinoma patients. • High-risk patients identified by the radiologic score based on [18F]FDG PET/CT and MRI could benefit from the addition of induction chemotherapy.
Collapse
Affiliation(s)
- Shan-Shan Yang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Yi-Shan Wu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Ya-Jun Pang
- Cancer Center, Affiliated Hospital of Guangdong Medical University, Renmin Avenue, Xiashan District, Zhanjiang, China
| | - Su-Ming Xiao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Bao-Yu Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Zhi-Qiao Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - En-Ni Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Xu Zhang
- Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Pu-Yun OuYang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| | - Fang-Yun Xie
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou, 510060 China
| |
Collapse
|
18
|
Guo Q, Xiao N, Xu H, Zong J, Xiao Y, Lu T, Xu Y, Wang B, Chen B, Pan J, Lin S. Level Ib sparing intensity-modulated radiation therapy in selected nasopharyngeal carcinoma patients based on the International Guideline. Radiother Oncol 2021; 167:239-243. [PMID: 34973279 DOI: 10.1016/j.radonc.2021.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the feasibility of level Ib sparing in selected nasopharyngeal carcinoma (NPC) patients during intensity-modulated radiation therapy (IMRT) based on the International Guideline. PATIENTS AND MATERIALS Patients with histologically-proven NPC who received definitive IMRT at our group were candidates for this analysis. Other eligibility criteria for analysis were designed according to the recommendation of International Guideline for selective coverage of level Ib. Survival outcomes focused on regional recurrence-free survival (RRFS) and level Ib recurrence rate were analyzed. RESULTS A total of 450 patients were included, 60 of them received level Ib-covering IMRT due to the first three principles of the International Guideline according to our protocol. Of note, patients with level Ib involvement would receive ultrasound guided puncture, only those with positive pathological results would undergo level Ib-covering IMRT. For the remaining 390 patients who only fulfilled the last two criteria and/or level Ib involvement with negative pathological results, level Ib-sparing IMRT was delivered, with a median follow-up time of 112 months (range 6 to 194 months), reported 5- and 10-year RRFS were 95.4% and 92.9%, respectively. Twenty-two patients occurred regional recurrence at censorship (median 44.5 months), only 4(4/390, 1.03%) were recorded as level Ib recurrence. CONCLUSION Level Ib-sparing IMRT should be safe and feasible for patients who only had level II involvement with ECE, and/or had a MAD of greater than 2 cm in level II, and/or level Ib involvement with negative pathological results. Further well-designed multi-center prospective trials should be conducted.
Collapse
Affiliation(s)
- Qiaojuan Guo
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China; Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Xiao
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hanchuan Xu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jingfeng Zong
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Youping Xiao
- Department of Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Tianzhu Lu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Yun Xu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Bingyi Wang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Bijuan Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China; Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
| |
Collapse
|
19
|
Chin O, Yu E, O'Sullivan B, Su J, Tellier A, Siu L, Waldron J, Kim J, Hansen A, Hope A, Cho J, Giuliani M, Ringash J, Spreafico A, Bratman S, Hosni A, Hahn E, Tong L, Xu W, Huang SH. Prognostic importance of radiologic extranodal extension in nasopharyngeal carcinoma treated in a Canadian cohort. Radiother Oncol 2021; 165:94-102. [PMID: 34718052 DOI: 10.1016/j.radonc.2021.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To confirm the prognostic value of radiologic extranodal extension (rENE) and its role in clinical-N classification in nasopharyngeal carcinoma (NPC) treated in a western institution. METHODS AND MATERIALS NPC treated between 2010 and 2017 were included. Pre-treatment MRI were reviewed for unequivocal rENE and its grade: grade-1: tumour invading through any nodal capsule but confined to perinodal fat; grade-2: ≥2 adjacent nodes forming a coalescent nodal mass; grade-3: tumour extending beyond perinodal fat to invade/encase adjacent structures. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) and rENE-negative (rENE-) patients. Multivariable analysis (MVA) confirmed the prognostic importance of rENE and its grade. Staging schemas including rENE in N-classification were proposed and their performance evaluated. RESULTS A total of 274 patients were eligible (43 cN0; 231 cN-positive). rENE was identified in 83/231 (36%) cN-positive, including grade 1/2/3 rENE in 14/58/11 cases. Compared to rENE-, rENE+ patients had a lower OS (68% vs 89%, p < 0.001) and DFS (58% vs 80%, p < 0.001). MVA confirmed the prognostic importance of grade-2 [HR: OS: 2.85 (p = 0.005); DFS: 2.89 (p < 0.001)] and grade-3 rENE [HR: OS 5.28 (p = 0.004); DFS 3.86 (p = 0.005)], with a trend for grade-1 vs rENE- [HR: OS 2.63 (p = 0.13); DFS 1.49 (p = 0.520)]. We evaluated classifying any rENE as cN3 (Proposal-I) or any grade-2/grade-3 rENE as cN3 (Proposal-II). The stage schema with Proposal-I cN-classification ranked the highest in the performance evaluation. CONCLUSIONS rENE is an important prognostic factor in this western NPC cohort. We propose classifying any unequivocal rENE as cN3.
Collapse
Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Canada
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Anais Tellier
- Department of Neuroradiology, University of Toronto, Canada
| | - Lillian Siu
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Aaron Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Anna Spreafico
- Division of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Scott Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada.
| |
Collapse
|
20
|
The prognostic value of radiologic extranodal extension in nasopharyngeal carcinoma: Systematic review and meta-analysis. Oral Oncol 2021; 122:105518. [PMID: 34507205 DOI: 10.1016/j.oraloncology.2021.105518] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/21/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The prognostic value of radiologic extranodal extension (rENE) in nasopharyngeal carcinoma remains controversial. In this study, a meta-analysis was performed to assess the prognostic value of ungraded rENE and unambiguous advanced rENE. METHODS A literature search through PubMed, Cochrane Library, EMBASE and manual searches was conducted until May 2021. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival and distant metastasis-free survival were extracted and pooled. RESULTS Nine eligible studies were published between 2012 and 2021. The pooled patient number was 7532 (range 61-1887). Seven studies were eligible for the analysis of ungraded rENE, while 3 studies were eligible for unambiguous advanced rENE. The results showed that ungraded rENE was associated with worse overall survival (HR 1.85, 95% CI 1.04-3.27) and significantly associated with worse distant metastasis-free survival (HR 2.07, 95% CI 1.36-3.13). On the other hand, unambiguous advanced rENE was significantly associated with worse overall survival (HR 2.62, 95% CI 2.12-3.25) and worse distant metastasis-free survival (HR 3.14, 95% CI 1.85-5.33). CONCLUSIONS In nasopharyngeal carcinoma, both ungraded and unambiguous advanced rENE are significant prognosticators of overall survival and distant metastasis-free survival. More prospective studies are required to determine its role in risk stratification or clinical staging.
Collapse
|
21
|
Karakurt Eryılmaz M, Kadıyoran C. Prognostic Significance of Radiologic Extranodal Extension in Nasopharyngeal Cancer. Otolaryngol Head Neck Surg 2021; 166:321-326. [PMID: 33874793 DOI: 10.1177/01945998211008887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the prognostic value of radiologic extranodal extension (rENE) in patients with nasopharyngeal cancer. STUDY DESIGN Retrospective review. SETTING Tertiary university hospital. METHODS We identified patients with nasopharyngeal cancer and lymph node metastasis who underwent pretreatment neck computed tomography or magnetic resonance imaging and evaluated rENE from the involved lymph node. Univariate Kaplan-Meier and multivariate Cox regression analyses were used to compare rENE+ and rENE- groups for local regional relapse-free survival, distant metastasis-free survival, and overall survival. RESULTS Of 61 cases, 24 (39.3%) were rENE+ and 37 (60.7%) were rENE-. The median follow-up was 65.5 months. The 5-year distant metastasis-free survival and overall survival rates were lower in the rENE+ group than the rENE- group (70.8% vs 89.2%, P = .016; 66.7% vs 89.2%, P = .01, respectively). Differences in locoregional control between the groups were not significant (P = .18). The 5-year rates for local regional relapse-free survival were 87.5% for rENE+ and 91.9% for rENE-. In multivariate analysis, the presence of rENE was a significant independent adverse prognostic factor for distant metastasis-free survival and overall survival. CONCLUSIONS We showed that rENE is an independent prognostic factor for poor distant control and survival in patients with nasopharyngeal cancer.
Collapse
Affiliation(s)
- Melek Karakurt Eryılmaz
- Department of Medical Oncology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cengiz Kadıyoran
- Department of Radiology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
22
|
Huang SH, Chernock R, O'Sullivan B, Fakhry C. Assessment Criteria and Clinical Implications of Extranodal Extension in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:265-278. [PMID: 34010048 DOI: 10.1200/edbk_320939] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tumor breaching the capsule of a lymph node is termed extranodal extension (ENE). It reflects aggressiveness of a tumor, creates anatomic challenges for disease clearance, and increases the risk of distant metastasis. Extranodal extension can be assessed on a pathology specimen, by radiology studies, and by clinical examination. Presence of ENE in a pathology specimen has long been considered a high-risk feature of disease progression and would ordinarily benefit from the addition of chemotherapy to adjuvant radiotherapy. Although the eighth edition of the Union for International Cancer Control/American Joint Committee on Cancer stage classification dichotomizes pathologic ENE according to its presence or absence, emerging evidence suggests that the extent of a pathologic ENE may provide additional value for risk stratification to guide adjuvant therapy. Recent data suggest that the prognostic importance of pathologic ENE is also applicable for HPV-associated head and neck squamous cell carcinoma. In addition, compelling data demonstrate that indisputable radiologic ENE is a powerful risk stratification tool to identify patients at high risk for treatment failure, especially distant metastasis, applicable for both HPV-positive and HPV-negative head and neck squamous cell carcinoma. However, the definition and taxonomy of radiologic ENE requires standardization. The goal of this review is to clarify the contemporary understanding of the prognostic implications of ENE in head and neck squamous cell carcinoma, present the nuances of what is presently known and unknown, and elucidate how to classify ENE pathologically and radiologically with an understanding of the strengths and weaknesses of each approach. Finally, with the development of several risk stratification methods, the relative role of ENE and other prognostic schema will be explored.
Collapse
Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology and Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Brian O'Sullivan
- Department of Radiation Oncology and Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Carole Fakhry
- Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
23
|
Tirelli G, de Groodt J, Sia E, Belgrano MG, Degrassi F, Boscolo-Rizzo P, Cova MA, Marcuzzo AV. Accuracy of the Anatomage Table in detecting extranodal extension in head and neck cancer: a pilot study. J Med Imaging (Bellingham) 2021; 8:014502. [PMID: 33542944 DOI: 10.1117/1.jmi.8.1.014502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered "cases" and patients with negative histological examination for ENE ( pENE - ) were considered "controls." Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15 mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15 mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.
Collapse
Affiliation(s)
- Giancarlo Tirelli
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | - Jasmina de Groodt
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Egidio Sia
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | | | - Ferruccio Degrassi
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- University of Padua, Treviso Regional Hospital, Otolaryngology, Treviso, Italy
| | - Maria Assunta Cova
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy.,ENT and Head and Neck Surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUGI, Trieste, Italy
| |
Collapse
|
24
|
Fan KH, Yeh CH, Hung SP, Kang CJ, Huang SF, Chang KP, Wang HM, Chia-Hsun Hsieh J, Lin CY, Cheng AJ, Ng SH, Tung-Chieh Chang J. Prognostic value of radiologic extranodal extension in patients with hypopharyngeal cancer treated with primary chemoradiation. Radiother Oncol 2020; 156:217-222. [PMID: 33385465 DOI: 10.1016/j.radonc.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the prognostic value of radiologic extranodal extension (rENE) in patients with hypopharyngeal cancer (HPC) treated with primary chemoradiation. MATERIALS AND METHODS Cancer registry data were reviewed from 2005 to 2014. Inclusion criteria included HPC, clinical N1-3 disease (AJCC staging system, 7th edition), and receiving radiotherapy. Patients with M1 diseaseor with synchronous/metachronous cancer were excluded. Staging images were reviewed by two radiologists. rENE was defined as infiltration of adjacent fat/muscles, irregular nodal surface, or irregular capsular enhancement. Clinical stage, rENE status, and clinical outcome were analyzed. RESULTS Overall, 355 patients were included. Patients with rENE had lower 3-year overall survival (OS) and recurrence-free survival (RFS) rates. Univariate analysis showed that clinical T4 or N3 stage, overall stage IV, and rENE correlated with OS and RFS. In multivariate analysis, clinical T4 or N3 stage correlated with poor OS, while clinical T4 or N3 stage and rENE were independent predictors of poor RFS. N1/2 without rENE was designated as Group 1, N1/2 with rENE as Group 2, and N3 with/without rENE as Group 3. The 3-year RFS rates in Groups 1, 2, and 3 were 55.8%, 41.0%, and 29.3%, respectively. The 3-year RFS rate in Group 1 was significantly higher than that in the other two groups. CONCLUSIONS rENE is an adverse prognostic factor for survival in patients with HPC treated with primary chemoradiation. It correlated with inferior RFS regardless of N stage. rENE may be used as a criterion for clinical ENE in future staging systems.
Collapse
Affiliation(s)
- Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, Taiwan; Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Xiamen, China.
| |
Collapse
|
25
|
Sananmuang T, Yu E, Su J, O'Sullivan B, Rathod S, Chan B, Bartlett E, Waldron J, Ringash J, Kim J, Bratman SV, Hope A, Spreafico A, Hansen AR, de Almeida J, Goldstein DP, Witterick I, Tong L, Xu W, Huang SH. Pre- and Post-Radiotherapy Radiologic Nodal Features and Oropharyngeal Cancer Outcomes. Laryngoscope 2020; 131:E1162-E1171. [PMID: 33002201 DOI: 10.1002/lary.29045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the prognostic value of pre-/post-radiotherapy (pre-/post-RT) radiologic lymph node (LN) features in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal carcinoma (OPC) patients treated with definitive (chemo-)RT. METHODS Clinical node-positive OPCs treated from 2011 to 2015 were reviewed. Nodal features were reviewed by a radiologist on pre-/post-RT computed tomography (CTs). Univariable analysis calculated hazard ratio (HR) for regional failure (RF), distant metastasis (DM), and deaths. Multivariable analysis estimated adjusted HR (aHR) of significant nodal features identified in univariable analysis adjusting for confounders. RESULTS Pre-RT CT was undertaken in 344 HPV-positive and 94 HPV-negative OPC patients, of whom 242 (70%) HPV-positive and 67 (71%) HPV-negative also had a post-RT CT. Median follow-up was 4.9 years. Pre-RT LN calcification (pre-RT_LN-cal) increased the risk of RF in HPV-negative (aHR: 5.3, P = .007) but not HPV-positive patients (P = .110). Pre-RT radiologic extranodal extension (pre-RT_rENE+) increased the risk of DM and death in both HPV-negative (DM: aHR 6.6, P < .001; death: aHR 2.1, both P = .019) and HPV-positive patients (DM: aHR 4.9; death: aHR 3.0, both P < .001). Increased risk of RF occured with < 20% post-RT LN size reduction in both HPV-negative (HR 6.0, P = .002) and HPV-positive cases (HR 3.0, P = .049). Post-RT_LN-cal did not affect RF, DM, or death regardless of tumor HPV status (all P > .05). CONCLUSION Pre-RT_LN-cal is associated with higher RF risk in HPV-negative but not in HPV-positive patients. Pre-RT_rENE increases risk of DM and death regardless of tumor HPV status. Minimal post-RT LN size reduction (< 20%) increases risk of RF in both diseases. Post-RT_LN-cal + has no apparent influence on outcomes in either disease. LEVEL OF EVIDENCE 4 (a single institution case-control series) Laryngoscope, 131:E1162-E1171, 2021.
Collapse
Affiliation(s)
- Thiparom Sananmuang
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine, Ramathibodi Hospital/Mahidol University, Bangkok, Thailand
| | - Eugene Yu
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Shrinivas Rathod
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biu Chan
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Eric Bartlett
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer, Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Division of Medical Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Li Tong
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, The Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Shao H Huang
- Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Ma H, Qiu Y, Li H, Xie F, Ruan G, Liu L, Cui C, Dong A. Prognostic Value of Nodal Matting on MRI in Nasopharyngeal Carcinoma Patients. J Magn Reson Imaging 2020; 53:152-164. [PMID: 32860315 DOI: 10.1002/jmri.27339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Nodal (N) stage is one of the most important predictors for distant metastasis in nasopharyngeal carcinoma (NPC) patients. It may ignore potentially useful nodal features, such as nodal matting (three or more lymph nodes abutting together with the absence of intervening fat planes). PURPOSE To explore the prognostic value of nodal matting in NPC patients and construct a nomogram with nodal matting for predicting distant metastasis-free survival (DMFS). STUDY TYPE Retrospective. POPULATION In all, 792 NPC patients treated with intensity modulated radiation therapy from 2010 to 2013 were enrolled with 2:1 training (n = 527) and validation (n = 65) cohorts. FIELD STRENGTH/SEQUENCE T1 - and T2 -weighted imaging at 1.5 or 3.0T. ASSESSMENT Nodal matting and other nodal characteristics were assessed with MRI. MR images were evaluated separately by three radiologists. The association between nodal matting and DMFS was analyzed. STATISTICAL TESTS Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. Nomograms were constructed from a multivariate logistic regression model with and without nodal matting. The predictive accuracy and discriminative ability of the nomograms were determined by concordance index (C-index) and calibration curves. The results were validated using bootstrap resampling and validation cohort. RESULTS The incidence of nodal matting was 24.6% (195/792) in all patients. In the training cohort, nodal matting was independently associated with DMFS (hazard ratio [HR] = 1.97 [1.05-3.69], P < 0.05). N1 patients with nodal matting had worse DMFS than N1 patients without (P < 0.05). However, no significant difference was observed when comparing N1 patients with nodal matting to N2 patients (P = 0.464). The C-index of the nomogram with nodal matting was higher than the nomogram without (0.717 vs. 0.699, P = 0.084). DATA CONCLUSION Nodal matting was an independent prognostic factor for DMFS in NPC patients. It may help to select patients at high risk of distant metastasis.
Collapse
Affiliation(s)
- Huali Ma
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yinyi Qiu
- Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Fei Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | | | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| |
Collapse
|
27
|
Pan XB, Li L, Qu S, Chen L, Liang SX, Zhu XD. The efficacy of chemotherapy in survival of stage II nasopharyngeal carcinoma. Oral Oncol 2019; 101:104520. [PMID: 31841883 DOI: 10.1016/j.oraloncology.2019.104520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Chemotherapy use remains controversial for stage II nasopharyngeal carcinoma (NPC). This retrospective study was conducted to identify whether chemoradiotherapy was associated with better survival compared to radiotherapy. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for stage II NPC patients between 2004 and 2015. Patients were divided into radiotherapy and chemoradiotherapy groups. Overall survival (OS) and cancer-specific survival (CSS) were examined using the Kaplan-Meier method, Cox proportional hazards models, and propensity score matching analyses. RESULTS This study examined 908 patients, including 102 receiving radiotherapy and 806 receiving chemoradiotherapy. Chemoradiotherapy was associated with 5-year OS (78.01% vs. 75.12%; p = 0.22) and CSS (78.92% vs. 78.26%; p = 0.40) rates comparable to those of radiotherapy. Propensity score matching analyses demonstrated similar OS (HR: 0.63, 95% CI: 0.36--1.10; p = 0.10) and CSS (HR: 0.77, 95% CI: 0.41-1.48; p = 0.44) rates with radiotherapy. Age >60 years and non-Asian patients were associated with worse survival. CONCLUSION This study revealed that chemoradiotherapy showed similar survivals to stage II NPC patients compared with radiotherapy. Due to the limitations of SEER database, further studies should be performed to verify the results.
Collapse
Affiliation(s)
- Xin-Bin Pan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Ling Li
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Song Qu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Long Chen
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, PR China.
| |
Collapse
|
28
|
Prognostic value of radiologic extranodal extension and its potential role in future N classification for nasopharyngeal carcinoma. Oral Oncol 2019; 99:104438. [DOI: 10.1016/j.oraloncology.2019.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/21/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022]
|