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Ben-Ami T. Nasopharyngeal Carcinoma in Children, Current Treatment Approach. J Pediatr Hematol Oncol 2024; 46:117-124. [PMID: 38447121 PMCID: PMC10956687 DOI: 10.1097/mph.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of pediatric NPC includes chemotherapy and radiotherapy. Most studies on the treatment of pediatric NPC are single-arm studies. With current treatment protocols survival rates for patients with nonmetastatic disease exceed 80%, although most children will have long-term treatment-related late effects. Efforts to reduce early and late toxicities include reduced radiotherapy doses in children with good responses to induction chemotherapy. Further studies are needed to evaluate the role of immunotherapy in both the primary setting and in children with progressive or relapsed disease. This review summarizes current clinical approaches to the treatment of pediatric NPC.
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Guo SS, Yang JH, Sun XS, Liu LZ, Yang ZC, Liu LT, Liu SL, Li XY, Lv XF, Luo DH, Li JB, Liu Q, Wang P, Guo L, Mo HY, Sun R, Yang Q, Liang YJ, Jia GD, Zhao C, Chen QY, Tang LQ, Mai HQ. Reduced-dose radiotherapy for Epstein-Barr virus DNA selected staged III nasopharyngeal carcinoma: A single-arm, phase 2 trial. Eur J Cancer 2023; 194:113336. [PMID: 37801967 DOI: 10.1016/j.ejca.2023.113336] [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: 05/08/2023] [Revised: 08/20/2023] [Accepted: 09/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Radiotherapy-related toxicities of nasopharyngeal carcinoma (NPC) caused by a standard dose of 70 Gy remain a critical issue. Therefore, we assessed whether a radiotherapy dose of 60 Gy was non-inferior to the standard dose in patients with low-risk stage III NPC with a favourable response to induction chemotherapy (IC). PATIENTS AND METHODS We did a single-arm, single-centre, phase II clinical trial in China. Patients with low-risk (Epstein-Barr virus [EBV] DNA level <4000 copies/ml) stage III NPC were treated with two cycles IC. Patients with complete/partial response and undetectable EBV DNA level were assigned 60 Gy intensity-modulated radiotherapy concurrently with three cycles of cisplatin. The primary end-point was 2-year progression-free survival (PFS). This trial is registered with ClinicalTrials.gov, number NCT03668730. RESULTS One patient quit because of withdrawal of informed consent after IC. In total, 215 patients completed two cycles of IC, after which 116 (54.0%) and 99 (46.0%) patients were assigned 60 and 70 Gy radiotherapy, respectively. For 215 patients, the 2-year PFS was 90.7% (95% CI, 86.8%-94.6%) with a median follow-up of 43.9 months (interquartile range [IQR], 39.8-46.2). For patients treated with 60 Gy radiotherapy, the 2-year PFS rate was 94.8% (95%CI 90.7%-98.9%) with a median follow-up of 43.9 months (IQR 40.2-46.2). The most common late toxicity was grade 1-2 dry mouth (incidence rate: 54.3%). No grade 3+ long-term adverse event was observed, and most quality-of-life items, domains, and symptom scores returned to baseline by 6 months. CONCLUSION Reduced-dose radiation (60 Gy) is associated with favourable survival outcomes and limited treatment-related toxicities in patients with low-risk stage III NPC sensitive to IC.
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Affiliation(s)
- Shan-Shan Guo
- 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, Guangzhou, People's Republic of China
| | - Jin-Hao Yang
- 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, Guangzhou, People's Republic of China
| | - Xue-Song Sun
- 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, Guangzhou, People's Republic of China
| | - Li-Zhi 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, People's Republic of China
| | - Zhen-Chong Yang
- 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, Guangzhou, People's Republic of China
| | - Li-Ting Liu
- 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, Guangzhou, People's Republic of China
| | - Sai-Lan Liu
- 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, Guangzhou, People's Republic of China
| | - Xiao-Yun Li
- 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, Guangzhou, People's Republic of China
| | - Xiao-Fei Lv
- 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, People's Republic of China
| | - Dong-Hua Luo
- 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, Guangzhou, People's Republic of China
| | - Ji-Bin Li
- Clinical Trials Center, 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, People's Republic of China
| | - Qing Liu
- Clinical Trials Center, 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, People's Republic of China
| | - Pan Wang
- 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, Guangzhou, People's Republic of China
| | - Ling Guo
- 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, Guangzhou, People's Republic of China
| | - Hao-Yuan Mo
- 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, Guangzhou, People's Republic of China
| | - Rui Sun
- 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, Guangzhou, People's Republic of China
| | - Qi Yang
- 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, Guangzhou, People's Republic of China
| | - Yu-Jing Liang
- 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, People's Republic of China
| | - Guo-Dong Jia
- 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, Guangzhou, People's Republic of China
| | - Chong Zhao
- 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, Guangzhou, People's Republic of China
| | - Qiu-Yan Chen
- 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, Guangzhou, People's Republic of China
| | - Lin-Quan Tang
- 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, Guangzhou, People's Republic of China
| | - Hai-Qiang Mai
- 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, Guangzhou, People's Republic of China.
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Hou FJ, Zhao D, Yan XY, Li XT, Sun Y, Sun YS, Gao SY. Efficacy evaluation of different measurement methods for target lesions after neoadjuvant chemotherapy and radical radiotherapy in locally advanced hypopharyngeal carcinoma. Asia Pac J Clin Oncol 2023; 19:187-195. [PMID: 35692104 DOI: 10.1111/ajco.13796] [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: 12/17/2021] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 01/22/2023]
Abstract
AIM To assess the diagnostic efficacy in response evaluation of hypopharyngeal carcinoma (HPC) using different CT measurement methods. METHODS AND MATERIALS One hundred and three patients with locally advanced HPC receiving neoadjuvant chemotherapy (NACT) and radical radiotherapy (RT) were retrospectively enrolled. The long diameter, short diameter and largest axial area of the tumors and the largest metastatic cervical lymph node (LN) were measured before and after NACT, at the end of RT and 1 month after RT. Tumor regression ratios of the sum of the tumor's long diameter and LN's short diameter (LDTSDL), the sum of tumor and LN's short diameter (TTSDL), the sum of tumor and LN's largest axial area (AATML) were calculated. Analysis was conducted for overall survival (OS), metastasis-free survival, regional recurrence-free survival (RRFS), and local recurrence-free survival (LRFS). RESULTS Note that 35, 28, 23, and 16 patients suffered death, local recurrence, regional recurrence and distant metastasis, respectively. TTSDL-defined effective group demonstrated better LRFS (p = .039) and RRFS (p = .047) after NACT and better OS since the end of RT (p = .037); AATML-defined effective groups demonstrated better OS, LRFS, and RRFS since the end of RT (p = .015, .008, and .005). While LDTSDL-defined groups showed differences in OS and LRFS until 1 month after RT (p = .013 and .014). CONCLUSIONS The regression rate of TTSDL and AATML can distinguish prognosis at an earlier time and demonstrated better reliability compared with LDTSDL. They were recommended for response evaluation in HPC.
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Affiliation(s)
- Fang-Jing Hou
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Dan Zhao
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Xin-Yue Yan
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Xiao-Ting Li
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Yan Sun
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Ying-Shi Sun
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
| | - Shun-Yu Gao
- Department of Radiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Peking University, Beijing, P.R. China
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Temiz M, Duman SB, Abdelkarim AZ, Bayrakdar IS, Syed AZ, Eser G, Celik Ozen D, Gedik HT, Ugurlu M, Jagtap R. Nasopharynx evaluation in children of unilateral cleft palate patients and normal with cone beam computed tomography. Sci Prog 2023; 106:368504231157146. [PMID: 36855800 PMCID: PMC10364791 DOI: 10.1177/00368504231157146] [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] [Indexed: 03/02/2023]
Abstract
OBJECTIVE This study aimed to examine the morphological characteristics of the nasopharynx in unilateral Cleft lip/palate (CL/P) children and non-cleft children using cone beam computed tomography (CBCT). METHODS A retrospective study consisted of 54 patients, of which 27 patients were unilateral CL/P, remaining 27 patients have no CL/P. Eustachian tubes orifice (ET), Rosenmuller fossa (RF) depth, presence of pharyngeal bursa (PB), the distance of posterior nasal spine (PNS)-pharynx posterior wall were quantitatively evaluated. RESULTS The main effect of the CL/P groups was found to be effective on RF depth-right (p < 0.001) and RF depth-left (p < 0.001). The interaction effect of gender and CL/P groups was not influential on measurements. The cleft-side main effect was found to be effective on RF depth-left (p < 0.001) and RF depth-right (p = 0002). There was no statistically significant relationship between CL/P groups and the presence of bursa pharyngea. CONCLUSIONS Because it is the most common site of nasopharyngeal carcinoma (NPC), the anatomy of the nasopharynx should be well known in the early diagnosis of NPC.
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Affiliation(s)
- Mustafa Temiz
- Department of Oral and Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Suayip Burak Duman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Ahmed Z. Abdelkarim
- Division of Oral & Maxillofacial Radiology, Collage of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Ibrahim Sevki Bayrakdar
- Eskisehir Osmangazi University Center of Research and Application for Computer Aided Diagnosis and Treatment in Health, Eskisehir, Turkey
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ali Z. Syed
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Gozde Eser
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Duygu Celik Ozen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Hatice Tugce Gedik
- Department of Anatomy, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mehmet Ugurlu
- Department of Orthodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Rohan Jagtap
- Division of Oral & Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MI, USA
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Ma LQ, Wu HX, Kong XQ, Fei ZD, Fang WN, Du KX, Chen F, Zhao D, Wu ZP. Which evaluation criteria of the short-term efficacy can better reflect the long-term outcomes for patients with nasopharyngeal carcinoma? Transl Oncol 2022; 20:101412. [PMID: 35395603 PMCID: PMC8987992 DOI: 10.1016/j.tranon.2022.101412] [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: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 12/08/2022] Open
Abstract
1D, 2D, and 3D measurements were all significantly correlated with PTV measurement. The 1D measurement more closely agreed with the PTV measurement than the 2D and 3D measurements. 1D tumor response assessment of the short-term efficacy can reflect the PFS for patients with nasopharyngeal carcinoma.
Purpose To compare the consistency of one-dimensional Response Evaluation Criteria in Solid Tumors (1D-RECIST), two-dimensional WHO criteria (2D-WHO), and three-dimensional (3D) measurement for therapeutic response assessment of nasopharyngeal carcinoma (NPC). Materials and methods Retrospective data of 288 newly diagnosed NPC patients were reviewed. Tumor size was assessed on magnetic resonance imaging (MRI) according to the 1D-RECIST, 2D-WHO, and 3D measurement criteria. Agreement between tumor responses was assessed using unweighted k statistics. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of the PTV. The Kaplan–Meier method and Cox regression were used for the survival analysis. Results The optimal cut-off point of the PTV for progression-free survival (PFS) was 29.6%. Agreement with PTV measurement was better for 1D measurement than for 2D and 3D measurements (kappa values of 0.646, 0.537, and 0.577 for 1D, 2D, and 3D measurements, respectively; P < 0.05). The area under the curve of the 1D measurement (AUC=0.596) was similar to that of the PTV measurement (AUC=0.621). Compared with 2D and 3D measurements, 1D measurement is superior for predicting prognosis in NPC (C-index of 0.672, 0.663, and 0.646 were for 1D, 2D, and 3D measurements, respectively; P < 0.005). Survival analysis showed that patients with non-responders had worse prognosis (P < 0.05). Conclusions The 1D measurement more closely agreed with the PTV measurement than the 2D and 3D measurements for predicting therapeutic responses in NPC. Therefore, we recommend using the less time-consuming 1D-RECIST criteria in routine clinical practice.
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Affiliation(s)
- Li-Qin Ma
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China; College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou 350128, China.
| | - Hai-Xia Wu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou 350128, China
| | - Xiang-Quan Kong
- Department of Radiation Oncology, Xiamen Humanity Hospital Fujian Medical University, Xiamen 361016, China
| | - Zhao-Dong Fei
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Wei-Ning Fang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Kai-Xin Du
- Department of Radiation Oncology, Xiamen Humanity Hospital Fujian Medical University, Xiamen 361016, China
| | - Fei Chen
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou 350128, China
| | - Dan Zhao
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou 350128, China
| | - Zhu-Peng Wu
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou 350128, China
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Abstract
Nasopharyngeal carcinoma is endemic in parts of the world such as southern China and Southeast Asia. It is predominantly an undifferentiated carcinoma with a strong genetic basis and a close association with the Epstein-Barr virus. The ability of MR imaging to depict the boundaries of the primary tumor and its relationship with the complex structures of the skull base makes it the technique of choice for imaging of this disease in the head and neck. This article describes the MR imaging findings pertinent to staging and management and a new role of MR imaging in early cancer detection, in addition to a brief discussion of differential diagnoses.
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Affiliation(s)
- Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China.
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Ben-Ami T, Kontny U, Surun A, Brecht IB, Almaraz RL, Dragomir M, Pourtsidis A, Casanova M, Fresneau B, Bisogno G, Schneider DT, Reguerre Y, Bien E, Stachowicz-Stencel T, Österlundh G, Wygoda M, Janssens GO, Zsiros J, Jehanno N, Brisse HJ, Gandola L, Christiansen H, Claude L, Ferrari A, Rodriguez-Galindo C, Orbach D. Nasopharyngeal carcinoma in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e29018. [PMID: 33844410 DOI: 10.1002/pbc.29018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare pediatric tumor. Collaborative studies performed over the last decades showed improved results compared to historical data, but standardized guidelines for diagnosis and management of pediatric NPC are still unavailable. This study presents a European consensus guideline for the diagnosis and treatment of pediatric NPC developed by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT). Main recommendations include induction chemotherapy with cisplatin and 5-flurouracil, concomitant chemoradiotherapy in advanced disease, and to consider maintenance treatment with interferon beta (IFN-β) for selected high-risk patients. Dose adjustments of radiotherapy based on response to induction chemotherapy may decrease the rates of long-term treatment-related complications that affect most of the survivors.
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Affiliation(s)
- Tal Ben-Ami
- Pediatric Hematology-Oncology Unit, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Udo Kontny
- Division of Pediatric Hematology Oncology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Aurore Surun
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Ines B Brecht
- Pediatric Hematology and Oncology, University Children's Hospital, Eberhard-Karls-Universitaet, Tuebingen, Germany
| | - Ricardo López Almaraz
- Pediatric Hematology and Oncology Unit, Hospital Universitario de Cruces, Barakaldo-Bizkaia, Spain
| | - Monica Dragomir
- Department of Pediatric Oncology, Oncology Institute "Prof. Dr. Al. Trestioreanu,", Bucharest, Romania
| | - Apostolos Pourtsidis
- Pediatric and Adolescents Oncology Clinic Children's Hospital MITERA, Athens, Greece
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Brice Fresneau
- Gustave Roussy, Department of Pediatric Oncology, Université Paris-Saclay, Villejuif, France.,Paris-Saclay University, Paris-Sud University, Paris, France
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Félix Guyon University Hospital, St. Denis, Réunion Island, France
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | | | - Gustaf Österlundh
- Department of Pediatric Hematology and Oncology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marc Wygoda
- Department of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - József Zsiros
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Herve J Brisse
- Department of Radiology, Institut Curie, Paris University, Paris, France
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hans Christiansen
- Department of Radiation Oncology, Hannover Medical School, Hanover, Germany
| | - Line Claude
- Department of Radiation Oncology, Léon Bérard Center, Lyon, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
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Erdem Ş, Zengin AZ, Erdem Ş. Evaluation of the pharyngeal recess with cone-beam computed tomography. Surg Radiol Anat 2020; 42:1307-1313. [PMID: 32794151 DOI: 10.1007/s00276-020-02545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the radiological anatomy of the pharyngeal recess (PR) by gender and age. METHODS Images of patients who underwent cone-beam computed tomography (CBCT) were analyzed retrospectively. A total of 600 PRs (140 male, 160 female) were examined. PR depths, distances between the posterior nasal spine (PNS) and the posterior wall of the pharynx, right and left torus levatorius lengths, and distances between the right and left torus levatorius were measured on the axial plane passing through the PNS-basion point. RESULTS PR depths differed significantly between age groups (right p = 0.030, left p = 0.047). The PR depths of individuals under 35 years of age were significantly higher than those of individuals aged 35 and over. Further, the distances between the PNS and the posterior wall of the pharynx differed significantly between age groups and between gender groups. The distances between the PNS and the posterior wall of the pharynx were shorter in patients under 35 years of age (p = 0.000). In terms of gender, these distances were significantly longer in males (p = 0.014). The distances between the right and left torus levatorius were also significantly longer in males (p = 0.029). CONCLUSION The PR is the region in which nasopharyngeal carcinoma originates most frequently and is very important for early diagnosis. The present results indicated that this region can be examined with CBCT.
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Affiliation(s)
- Şule Erdem
- Department of Dentomaxillofacial Radiology, Dentistry Faculty, Ondokuz Mayıs University, Atakum, 55270, Samsun, Turkey.
| | - Ayşe Zeynep Zengin
- Department of Dentomaxillofacial Radiology, Dentistry Faculty, Ondokuz Mayıs University, Atakum, 55270, Samsun, Turkey
| | - Şuheda Erdem
- Department of Dentomaxillofacial Radiology, Dentistry Faculty, Ondokuz Mayıs University, Atakum, 55270, Samsun, Turkey
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Unidimensional measurement may be superior to assess primary tumor response after neoadjuvant chemotherapy for nasopharyngeal carcinoma. Oncotarget 2018; 8:46937-46945. [PMID: 28159937 PMCID: PMC5564534 DOI: 10.18632/oncotarget.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/28/2016] [Indexed: 12/02/2022] Open
Abstract
Application of current response evaluation criteria in solid tumors (RECIST 1.1) for assessment of irregularly shaped nasopharyngeal carcinoma (NPC) is a gray area with much ambiguity. Our aim was to compare unidimensional measurements (UDM) and bidimensional measurements (BDM) on magnetic resonance images in alternative planes for measurement of tumor response after neoadjuvant chemotherapy (NACT) in patients with locally advanced NPC. 59 patients with untreated non-metastatic NPC were prospectively enrolled. The size or change in size of the primary tumor and retropharyngeal nodes was assessed by UDM and BDM on axial and coronal planes before and after 2 cycles of NACT. Tumor volume was considered as the reference standard. Correlation between volume and diameter was analyzed using a general linear model. The degree of agreement and discordance of response classification based on different measures were evaluated with κ statistic and McNemar's test, respectively. Both axial UDM (RECIST 1.1) and axial BDM (WHO) showed a significant association with volumetric standard. However, the agreement of axial UDM with VM was better than that of axial BDM (κ value: 0.514 to 0.372). In addition, when increasing coronal planes to evaluate tumor response with UDM and BDM, an inferior agreement between coronal BDM and VM was still observed. Notably, coronal UDM showed the best consistency with volume (κ = 0.585). Hence, axial UDM showed better correlation with volumetric measurements than axial BDM. Since coronal UDM showed high correlation to VM, we suggest further research to assess its use for response assessment of NPC after NACT.
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Shan GP, Wang BB, Zheng P, Du FL, Yang YW. Efficacy and Safety of Chemotherapy Combined with Stereotactic Radiotherapy in the Treatment of Nasopharyngeal Carcinoma. Med Sci Monit 2017; 23:5630-5636. [PMID: 29176539 PMCID: PMC5716374 DOI: 10.12659/msm.903903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to investigate the efficacy and safety of chemotherapy (CT) combined with stereotactic radiotherapy (SRT) in the treatment of nasopharyngeal carcinoma (NPC). Material/Methods A total of 329 NPC patients without any previous treatment were included in this study between January 2009 and November 2013. These patients were divided into three groups: CT group (n=114), SRT group (n=109), and CT + SRT group (n=106). Contrast-enhanced nasopharyngeal computed tomography (CT)/magnetic resonance (MR) scan was performed on the third month after treatment. Short-term efficacy was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). Toxicity was graded according to the Acute Radiation Morbidity Scoring Criteria (RTOG) and the World Health Organization (WHO) toxicity grading scale. Overall survival (OS), progression free survival (PFS), and incidence rate of acute toxicity (grade ≥3) were calculated after a 24 month follow-up. Results Total response rate of all patients was 85.41%. Compared with the CT group and the SRT group, the CT + SRT group showed a substantially improved efficacy in NPC treatment. The incidence rate of the acute toxicity in the CT + SRT group was slightly higher than in the CT group and the SRT group, but the difference was not statistically significant. No treatment-related deaths were observed. The CT + SRT group had the highest two-year OS and PFS, followed by the CT group and the SRT group. Conclusions It was shown that NPC patients treated with CT + SRT had better short- and long-term efficacy than those treated with CT or SRT alone.
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Affiliation(s)
- Guo-Ping Shan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, and Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Bing-Bing Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, and Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Peng Zheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, and Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Feng-Lei Du
- Department of Radiation Oncology, Zhejiang Cancer Hospital, and Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Yi-Wei Yang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, and Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
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Cervical nodal volume for prognostication and risk stratification of patients with nasopharyngeal carcinoma, and implications on the TNM-staging system. Sci Rep 2017; 7:10387. [PMID: 28871162 PMCID: PMC5583337 DOI: 10.1038/s41598-017-10423-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
We aim to evaluate the quantitative parameters of 18F-FDG PET/CT (metabolic parameters) and MRI (morphologic parameters) for prognostication and risk stratification in nasopharyngeal carcinoma (NPC). 200 (147 males, aged 50 ± 13 years-old, mean ± S.D.) newly diagnosed patients with NPC (TxNxM0) were prospectively recruited. Primary tumor and nodal lesions were identified and segmented for both morphologic (volume, VOL) and metabolic (SUV and MTV) quantification. Independent predictive factors for recurrence free survival (RFS) and overall survival (OS) were morphologic nodal volume (VOL_N, p < 0.001), TNM-stage (p = 0.022), N-Stage (p = 0.024) for RFS, and VOL_N (p = 0.014) for OS. Using Classification and Regression Tree (CART) analysis, three risk-layers were identified for RFS: Stage I/II with VOL_N < 18cc (HR = 1), stage III /IV with VOL_N < 18cc (HR = 2.93), VOL_N ≥ 18cc (HR = 7.84) regardless of disease stage (p < 0.001). For OS, two risk layers were identified: VOL_N < 18cc (HR = 1), VOL_N ≥ 18cc (HR = 4.23) (p = 0.001). The 18cc threshold for morphologic nodal volume was validated by an independent cohort (n = 105). Based on the above risk-classification, 35 patients (17.5%) would have a higher risk than suggested by the TNM-staging system. Thus, morphologic nodal volume is an important factor in prognostication and risk stratification in NPC, and should be incorporated into the staging system, while PET parameters have no advantage for this purpose in our cohort.
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Ma Y, Lin Y, Zou B, Liu W, Zhang Y, Zhao L, Huang Y, Yang Y, Fang W, Zhao Y, Sheng J, Qin T, Hu Z, Zhang L, Zhao H. Pharmacokinetic and Pharmacodynamic Analyses of 5-Fluorouracil in East-Asian Patients with Nasopharyngeal Carcinoma. Clin Pharmacokinet 2016; 55:1205-1216. [DOI: 10.1007/s40262-016-0395-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen C, Zhang M, Xu Y, Yue Q, Bai P, Zhou L, Xiao Y, Zheng D, Lin K, Qiu S, Chen Y, Pan J. Unidimensional Measurement May Evaluate Target Lymph Nodal Response After Induction Chemotherapy for Nasopharyngeal Carcinoma. Medicine (Baltimore) 2016; 95:e2667. [PMID: 26945354 PMCID: PMC4782838 DOI: 10.1097/md.0000000000002667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to evaluate whether short axis and long axis on axial and coronal magnetic resonance imaging planes would reflect the tumor burden or alteration in size after induction chemotherapy in nasopharyngeal carcinoma. Patients with pathologically confirmed nasopharyngeal carcinoma (n = 37) with at least 1 positive cervical lymph node (axial short axis ≥15 mm) were consecutively enrolled in this prospective study. Lymph nodal measurements were performed along its short axis and long axis in both axial and coronal magnetic resonance imaging planes at diagnosis and after 2 cycles of induction chemotherapy. In addition, lymph nodal volumes were automatically calculated in 3D treatment-planning system, which were used as reference standard. Student's t test or nonparametric Mann-Whitney U test was used to compare the continuous quantitative variables. Meanwhile, the κ statistic and McNemar's test were used to evaluate the degree of agreement and discordance in response categorization among different measurements. Axial short axis was significantly associated with volumes at diagnosis (P < 0.001). A good agreement (κ=0.583) was found between axial short axis and volumetric criteria. However, the inconsistent lymph nodal shrinkage in 4 directions was observed. Axial short-axis shrinking was more rapid than the other 3 parameters. Interestingly, when utilizing the alternative planes for unidimensional measurements to assess tumor response, coronal short-axis showed the best concordance (κ=0.792) to the volumes. Axial short axis may effectively reflect tumor burden or change in tumor size in the assessment of target lymph nodal response after induction chemotherapy for nasopharyngeal carcinoma. However, it should be noted that axial short axis may amplify the therapeutic response. In addition, the role of coronal short axis in the assessment of tumor response needs further evaluation.
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Affiliation(s)
- Chuanben Chen
- From the Department of Radiation Oncology (CC, MZ, YX, PB, LZ, SQ, JP), Fujian Provincial Cancer Hospital; The Shengli Clinical Medical College of Fujian Medical University (CC, MZ, YX, QY, LZ, YX, DZ, KL, SQ, YC, JP); and Department of Radiology (QY, YX, DZ, KL, YC), Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People's Republic of China
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Toxicity of concurrent chemoradiotherapy with cetuximab for locoregionally advanced nasopharyngeal carcinoma. Med Oncol 2014; 31:170. [DOI: 10.1007/s12032-014-0170-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Levine ZH, Pintar AL, Hagedorn JG, Fenimore CP, Heussel CP. Uncertainties in RECIST as a measure of volume for lung nodules and liver tumors. Med Phys 2012; 39:2628-37. [PMID: 22559633 DOI: 10.1118/1.3701791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The authors wish to determine the extent to which the Response Evaluation Criteria in Solid Tumors (RECIST) and the criteria of the World Health Organization (WHO) can predict tumor volumes and changes in volume using clinical data. METHODS The data presented are a reanalysis of data acquired in other studies, including the public database from the Lung Image Database Consortium (LIDC) and from a study of liver tumors. RESULTS The principal result is that a given RECIST diameter predicts volume to a factor of 16 or 10 for the two data sets, respectively, by examining 95% prediction bounds and that changes in volume are predicted only little better: to within a factor of 7 for the liver data. The WHO criteria reduce the prediction bounds by a factor of 1.3 in all cases. Also, the RECIST threshold of 10 mm to measure a nodule corresponds to a transition zone width of a factor of more than 2 in volume for the nodules in the LIDC database. CONCLUSIONS While the RECIST diameter is certainly correlated with the volume, and similarly for changes in these quantities, the use of the diameter introduces additional variation assuming volume is the quantity of interest. Exactly how much this reduces the statistical power of clinical drug trials is a key open question for future research.
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Affiliation(s)
- Zachary H Levine
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA.
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Ma BBY, Kam MKM, Leung SF, Hui EP, King AD, Chan SL, Mo F, Loong H, Yu BKH, Ahuja A, Chan ATC. A phase II study of concurrent cetuximab-cisplatin and intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma. Ann Oncol 2012; 23:1287-1292. [PMID: 21948811 DOI: 10.1093/annonc/mdr401] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Based on our previous work on the clinical activity of cetuximab in recurrent nasopharyngeal carcinoma (NPC), we evaluated the feasibility of adding cetuximab to concurrent cisplatin and intensity-modulated radiotherapy (IMRT) in locoregionally advanced NPC. PATIENTS AND METHODS Patients with American Joint Committee on Cancer stage III-IVB NPC were given an initial dose of cetuximab (400 mg/m(2)) 7-10 days before receiving concurrent IMRT, weekly cisplatin (30 mg/m(2)/week) and cetuximab (250 mg/m(2)/week). RESULTS Thirty patients (median age of 45 years) with stage III (67%), IVA (30%) and IVB (3%) nonkeratinizing NPC were enrolled. Grade 3-4 oropharyngeal mucositis occurred in 26 (87%) patients and 10 (33%) patients required short-term nasogastric feeding. Grade 3 radiotherapy-related dermatitis occurred in six patients (20%) and three patients (10%) had grade 3 cetuximab-related acneiform rash. These grade 3-4 skin and mucosal toxic effects were manageable and reversible. At a median follow-up of 31.8 months [95% confidence interval (CI) 26.2-32.1 months], the 2-year progression-free survival was 86.5% (95% CI 74.3% to 98.8%). CONCLUSIONS Concurrent administration of cetuximab, weekly cisplatin and IMRT is a feasible strategy against locoregionally advanced NPC. Preliminary survival data compare favorably with historic data and further follow-up is warranted.
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Affiliation(s)
- B B Y Ma
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong.
| | - M K M Kam
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - S F Leung
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - E P Hui
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - A D King
- Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - S L Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - F Mo
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - H Loong
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - B K H Yu
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
| | - A Ahuja
- Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - A T C Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute. The Chinese University of Hong Kong
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Comparison of volumetric methods for tumor measurements on two and three dimensional MRI in adult glioblastoma. Neuroradiology 2010; 53:565-9. [DOI: 10.1007/s00234-010-0789-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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Kim TJ, Lee YS, Kang JH, Kim YS, Kang CS. Prognostic significance of expression of vegf and cox-2 in nasopharyngeal carcinoma and its association with expression of C-erbB2 and EGFR. J Surg Oncol 2010; 103:46-52. [DOI: 10.1002/jso.21767] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Chang TS, Chu ST, Hou YY, Chang KP, Chi CC, Lee CC. Validation of bidimensional measurement in nasopharyngeal carcinoma. Radiat Oncol 2010; 5:72. [PMID: 20712871 PMCID: PMC2930639 DOI: 10.1186/1748-717x-5-72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 08/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our previous study showed a close relationship between computed tomography (CT)-derived bidimensional measurement of primary tumor and retropharyngeal nodes (BDMprn) and gross tumor volume of primary tumor and retropharyngeal nodes (GTVprn) in nasopharyngeal carcinoma (NPC) and better prognosis for NPC patients with smaller BDMprn. In this study, we report the results on of a study to validate the use of BDM in a separate cohort of NPC patients. METHODS We retrospectively reviewed 103 newly diagnosed NPC cases who were treated with radiotherapy/concurrent chemoradiotherapy (CCRT) or CCRT with adjuvant chemotherapy from 2002 to 2009. We used magnetic resonance imaging (MRI) to measure BDMprn. We calculated overall survival, recurrence-free and distant metastasis-free survival curves and set a BDMprn cut off point to categorize patients into a high- or low-risk group. We then used Cox proportional hazard model to evaluate the prognostic influence of BDMprn after correcting age, gender and chemotherapy status. RESULTS After adjusting for age, gender, and chemotherapy status, BDMprn remained an independent prognostic factor for distant metastasis [Hazard ratio (HR) = 1.046; P = 0.042] and overall survival (HR = 1.012; P = 0.012). Patients with BDMprn < 15 cm2 had a greater 3-year overall survival rate than those with BDMprn > or = 15 cm2 (92.3% vs. 73.7%; P = 0.009). They also had a greater 3-year distant metastasis-free survival (94% vs.75%; P = 0.034). CONCLUSION The predictive ability of BDMprn was validated in a separate NPC cohort. A BDMprn of 15 cm2 can be used to separate NPC patients into high- and low-risk groups and predict survival rates and metastasis potential. It can, therefore, be used as a reference to design clinical trials, predict prognosis, and make treatment decisions.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Buddhist Tzu Chi Dalin General Hospital, Chiayi County 622, Taiwan
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Lee CC, Ho HC, Su YC, Lee MS, Hsiao SH, Hwang JH, Hung SK, Chou P, Lee CC. Bidimensional measurement of nasopharyngeal carcinoma: a simple method to predict outcomes. Clin Otolaryngol 2009; 34:26-33. [DOI: 10.1111/j.1749-4486.2008.01839.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Improved inspection of the lateral pharyngeal recess using cone-beam computed tomography in the upright position. Oral Radiol 2008. [DOI: 10.1007/s11282-008-0078-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Marcus CD, Ladam-Marcus V, Cucu C, Bouché O, Lucas L, Hoeffel C. Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives. Crit Rev Oncol Hematol 2008; 72:217-38. [PMID: 18760935 DOI: 10.1016/j.critrevonc.2008.07.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 07/04/2008] [Accepted: 07/17/2008] [Indexed: 02/07/2023] Open
Abstract
Response evaluation in solid tumours currently uses radiological imaging techniques to measure changes under treatment. Imaging requires a well-defined anatomical lesion to be viewed and relies on the measurement of a reduction in tumour size during treatment as the basis for presumed clinical benefit. However, with the development of anti-angiogenesis agents, anatomical imaging has became inappropriate as certain tumours would not reduce in size. Functional studies are therefore necessary and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), DCE-computed tomography (CT) and DCE-ultrasonography (US) are currently being evaluated for monitoring treatments. Diffusion-weighted MR imaging (DW-MRI) and magnetic resonance spectroscopy (MRS) are also capable of detecting changes in cell density and metabolite content within tumours. In this article, we review anatomical and functional criteria currently used for monitoring therapy. We review the published data on DCE-MRI, DCE-CT, DCE-US, DW-MRI and MRS. This literature review covers the following area: basic principles of the technique, clinical studies, reproducibility and repeatability, limits and perspectives in monitoring therapy. Anatomical criteria such as response evaluation criteria in solid tumours (RECIST) will require adaptation to employ not only new tools but also different complementary techniques such as functional imaging in order to monitor therapeutic effects of conventional and new anti-cancer agents.
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Affiliation(s)
- C D Marcus
- Department of Radiology, Robert-Debre Hospital, University of Reims, France.
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Ma BBY, Hui EP, Chan ATC. Systemic approach to improving treatment outcome in nasopharyngeal carcinoma: current and future directions. Cancer Sci 2008; 99:1311-8. [PMID: 18498420 PMCID: PMC11158701 DOI: 10.1111/j.1349-7006.2008.00836.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 03/22/2008] [Accepted: 03/27/2008] [Indexed: 12/13/2022] Open
Abstract
Systemic therapy is an integral part of the management of non-keratinizing nasopharyngeal carcinoma (NPC). The purposes of this review are to provide the latest results and future directions of clinical and translational research for this disease, and to illustrate how some of these new therapies have improved the treatment outcome for patients with NPC. Particular attention will be paid to the clinical application of chemotherapy in the adjunctive treatment of locoregionally advanced NPC, novel targeted drugs, Epstein-Barr virus-targeted vaccine therapies, and the use of plasma Epstein-Barr virus DNA as a biomarker for selecting patients for adjunctive therapies.
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Affiliation(s)
- Brigette B Y Ma
- Department of Clinical Oncology at the Sir Y. K. Pao Center for Cancer, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China
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