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Chen Z, Chan ABW, Kam LS, Chan MH, Chan JYK, Lee WT, Chow C, Boon SS, Xia C, Lam B, Lam S, Ng RWY, Ho WCS, Lam EWH, Lai CKC, Chan PKS. Changes in the Incidence and Human Papillomavirus-Positive Portion of Oropharyngeal Squamous Cell Carcinoma in Hong Kong. Cancers (Basel) 2024; 16:226. [PMID: 38201653 PMCID: PMC10778352 DOI: 10.3390/cancers16010226] [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: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is rising in the West, but little is known in Asia. This study elucidated changes in the incidence and HPV-positive portion of OPSCC in Hong Kong. Data from population-based cancer registry were used to analyze the incidence of OPSCC in association with other head and neck cancers. Archived tumor tissues were tested for HPV. From 1986 to 2020, there was a marked decrease in the incidence of nasopharyngeal and laryngeal cancers, but a persistent increase in OPSCC from 36 cases in 1986 to 116 cases in 2020. The average positive rate for high-risk HPV was 36.1% (112/310) among OPSCC diagnosed in 2010-2020. The HPV-positive rate in recent years was significantly higher than earlier cases (tonsil SCC: 64.7% (55/85) in 2016-2020 vs. 40.4% (19/47) in 2010-2015, p = 0.007). Patients with HPV-positive tonsil cancers were significantly younger than those negative (mean [SD]: 58.9 [9.9] vs. 64.3 [13.3] years, p = 0.006), but no significant difference was observed between genders. A persistent increase in the incidence of oropharyngeal cancer over the last few decades was observed in Hong Kong, which can be explained by the remarkable increase in HPV-positive tonsil cancers.
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Affiliation(s)
- Zigui Chen
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Amy B. W. Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China; (A.B.W.C.); (C.C.)
| | - Lok-Sang Kam
- Department of Anatomical Pathology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Man-Hin Chan
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Jason Y. K. Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Tung Lee
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China;
| | - Chit Chow
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China; (A.B.W.C.); (C.C.)
| | - Siaw S. Boon
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Chichao Xia
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Brian Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Suki Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Rita W. Y. Ng
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Wendy C. S. Ho
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Eddy W. H. Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Christopher K. C. Lai
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Paul K. S. Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
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Guo Y, Dai G, Xiong X, Wang X, Chen H, Zhou X, Huang W, Chen F. Intravoxel incoherent motion radiomics nomogram for predicting tumor treatment responses in nasopharyngeal carcinoma. Transl Oncol 2023; 31:101648. [PMID: 36905870 PMCID: PMC10020114 DOI: 10.1016/j.tranon.2023.101648] [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: 09/20/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) plays an important role in predicting treatment responses in patient with nasopharyngeal carcinoma (NPC). The goal of this study was to develop and validate a radiomics nomogram based on IVIM parametric maps and clinical data for the prediction of treatment responses in NPC patients. METHODS Eighty patients with biopsy-proven NPC were enrolled in this study. Sixty-two patients had complete responses and 18 patients had incomplete responses to treatment. Each patient received a multiple b-value diffusion-weighted imaging (DWI) examination before treatment. Radiomics features were extracted from IVIM parametric maps derived from DWI image. Feature selection was performed by the least absolute shrinkage and selection operator method. Radiomics signature was generated by support vector machine based on the selected features. Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) values were used to evaluate the diagnostic performance of radiomics signature. A radiomics nomogram was established by integrating the radiomics signature and clinical data. RESULTS The radiomics signature showed good prognostic performance to predict treatment response in both training (AUC = 0.906, P<0.001) and testing (AUC = 0.850, P<0.001) cohorts. The radiomic nomogram established by integrating the radiomic signature with clinical data significantly outperformed clinical data alone (C-index, 0.929 vs 0.724; P<0.0001). CONCLUSIONS The IVIM-based radiomics nomogram provided high prognostic ability to treatment responses in patients with NPC. The IVIM-based radiomics signature has the potential to be a new biomarker in prediction of the treatment responses and may affect treatment strategies in patients with NPC.
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Affiliation(s)
- Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Ganmian Dai
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Xiaoli Xiong
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Xiaoyi Wang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Huijuan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Xiaoyue Zhou
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai 201306, China
| | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China.
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China.
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Hung HM, Chan OCM, Mak CH, Hung WM, Ng WT, Lee MCH. Dosimetric comparison of intensity modulated radiotherapy and intensity modulated proton therapy in the treatment of recurrent nasopharyngeal carcinoma. Med Dosim 2021; 47:14-19. [PMID: 34470708 DOI: 10.1016/j.meddos.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/11/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To compare the dosimetric performance of Intensity Modulated Proton Therapy (IMPT) and Intensity Modulated Radiotherapy (IMRT) in terms of target volume coverage and sparing of neurological organs-at-risk (OARs) in salvaging recurrent nasopharyngeal carcinoma (rNPC). The maximum dose to the internal carotid artery (ICA) and nasopharyngeal (NP) mucosa, which are associated with potential carotid blowout and massive epistaxis, were also evaluated. MATERIALS AND METHODS IMRT and IMPT treatment plans were created for twenty patients with locally advanced rNPC. Planning Target Volume (PTV) was used to account for the setup and spatial error/uncertainty in the IMRT planning. Robust optimization on Clinical Target Volume (CTV) coverage with consideration of range and setup uncertainty was employed to produce two IMPT plans with 3-field and 4-field arrangements. The planning objective was to deliver 60 Gy to the PTV (IMRT) and CTV (IMPT) without exceeding the maximum lifetime cumulative Biologically Effective Dose (BED) of the neurological OARs (applied to the Planning organs-at-risk volume). The target dose coverage as well as the maximum dose to the neurological OARs, ICA, and NP mucosa were compared. RESULTS Compared with IMRT, 3-field IMPT achieved better coverage to GTV V100% (83.3% vs. 73.2%, P <0.01) and CTV V100% (80.5% vs. 72.4%, P <0.01), and lower maximum dose to the critical OARs including the spinal cord (19.2 Gy vs. 22.3 Gy, P <0.01), brainstem (30.0 Gy vs. 32.3 Gy, P <0.01) and optic chiasm (6.6 Gy vs. 9.8 Gy, P <0.01). The additional beam with the 4-fields IMPT plans further improved the target coverage from the 3-field IMPT (CTV V98%: 85.3% vs. 82.4%, P <0.01) with similar OAR sparing. However, the target dose was highly non-uniform with both IMPT plans, leading to a significantly higher maximum dose to the ICA (∼68 Gy vs. 62.6 Gy, P <0.01) and NP mucosa (∼72 Gy vs. 62.8 Gy, P <0.01) than IMRT. CONCLUSION IMPT demonstrated some dosimetric advantage over IMRT in treating rNPC. However, IMPT could also result in very high dose hot spots in the target volume. Careful consideration of the ICA and NP mucosal complications is recommended when applying IMPT on rNPC patients.
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Affiliation(s)
- Hing Ming Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
| | | | - Chi Hang Mak
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Wai Man Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Comprehensive Oncology Center, Hong Kong Sanatorium & Hospital, Hong Kong
| | - Michael Chi Hang Lee
- Department of Medical Physics, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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Guo W, Zheng X, Hua L, Zheng X, Zhang Y, Sun B, Tao Z, Gao J. Screening and bioinformatical analysis of differentially expressed genes in nasopharyngeal carcinoma. J Cancer 2021; 12:1867-1883. [PMID: 33753985 PMCID: PMC7974527 DOI: 10.7150/jca.48979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: To identify differentially expressed genes via bioinformatical analysis for nasopharyngeal carcinoma (NPC) and explore potential biomarkers for NPC. Methods: We downloaded the NPC gene expression datasets (GSE40290, GSE53819) and obtained differentially expressed genes (DEGs) via GEO2R. Functional analysis of DEGs was performed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. In order to explore the interaction of DEGs and screen the core genes, we established protein-protein interaction (PPI) network. Then the expression level, prognostic and diagnostic analysis of the core genes in NPC were performed to reveal their potential effects on NPC. Furthermore, we obtained the transcription factors (TF) and microRNAs of core genes to construct the coregulatory network. Results: We obtained 124 up-regulated genes and 190 down-regulated genes in total. These genes were found to be related to signal transduction, extracellular matrix organization and cell adhesion based on GO analysis. KEGG analysis revealed that the NF-kappa B (NF-κB) signaling pathway, pathways in cancer were mainly enriched signaling pathways. 25 core genes were obtained by constructing PPI network. Then the high expression of 10 core genes in NPC were verified via GEPIA, Oncomine databases and laboratory experiments. The TF-microRNA coregulatory network of the 10 core genes was built. Survival and diagnostic analysis indicated that SPP1 had negative influence on the prognosis of NPC patients based on two datasets and nine up-regulated core genes (FN1, MMP1, MMP3, PLAU, PLAUR, SERPINE1, SPP1, COL8A1, COL10A1) might be diagnostic markers for NPC. Conclusions: Core genes of NPC were screened out by bioinformatical analysis in the present study and these genes may serve as prognostic and diagnostic biomarkers for NPC.
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Affiliation(s)
- Weiqian Guo
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Xiaomin Zheng
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | - Lei Hua
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
| | | | - Yangyang Zhang
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230031, China
| | - Bin Sun
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230031, China
| | - Zhenchao Tao
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230031, China
| | - Jin Gao
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China.,Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230031, China
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Fong R, Ward EC, Rumbach AF. Dysphagia after chemo-radiation for nasopharyngeal cancer: A scoping review. World J Otorhinolaryngol Head Neck Surg 2020; 6:10-24. [PMID: 32426699 PMCID: PMC7221212 DOI: 10.1016/j.wjorl.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023] Open
Abstract
Objective Nasopharyngeal cancer (NPC) has distinct characteristics regarding its global prevalence, initial presentation, management and patient outcomes compared to other subtypes of head and neck cancer (HNC). The mainstay of NPC treatment is chemo-radiation (C/RT) and while dysphagia is a known early and late toxicity of C/RT treatment, the nature of dysphagia post NPC treatment has had limited investigation. The objective of this review is to summarise the existing evidence regarding dysphagia following NPC to inform the future research agenda for this population. Dysphagia incidence, characteristic deficits observed across the phases of swallowing, efficacy of current dysphagia interventions, and effect on quality of life will be explored. Data sources Databases including MEDLINE, CINAHL, Embase, Scopus and Web of Science were included. Methods A scoping review was conducted according to PRISMA-ScR guidelines. Two independent reviewers screened selected full text articles. Results Of the initial 2495 articles found, 28 articles were included. Reports of penetration and aspiration varied widely (0%–91.6%), with high rates of silent aspiration identified in 2 studies (42%, 66%). Oral, pharyngeal and upper esophageal phase impairments were reported. Of these, upper esophageal stasis and multiple pharyngeal stage deficits were most prevalent. The pharyngeal constrictors were found to have a significant dose–effect relationship and shielding to the anterior neck field was effective to preserve swallowing function. Six treatment studies were identified with limited evidence supporting the use of neuromuscular electrical stimulation, dilatation and swallowing exercises. Quality of life was adversely affected. Conclusions Dysphagia is a prevalent early and late problem post NPC treatment, with impairments across all phases of the swallow. Studies on preventing dysphagia and treatment efficacy remain limited. More systematic study of the nature of dysphagia and the efficacy of treatment in this population is warranted.
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Affiliation(s)
- Raymond Fong
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anna F Rumbach
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
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Murakami N, Mori T, Kubo Y, Yoshimoto S, Ito K, Honma Y, Ueno T, Kobayashi K, Okamoto H, Boku N, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. Prognostic impact of immunohistopathologic features in definitive radiation therapy for nasopharyngeal cancer patients. JOURNAL OF RADIATION RESEARCH 2020; 61:161-168. [PMID: 31822892 PMCID: PMC6976734 DOI: 10.1093/jrr/rrz071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/27/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Our previous study by Murakami N, Mori T, Nakamura S, Yoshimoto S, Honma Y, Ueno T, Kobayashi K, Kashihara T, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. (J Radiat Res. 2019 Jul 30. pii: rrz053. doi: 10.1093/jrr/rrz053. [Epub ahead of print]) showed that strong expression of epithelial cell adhesion molecule (EpCAM) was associated with radiation resistance in head and neck squamous cell cancer patients (SCC). In this study, the prognostic impact of histopathologic features including EpCAM for nasopharyngeal cancer (NPC) patients was investigated. Since 2009, our institution has performed chemoradiation for locally advanced NPC patients with intensity modulated radiation therapy (IMRT). Tri-weekly adjuvant cisplatin (CDDP, 80 mg/m2) was administered concurrently with definitive radiation therapy 70 Gy in 35 fractions. One month after radiation therapy, adjuvant chemotherapy of three cycles of CDDP/5 fluorouracil (5-FU) was administered. Using a pretreatment biopsy specimen, EBV-encoded small RNA in situ hybridization (EBER-ISH), EpCAM, p16 and p53 were assessed by immunohistochemical analysis. Between May 2009 and September 2017, 51 NPC patients received definitive radiation therapy. Five, 13, 17 and 16 patients were staged as I, II, III and IV, respectively. The median follow-up period for alive patients was 31.1 months (12.4-109.7 months). Three-year overall survival (OS), progression-free survival (PFS) and locoregional control (LRC) were 87.1, 57.1 and 85.7%, respectively. EpCAM, p16 and p53 were not associated with PFS, OS nor LRC. Three-year PFS for patients with keratinizing and non-keratinizing SCC were 25 and 60.5%, respectively (P = 0.033, hazard ratio 4.851 (95% confidence interval 1.321-17.814)).Prognosis of NPC patients with keratinizing SCC was worse than non-keratinizing SCC patients, suggesting a biological difference between the two types of tumor.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Japan
| | - Yuko Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yoshitaka Honma
- Department of Head and Neck Medical Oncology, Head and Neck Medical Oncology Division, National Cancer Center Hospital, Japan
| | - Takao Ueno
- Department of Oral Health and Diagnostic Sciences, National Cancer Center Hospital, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Narikazu Boku
- Department of Head and Neck Medical Oncology, Head and Neck Medical Oncology Division, National Cancer Center Hospital, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Japan
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Yu TT, Lam SK, To LH, Tse KY, Cheng NY, Fan YN, Lo CL, Or KW, Chan ML, Hui KC, Chan FC, Hui WM, Ngai LK, Lee FKH, Au KH, Yip CWY, Zhang Y, Cai J. Pretreatment Prediction of Adaptive Radiation Therapy Eligibility Using MRI-Based Radiomics for Advanced Nasopharyngeal Carcinoma Patients. Front Oncol 2019; 9:1050. [PMID: 31681588 PMCID: PMC6805774 DOI: 10.3389/fonc.2019.01050] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
Background and purpose: Adaptive radiotherapy (ART) can compensate for the dosimetric impacts induced by anatomic and geometric variations in patients with nasopharyngeal carcinoma (NPC); Yet, the need for ART can only be assessed during the radiation treatment and the implementation of ART is resource intensive. Therefore, we aimed to determine tumoral biomarkers using pre-treatment MR images for predicting ART eligibility in NPC patients prior to the start of treatment. Methods: Seventy patients with biopsy-proven NPC (Stage II-IVB) in 2015 were enrolled into this retrospective study. Pre-treatment contrast-enhanced T1-w (CET1-w), T2-w MR images were processed and filtered using Laplacian of Gaussian (LoG) filter before radiomic features extraction. A total of 479 radiomics features, including the first-order (n = 90), shape (n = 14), and texture features (n = 375), were initially extracted from Gross-Tumor-Volume of primary tumor (GTVnp) using CET1-w, T2-w MR images. Patients were randomly divided into a training set (n = 51) and testing set (n = 19). The least absolute shrinkage and selection operator (LASSO) logistic regression model was applied for radiomic model construction in training set to select the most predictive features to predict patients who were replanned and assessed in the testing set. A double cross-validation approach of 100 resampled iterations with 3-fold nested cross-validation was employed in LASSO during model construction. The predictive performance of each model was evaluated using the area under the receiver operator characteristic (ROC) curve (AUC). Results: In the present cohort, 13 of 70 patients (18.6%) underwent ART. Average AUCs in training and testing sets were 0.962 (95%CI: 0.961-0.963) and 0.852 (95%CI: 0.847-0.857) with 8 selected features for CET1-w model; 0.895 (95%CI: 0.893-0.896) and 0.750 (95%CI: 0.745-0.755) with 6 selected features for T2-w model; and 0.984 (95%CI: 0.983-0.984) and 0.930 (95%CI: 0.928-0.933) with 6 selected features for joint T1-T2 model, respectively. In general, the joint T1-T2 model outperformed either CET1-w or T2-w model alone. Conclusions: Our study successfully showed promising capability of MRI-based radiomics features for pre-treatment identification of ART eligibility in NPC patients.
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Affiliation(s)
- Ting-Ting Yu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Sai-Kit Lam
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lok-Hang To
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ka-Yan Tse
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Nong-Yi Cheng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yeuk-Nam Fan
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Cheuk-Lai Lo
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ka-Wa Or
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Man-Lok Chan
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ka-Ching Hui
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Fong-Chi Chan
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wai-Ming Hui
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lo-Kin Ngai
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Francis Kar-Ho Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Kwok-Hung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Celia Wai-Yi Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Yong Zhang
- Department of Physics, Xiamen University, Xiamen, China
| | - Jing Cai
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat Rev 2019; 79:101890. [PMID: 31470314 DOI: 10.1016/j.ctrv.2019.101890] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022]
Abstract
As a consequence of the current excellent loco-regional control rates attained using the generally accepted treatment paradigms involving intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC), only 10-20% of patients will suffer from local and/or nodal recurrence after primary treatment. Early detection of recurrence is important as localized recurrent disease is still potentially salvageable, but this treatment often incurs a high risk of major toxicities. Due to the possibility of radio-resistance of tumors which persist or recur despite adequate prior irradiation and the limited tolerance of adjacent normal tissues to sustain further additional treatment, the management of local failures remains one of the greatest challenges in this disease. Both surgical approaches for radical resection and specialized re-irradiation modalities have been explored. Unfortunately, available data are based on retrospective studies, and the majority of them are based on a small number of patients or relatively short follow-up. In this article, we will review the different salvage treatment options and associated prognostic factors for each of them. We will also propose a treatment algorithm based on the latest available evidence and discuss the future directions of treatment for locally recurrent NPC.
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