Grading of MRI‐detected skull‐base invasion in nasopharyngeal carcinoma and its prognostic value

Chen, Lei; Liu, Li Zhi; Mao, Yan Ping; TANG, Ling; Sun, Ying; Chen, Yong; Lin, Ai Hua; Li, Li; Ma, Jun

doi:10.1002/hed.21606

Cited by 33 publications

(29 citation statements)

References 22 publications

(32 reference statements)

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“…Although the diagnosis of skull base extension based entirely on MRI leads to an upstaging according to the UICC/AJCC staging system, skull base extension has not been confirmed as a significant prognostic factor for DMFS. However, the prognostic value of MRI-detected skull base extension varies in different studies; although MRI-detected skull base extension was not an independent prognostic factor, the grading of skull base extension according to the site of extension has previously been reported to be an independent prognostic factor for both OS and DMFS [33]. …”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

et al. 2016

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BackgroundThe prognostic values of staging parameters require continual re-assessment amid changes in diagnostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non-metastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.MethodsWe reviewed the data from 749 patients with newly diagnosed, biopsy-proven, non-metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients underwent magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log-rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insignificant explanatory variables.ResultsThe 5-year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5-year survival rates were as follows: local relapse-free survival, 94.6%; nodal relapse-free survival, 97.0%; distant metastasis-free survival, 82.6%; disease-free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only significant prognostic factor for local failure (P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were significant prognostic factors for both distant failure and disease failure (all P < 0.05). Intracranial extension had significant prognostic value for distant failure (P = 0.040).ConclusionsThe key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the significant prognostic parameters for local control have also been altered substantially.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

et al. 2016

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“…MRI is more sensitive in detecting the invasion of early tumor to bone marrow, and has a detection rate higher than CT at 50%–70% 11,13. MRI can also identify slight destruction, thus decreasing the prognosis value.…”

Section: Discussionmentioning

confidence: 99%

“…The CT-evident skull base erosion has been proved to be a significant independent prognostic factor for the regional control and distant metastasis in NPC 7. The incidence rate of skull base bone destruction was found to be in the range of 30%–40% on the CT scan8–10 and 55%–66% on the MRI scan 11–13. Although intensity-modulated radiotherapy could improve the local control rates, distant metastasis mainly accounts for the failure of NPC treatment 4,14.…”

Section: Introductionmentioning

confidence: 99%

CT-diagnosed severe skull base bone destruction predicts distant bone metastasis in early N-stage nasopharyngeal carcinoma

Yi¹,

Liu²,

Li³

et al. 2016

OTT

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Bone metastasis is the most frequent type of distant metastasis in nasopharyngeal carcinoma (NPC). In this study, we investigated the correlation between the skull base bone destruction and the distant bone metastasis in patients with NPC. A total of 449 cases with NPC who were diagnosed and had definitive radiotherapy from 2001 to 2006 were enrolled in this study. The skull base bone destruction was diagnosed by computed tomography (CT) in all cases, and 191 patients also underwent magnetic resonance imaging scan. Kaplan–Meier method was adopted to perform the univariate analysis; Cox regression model was used to perform multivariate analysis to determine whether the skull base bone destruction when diagnosed by CT was an independent impact factor of the distant bone metastases. The group with skull base bone destruction had a distant bone metastases rate of 9.0% (14/155), whereas the group without skull base bone destruction had rate of 4.1% (12/294). The multivariate analysis showed that the skull base bone destruction, when diagnosed by CT, was an independent impact factor of the distant bone metastases-free survival in the early N-staging cases, but was not an independent impact factor when diagnosed by MRI. The skull base bone destruction diagnosed by CT in patients with NPC had predictive value for the distant bone metastases, especially for the early N-staging cases.

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“…The diagnosis of CN palsy mostly depends on clinical symptoms and a physical examination, and magnetic resonance imaging (MRI) has proven to be an important tool for defining CN involvement in NPC [4-6]. However, CN palsy frequently accompanies skull-base invasion in upper CN palsy and carotid sheath erosion in lower CN palsy.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of pretreatment and recovery duration of cranial nerve palsy in nasopharyngeal carcinoma

Sun

et al. 2012

Radiat Oncol

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BackgroundThe purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients.MethodsA retrospective analysis was performed on CN involvement using medical records of 178 consecutive patients with histologically diagnosed, non-disseminated NPC.ResultsIn 178 NPC patients with CN palsy, the 5-year survival rates were as follows: overall survival (OS), 61.0%; disease-specific survival (DSS), 69.6%; local relapse-free survival (LRFS), 75.2%; distant metastasis-free survival (DMFS), 73.4%; and disease-free survival (DFS), 55.3%. Significant differences were observed in the 5-year OS rates between patients with single and multiple CN palsy (69.8% vs. 54.3%; P = 0.033) and the OS rates between patients with different pretreatment durations (68.7% vs. 43.3%, P = 0.007). However, no significant differences were observed in OS, DSS, LRFS and DFS rates between patients with upper and lower CN palsy (P = 0.581, P = 0.792, P = 0.729 and P = 0.212, respectively). The results showed that recovery duration was an independent prognostic factor for OS (HR = 2.485; P < 0.001), DSS (HR = 2.065; P = 0.016), LRFS (HR = 3.051; P = 0.001) and DFS (HR = 2.440; P < 0.001).ConclusionsRecovery duration is an independent prognostic factor for NPC patients with CN palsy and is related to recurrence, which leads to poor survival. Recovery duration requires close surveillance and different treatment regimens.

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Grading of MRI‐detected skull‐base invasion in nasopharyngeal carcinoma and its prognostic value

Abstract: MRI-detected skull-base invasion is not an independent prognostic factor for nasopharyngeal carcinoma. However, grading according to the site of invasion as either low grade or severe has prognostic value.

Cited by 33 publications

References 22 publications

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

CT-diagnosed severe skull base bone destruction predicts distant bone metastasis in early N-stage nasopharyngeal carcinoma

Prognostic value of pretreatment and recovery duration of cranial nerve palsy in nasopharyngeal carcinoma

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