Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system

Zong, Jingfeng; Shen, Lin; Lin, Jianhua; Tang, Linbo; Chen, Bijuan; Zhang, Mingwei; Zhong, Yu; Xu, Lanfang; Chen, Yunbin; Xiao, Youping; Fang, Yanhong

doi:10.1016/j.oraloncology.2014.10.012

Cited by 74 publications

(59 citation statements)

References 26 publications

(33 reference statements)

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“…Based on MRI and IMRT, no systematic data referring to prognostic factors in patients with NPC were available. Zong et al [24] focused on skull base extension and found that it did not influence local failure in the IMRT era. Based on the same database presented here, our previous studies reported that skull base extension [25] and parapharyngeal tumor extension [26] were not independent prognostic factors for local control in patients with NPC treated with IMRT.…”

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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“…Combination therapy, with IMRT as the lead therapy, has dramatically improved the prognosis of NPC patients and the 5-year overall survival has reached 80% [6][7][8][9][10][11][12]. Zong et al [23] surveyed 1241 nasopharyngeal carcinoma (NPC) patients treated with IMRT, of whom 88.7% of patients received concurrent platinum-based chemotherapy. The 5-year rates of OS, DSS, DMFS, RRFS and LRFS were 81.1%, 82.6%, 82.6%, 95.4%, and 92.9% respectively.…”

Section: Discussionmentioning

confidence: 99%

The New T Staging System for Nasopharyngeal Carcinoma Based on Intensity Modulated Radiation Therapy: Results of a Prospective Multicentric Clinical Study

Kang

Zhou

Wei

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…In Chen et al’s [4] and Zong et al’s [7] trials, there were no significant differences in DMFS between the N2 and N3a categories when using the 7 th edition AJCC staging system. Thus, it might be feasible to downstage N3 to N2 in both staging systems.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

Liang¹,

Chen²,

Niu³

et al. 2016

PLoS ONE

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ObjectiveThe aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system.MethodsBetween January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).ResultsIn terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2.ConclusionsThe two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2.

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Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system

Abstract: When treated with IMRT, the difference in the LRFS, DSS, and OS between T1 and T2 patients diminished, indicating that it is rational to merge T2 into T1. The prognostic value of the N classification of the current staging system had not changed much compared to the 6th edition.

Cited by 74 publications

References 26 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

The New T Staging System for Nasopharyngeal Carcinoma Based on Intensity Modulated Radiation Therapy: Results of a Prospective Multicentric Clinical Study

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

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