Prognostic impact of magnetic resonance imaging‐detected cranial nerve involvement in nasopharyngeal carcinoma

Abstract

BACKGROUND:The purpose of this study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‐detected cranial nerve (CN) involvement in nasopharyngeal carcinoma (NPC).METHODS:Retrospective analysis was made of the magnetic resonance images and medical records of 924 consecutive patients with newly diagnosed NPC.RESULTS:Of 924 patients, 82 (8.9%) initially presented with CN palsy. CN involvement was seen on MRI in 333 (36%) patients. In T3‐4 disease, MRI‐evidenced CN involvement was associated with poor 3‐year overall survival (OS) (35.7% vs 89.2%, P = .001) and distant metastasis‐free survival (DMFS) (77.1% vs 87.8%, P = .002) rates. The survival curves of OS and DMFS for T3 disease with MRI‐detected CN involvement approximated those of T4 disease (P = .322 and P = .809, respectively). In patients with MRI‐detected CN involvement, no significant differences were observed in 3‐year OS (78.3% vs 72.9%, P = .120), local relapse‐free survival (LRFS) (89.7% vs 84.1%, P = .154), or DMFS (79.6% vs 74.8%, P = .466) rates between those with and without intracranial or orbital CN involvement. Furthermore, in patients with clinical and/or MRI‐detected CN involvement, there were no significant differences in the 3‐year OS (74.2% vs 80.1%, P = .067), LRFS (86.7% vs 87.9%, P = .899), or DMFS (74.6% vs 84.6%, P = .094) rates between symptomatic and asymptomatic patients.CONCLUSIONS:The incidence of MRI‐detected CN involvement was higher than CN palsy. MRI‐detected CN involvement has a negative impact on the prognosis independent of lesion localization and symptoms. Cancer 2009. © 2009 American Cancer Society.

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

“…NPC always invades the intracranial region and orbit through the skull base and neural foramina. Liu et al demonstrated that intracranial and orbit extension are frequently associated with MRIdetected intracranial nerve involvement, including invasion of the cavernous sinus segment of cranial nerves III and VI, the trigeminal ganglion, cranial nerves in the cistern, the inferior orbital fissure, orbital apex, and the superior orbital fissure [36]. This is consistent with our results showing that the occurrence of invasions of the orbit and intracalvarium are 6.7% and 13.0% respectively.…”

“…In our study, the incidence of skull base invasion is 66.0%, which is a little higher than multiple reports showing that skull base erosion could be detected in 25-63% of NPC patients [25,[27][28][29][30][31]. The incidence of cranial nerve invasion is 21.3%, which is consistent with previous data 2.9-36% [32][33][34]. The incidence of cavernous sinus invasion is 33.3%, which is a little higher than two other groups [33,35].…”

The preliminary study of 18F-FLT micro-PET/CT in predicting radiosensitivity of human nasopharyngeal carcinoma xenografts

“…In keeping with this distinct pathological behavior, cross-sectional imaging is important to achieve an accurate delineation of tumor Magnetic resonance imaging (MRI) is currently considered the best modality to assess for NPC [13,14]. Several studies showed that MRI could be used to predict the prognostic value after radiotherapy [15][16][17]. Regretfully, these results only proved that MRI could precisely delineate the involvement extent of the tumor, they did not suggest the radiosensitivity.…”

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

“…The pterygoid canal, pterygopalantine fossa, foramen rotundum, foramen ovale, jugular foramen, hypoglossal canal, and internal acoustic meatus all belong to group 2 and are neural foramina. According to our previous study, 21 these site invasions were frequently associated with MRI-detected cranial nerve involvement. Disease with MRI-detected cranial nerve involvement has a high distant metastasis rate and poor survival rate, independent of lesion localization and symptoms.…”