Report on revision of the Chinese 1992 staging system for nasopharyngeal carcinoma

Xu, Gelin; Lu, Tai‐Xiang; Hong, Ming; Pan, Jianji; Lang, Jinyi; Hu, Chaosu; Gao, Li; Wang, Rensheng; Pi, Zhiming; Zhu, Xiaodong; Zhang, Yiqin; Wu, Meng; Jin, Feng; Chen, Xianzhao; Chen, Xiaozhong; Chen, Yunbin; Yang, Xinhua; Xu, Xuping; Liang, Beibei; Sakata, Jun; Yi, Junlin; Zhao, Chong

doi:10.1007/s13566-013-0088-5

Cited by 16 publications

(4 citation statements)

References 39 publications

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“…However, several studies have found that the invasion rate of the hypopharynx, orbit, and cervical vertebra of NPC were very low 5,16,25,26. Based on the above results, the orbit and cervical vertebra were excluded in the Chinese system (2008 version) for NPC 27. Our research was consistent with the results of these studies.…”

Section: Discussionsupporting

confidence: 87%

<p>A simplified T classification based on the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma</p>

Pan¹,

Tong²,

Chen³

et al. 2019

CMAR

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Objective: This study aimed to establish a simplified T classification based on the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC). Methods: In total, 325 patients with NPC were included in this study. All patients underwent magnetic resonance imaging, and the staging criteria were recorded. These patients were subjected to staging with the 8th edition of the UICC/AJCC staging system for NPC. Results: Involvement of the oropharynx, nasal cavity, adjacent soft tissue (medial pterygoid, lateral pterygoid, and prevertebral muscles), cervical vertebra, orbit, and hypopharynx were always accompanied by other equivalently or more advanced T-stage classifications. All cases with involvement of the paranasal sinuses showed skull base erosion. The majority of cases with involvement of the pterygoid structure showed skull base erosion. Conclusion: According to the simplification principle, the following new T classification based on the 8th edition of the UICC/AJCC staging system was established: T1, tumor confined to nasopharynx, or beyond the nasopharynx without parapharyngeal involvement; T2, tumor with extension to the parapharyngeal space; T3, tumor with infiltration to bony structures at the skull base; T4, tumor with intracranial extension, involvement of the cranial nerves or parotid gland, and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle. Validation with a large series of patients is needed.

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Section: Discussionsupporting

confidence: 87%

<p>A simplified T classification based on the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma</p>

Pan¹,

Tong²,

Chen³

et al. 2019

CMAR

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“…The present study was approved by the Institutional Review Board of Nanfang Hospital (Guangzhou, China), and all patients provided written informed consent for the use of their imaging data. Staging was done using the 2008 nasopharyngeal carcinoma staging system in People's Republic of China (10). A summary of the patients' information is presented in Table I.…”

Section: Methodsmentioning

confidence: 99%

Assessment of the therapeutic accuracy of cone beam computed tomography‑guided nasopharyngeal carcinoma radiotherapy

et al. 2019

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The aim of the present study was to determine the ability of cone beam computed tomography (CBCT) to improve the accuracy of nasopharyngeal carcinoma (NPC) radiotherapy by analyzing the setup and inter-fraction errors at different levels and directions of the target volumes. A total of 113 patients with NPC who were undergoing intensity-modulated radiotherapy were recruited for the present study. Each patient had at least three CBCT exams prior to the start of radiation therapy. Three anatomic bony landmarks, including the upper neck, lower neck and head, were used to represent the different levels of assessment. The positioning errors were registered in three planes throughout the course of radiotherapy: The right-left (RL), superior-inferior (SI) and anterior-posterior (AP) directions. The planning CT images were matched with the CBCT images to determine the naso-pharynx shifts. A receiver operating characteristic curve was plotted to establish the specificity and sensitivity of CBCT. The planning target volume margin (MPTV) for the head was 0.9 mm, 1.4 mm for the upper neck and 2.0 mm for the lower neck. MPTVs of 1.5, 0.6 and 2.2 mm in the RL, SI and AP directions, respectively, were detected. In addition, there was evidence of setup errors in the three planes (RL, SI and AP) with the greatest error observed in the AP direction. Furthermore, the setup uncertainties in the neck region were greater than those of the head. In conclusion, CBCT could greatly improve the accuracy of radiotherapy by minimizing the setup errors and MPTV.

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“…Paranasal sinus invasion (PSI) occurs in ∼30% NPC patients (5), and yet, it has been controversial in its prognostic value. In the Chinese 2008 staging system for NPC, PSI was classified as T4 (6), but it was retained within the T3 category in the 8th edition of AJCC staging system (7). Recently, cumulating data through MRI-guided diagnosis and IMRT-based treatment revealed that T3 NPC with PSI have similar 5-year local recurrence-free survival (LRFS) and overall survival (OS) with T4 disease (8,9), suggesting the plausibility of further risk stratification within T3 classification.…”

Section: Introductionmentioning

confidence: 99%

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

Zhou

Xue

et al. 2020

Front. Oncol.

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Purpose: This study aims to investigate the prognostic value and dosimetric impact of paranasal sinus invasion (PSI) in patients with nasopharyngeal carcinoma (NPC), and further to explore the feasibility of an integrative prognostic model based on anatomic, volumetric, and dosimetric features.Methods: Two hundred six patients with T3 NPC receiving intensity-modulated radiation therapy (IMRT) were retrospectively analyzed. Dosimetric parameters were calculated from dose-volume histograms. Primary gross tumor volume (GTV-P) and dosimetric parameters were categorized using optimal cutpoints determined by R. Local recurrence-free survival (LRFS) was estimated using Kaplan-Meier method. Independent risk factors for LRFS were identified through univariable and multivariable analyses by Cox proportional hazards models.Results: The incidence of PSI was 10.7% (22/206). Patients with PSI had significantly inferior 5-year LRFS (77.3 vs. 93.8%, P = 0.006). IMRT plans for patients with PSI had larger dose heterogeneity, higher frequency of underdosing, and higher maximum dose to optic structures. When categorized by optimal cutpoints, GTV-P > 38.67 cm 3 (5-year LRFS, 84.8 vs. 97.4%, P = 0.008), and V66.88 < 89.87% (5-year LRFS, 67.1 vs. 94.5%, P < 0.001) were associated with significantly worse local outcome. Multivariable analyses showed that PSI, GTV-P > 38.67 cm 3 , and V66.88 < 89.87% were independent risk factors for local relapse, either in patients with or without concurrent chemotherapy. An integrative prognostic model was then established upon the cumulative score of risk factors. Subgroups with score of 0, 1-2, and 3 had distinctive local outcomes; the 5-year LRFS was 96.6, 84.7, and 58.3%, respectively (P < 0.001).Zhou et al. Impact of PSI on NPC Following IMRTConclusions: Paranasal sinus invasion jeopardized local control in T3 NPC patients due to large tumor burden and inadequate radiation dose in GTV-P. The presence of PSI, GTV-P, and radiation underdosing combined are critical for the risk stratification of local failure.

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Report on revision of the Chinese 1992 staging system for nasopharyngeal carcinoma

Cited by 16 publications

References 39 publications

<p>A simplified T classification based on the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma</p>

<p>A simplified T classification based on the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma</p>

Assessment of the therapeutic accuracy of cone beam computed tomography‑guided nasopharyngeal carcinoma radiotherapy

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

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