Should all nasopharyngeal carcinoma with masticator space involvement be staged as T4?

Sze, Henry C.K.; Chan, Lucy; Ng, Wai Tong; Hung, Albert W M; Lee, Michael C. H.; Chang, Amy; Chan, Oscar S.H.; Cheung, Florence; Yeung, Richie; Lee, Anne W.M.

doi:10.1016/j.oraloncology.2014.09.001

Cited by 34 publications

(24 citation statements)

References 20 publications

(26 reference statements)

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“…The 7th edition of the AJCC Staging System was adopted in our study and medial or lateral pterygoid involvement was staged as T4. However, medial and/or lateral pterygoid involvement was staged as T3 or T2 by other studies due to better prognosis compared to skull base involvement which being staged as T3 [26,27]. The reason of T stage and overall stage has no significant effect on NPC may be caused by the pitfall of the 7th AJCC Staging System.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the prognostic value of MRI-derived residual tumors at the end of intensity-modulated radiotherapy in 358 patients with locally-advanced nasopharyngeal carcinoma

Zhou

Shen

et al. 2015

Radiat Oncol

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ObjectiveTo retrospectively analyze the prognostic value of magnetic resonance imaging (MRI)-derived residual tumors after intensity-modulated radiation therapy (IMRT) in the patients with locally-advanced nasopharyngeal carcinoma.MethodsA total of 358 patients with locally-advanced nasopharyngeal carcinoma who received IMRT were classified as having residual tumors or no residual tumor based on MRI at the end of radiotherapy. The χ2 test, log-rank test, Cox proportional hazards regression model and Kaplan-Meir survival curves were used to investigate the relationship of clinicopathological features and residual tumors and to assess the prognostic value of residual tumors.ResultsThe 3-year overall survival (OS) rate was 73% in the residual tumor group and 90% in the no residual tumor group (HR 2.15, 95% CI 1.21-3.82,, P = 0.007); 3-year local relapse-free survival (LRFS) was 89% in the residual tumor group and 97% in the no residual tumor group (HR 4.46, 95% CI 1.61-12.38, P = 0.002); 3-year disease free survival (DFS) was 67% in the residual tumor group and 82% in the no residual tumor group (HR 2.21, 95% CI 1.40-3.48, P = 0.001). A high prescribed radiation dose (>73.92 Gy) did not increase the percentage volume of the GTVnx receiving 95% of the prescribed dose (GTVnx V95%) or improve any survival outcome.ConclusionThe presence of a residual tumor after IMRT was a significant negative independent prognostic factor for OS, LRFS and DFS. Although IMRT have improved the distribution of radiotherapy doses into the tumors, residual tumors detected by MRI after IMRT are still associated with poor prognosis in patients with advanced nasopharyngeal carcinoma.

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Section: Discussionmentioning

confidence: 99%

A retrospective study of the prognostic value of MRI-derived residual tumors at the end of intensity-modulated radiotherapy in 358 patients with locally-advanced nasopharyngeal carcinoma

Zhou

Shen

et al. 2015

Radiat Oncol

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“…The preparatory processes for the 8th edition of the AJCC/UICC staging system included an extensive literature review and validation of recommendations by contemporary series before consensus was attained by international multidisciplinary experts. Among the suggestions reported in the literature, 4 issues demand serious consideration: 1) the controversy about the significance of the masticator space, 2) the uncertainty about the significance of prevertebral muscle invasion, 3) the possibility of replacing the supraclavicular fossa (SCF) with anatomic nodal levels, and 4) the simplification of unnecessary subgroups by elimination …”

Section: Introductionmentioning

confidence: 99%

“…12 The preparatory processes for the 8th edition of the AJCC/UICC staging system included an extensive literature review and validation of recommendations by contemporary series before consensus was attained by international multidisciplinary experts. Among the suggestions reported in the literature, 4 issues demand serious consideration: 1) the controversy about the significance of the masticator space, [13][14][15][16][17][18] 2) the uncertainty about the significance of prevertebral muscle invasion, [19][20][21] 3) the possibility of replacing the supraclavicular fossa (SCF) 3 with anatomic nodal levels, [22][23][24][25][26][27] and 4) the simplification of unnecessary subgroups by elimination. 27,28 In this study, we evaluated patients who were staged with magnetic resonance imaging (MRI) and irradiated with IMRT at 2 hospitals (one in Hong Kong and the other in Fujian in mainland China) to address these issues and to develop consensus recommendations by AJCC and UICC for the coming 8th edition.…”

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confidence: 99%

Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity‐modulated radiotherapy

Pan

Zong

et al. 2015

Cancer

267

255

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BACKGROUND An accurate staging system is crucial for cancer management. Evaluations for continual suitability and improvement are needed as staging and treatment methods evolve. METHODS This was a retrospective study of 1609 patients with nasopharyngeal carcinoma investigated by magnetic resonance imaging, staged with the 7th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system, and irradiated by intensity-modulated radiotherapy at 2 centers in Hong Kong and mainland China. RESULTS Among the patients without other T3/T4 involvement, there were no significant differences in overall survival (OS) between medial pterygoid muscle (MP)±lateral pterygoid muscle (LP), prevertebral muscle, and parapharyngeal space involvement. Patients with extensive soft tissue involvement beyond the aforementioned structures had poor OS similar to that of patients with intracranial extension and/or cranial nerve palsy. Only 2% of the patients had lymph nodes>6cm above the supraclavicular fossa (SCF), and their outcomes resembled the outcomes of those with low extension. Replacing SCF with the lower neck (extension below the caudal border of the cricoid cartilage) did not affect the hazard distinction between different N categories. With the proposed T and N categories, there were no significant differences in outcome between T4N0-2 and T1-4N3 disease. CONCLUSIONS After a review by AJCC/UICC preparatory committees, the changes recommended for the 8th edition include changing MP/LP involvement from T4 to T2, adding prevertebral muscle involvement as T2, replacing SCF with the lower neck and merging this with a maximum nodal diameter>6 cm as N3, and merging T4 and N3 as stage IVA criteria. These changes will lead not only to a better distinction of hazards between adjacent stages/categories but also to optimal balance in clinical practicability and global applicability.

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“…Sze et al. suggested that NPC with involvement of the medial pterygoid and/or lateral pterygoid muscle alone should be classified as T2 disease. Zhang et al.…”

Section: Introductionmentioning

confidence: 99%

“…The two systems differ mainly with respect to how paranasal sinus and masticator space involvement are used to classify the T stage (Table 1). Sze et al [2] suggested that NPC with involvement of the medial pterygoid and/or lateral pterygoid muscle alone should be classified as T2 disease. Zhang et al [3] proposed that parapharyngeal extension should be subclassified as mild or extensive and regarded as stages T2 and T4 disease, respectively.…”

Section: Introductionmentioning

confidence: 99%

Impact of paranasal sinus invasion on advanced nasopharyngeal carcinoma treated with intensity‐modulated radiation therapy: the validity of advanced T stage of AJCC/UICC eighth edition staging system

Wang

Zhao

et al. 2018

Cancer Medicine

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The aim of this study was to clarify the prognostic role of paranasal sinus invasion in advanced NPC patients. Data of patients (n = 295) with advanced NPC (T3/T4N0‐3 M0) treated with intensity‐modulated radiation therapy were retrospectively analyzed. Staging was according to the AJCC/UICC eighth edition staging system. Overall survival (OS), local recurrence‐free survival (LRFS), distant metastasis‐free survival (DMFS), and disease‐free survival (DFS) were calculated, and differences were compared between patients with and without paranasal sinus invasion. Multivariate analysis was used to identify the independent predictors of different survival parameters. Paranasal sinus invasion was present in 126 of 295 (42.7%) patients. Sphenoid, ethmoid, maxillary, and frontal sinus involvements were present in 123 of 295 (41.7%), 95 of 295 (32.2%), 45 of 295 (15.3%), and 0 of 295 (0%), respectively. All survival parameters were significantly better in patients without paranasal sinus invasion. When paranasal sinus invasion was reclassified as T4 instead of T3, all survival rates, other than LRFS (P = 0.156), were significantly better in the new T3 patients, and differences in all survival parameters remained nonsignificant between T3 with paranasal sinus invasion and T4 without paranasal sinus invasion patients (all P > 0.05). In multivariate analysis, paranasal sinus invasion was found to be an independent negative prognostic factor for OS, DFS, and DMFS (P = 0.016, P = 0.004, and P = 0.006, respectively), but not for LRFS (P = 0.068). Paranasal sinus invasion has prognostic value in advanced NPC. It may be reasonable to classify paranasal sinus invasion as T4 stage.

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Should all nasopharyngeal carcinoma with masticator space involvement be staged as T4?

Cited by 34 publications

References 20 publications

A retrospective study of the prognostic value of MRI-derived residual tumors at the end of intensity-modulated radiotherapy in 358 patients with locally-advanced nasopharyngeal carcinoma

A retrospective study of the prognostic value of MRI-derived residual tumors at the end of intensity-modulated radiotherapy in 358 patients with locally-advanced nasopharyngeal carcinoma

Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity‐modulated radiotherapy

Impact of paranasal sinus invasion on advanced nasopharyngeal carcinoma treated with intensity‐modulated radiation therapy: the validity of advanced T stage of AJCC/UICC eighth edition staging system

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