Significance of Primary Tumor Volume and T-stage on Prognosis in Nasopharyngeal Carcinoma Treated with Intensity-modulated Radiation Therapy

Abstract

This study demonstrated that the primary tumor volume had significantly impacted on the prognosis of patients with nasopharyngeal carcinoma. We proposed that the primary tumor volume should be considered as an additional stage indicator in the new revision of the clinical stage of nasopharyngeal carcinoma.

A Comparison Between the Chinese 2008 and the 7th Edition AJCC Staging Systems for Nasopharyngeal Carcinoma

“…The other reason may be that most of AJCC T4 patients have relatively larger primary volume, which has been reported to have poorer prognosis than other subgroups. 23,24 In contrast, LRFS curves of Chinese 2008 T4 subgroup was found to be similar to T2 and T3, this could be due to paranasal sinus, lateral pterygoid muscle, or MRI-detected cranial nerve involvement being assigned to T4 of the Chinese 2008 system, which pointed to upstaging in 178 patients of AJCC T3. As we know, the paranasal sinus included in T4 would make for a somewhat easier treatment plan, given the fact that paranasal sinus was an anterior structure having fewer critical structures compared with the intracranial structures preferred by the AJCC T4.…”

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

“…Our previous study also demonstrated that the primary tumor volume had a significant impacted on the prognosis of NPC patients treated with IMRT. The 5-year OS was significantly reduced for patients with a large tumor volume (>50 ml), which is almost equal to that of stage T4 patients [28]. To take tumor volume into consideration as an additional stage indicator in the future revision of NPC staging, more studies should be done to identify a uniform cut-off point of tumor volume.…”

The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy

“…Therefore, it is important to identify other prognostic factors to improve the ability of the TNM staging system to predict prognosis. In recent years, there have been several published reports focusing on the correlation between the prognosis of NPC patients treated with IMRT and tumour-or host-related factors, such as the primary tumour volume (GTV-P) (Guo et al 2012;Chen et al 2011), the maximum standardized uptake value of the primary tumour (SUVmax-P), which is tested by 18 F-FDG PET/CT , weight loss during treatment (Qiu et al 2011), baseline serum LDH levels Zhou et al 2012), and the albumin-globulin ratio before treatment (pretreatment AGR) . The results of those studies indicated that advanced large GTV-P (Guo et al 2012;Chen et al 2011), high SUVmax-P , high weight loss during treatment (Qiu et al 2011), high baseline serum LDH levels Zhou et al 2012) and lower pretreatment AGR all are predictors of a poor prognosis and could be used to facilitate treatment options when combined with the TNM staging system.…”