Computed tomography in nasopharyngeal carcinoma: Part I: T-stage conversion with CT-staging

doi:10.1016/0360-3016(90)90224-8

International Journal of Radiation OncologyBiologyPhysics

Volume 19, Issue 5, November 1990, Pages 1171-1175

https://doi.org/10.1016/0360-3016(90)90224-8 Get rights and content

Abstract

Two hundred seventeen consecutive patients were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. The distribution according to T and N staging with polytomography was compared to patients (106 out of 217) who had CT scans done at presentation. T1 cases were less frequent (6.6% vs 27%) in the Cf-staged series, whereas T3 showed a higher incidence (30.2% vs 12.6%). The advantages of CT over conventional tomography were quantitated in a subset of 97 patients who underwent both staging procedures. Site-by-site, CT displayed a higher percentage of involvement than polytomography: parapharyngeal spread 18% vs 2%, oropharynx 16% vs 8%, choanae and nasal cavities 28% vs 13%, ethmoid and maxillary sinus 29% vs 13%. Information provided by CT caused a T-stage conversion in 23 out of 97 cases (23%): 4 out of 11 T1, 16 out of 44 T2, 3 out of 16 T3.

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Cited by (25)

How Does Magnetic Resonance Imaging Influence Staging According to AJCC Staging System for Nasopharyngeal Carcinoma Compared With Computed Tomography?
2008, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
Magnetic resonance imaging is used widely in both staging and treatment planning for radiotherapy. The improvements in staging accuracy and treatment techniques could affect, not only the ultimate outcome, but also the relative significance of different factors (8). Although Ng et al.(4) and Poon et al.(5) have demonstrated that the T stage changed from 26.9% to 33.3% and N stage changed 6%, the exact role of MRI in improving accuracy with the 6th edition of the AJCC staging system compared with CT has not been well established.
To analyze the degree and pattern of influence of magnetic resonance imaging (MRI) on staging according to the 6th edition of the American Joint Committee on Cancer staging system compared with computed tomography (CT).
The MRI and CT scans and medical records of 420 consecutive patients with newly diagnosed nasopharyngeal carcinoma (NPC) were analyzed retrospectively. The tumors of all patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system.
A significant difference (p <0.05) was found between CT and MRI in demonstrating involvement in the oropharynx (CT, 25.0% vs. MRI, 14.5%), prevertebral muscle (CT, 18.4% vs. MRI, 36.0%), parapharyngeal space (CT, 82.6% vs. MRI, 68.8%), skull base (CT, 31.0% vs. MRI, 52.6%), sphenoid sinus (CT, 13.6% vs. MRI, 16.7%), ethmoid sinus (CT, 7.1% vs. MRI, 3.3%), intracranial area (CT, 4.8% vs. MRI, 16.0%), and retropharyngeal lymph nodes (CT, 52.1% vs. MRI, 69.0%). The incidence of cervical lymph node metastasis and lymph node metastasis at each level was similar according to CT and MRI. MRI resulted in changes in 49.8% of T stage cases, 10.7% of N stage cases, and 38.6% of clinical stage cases.
MRI demonstrated early primary tumor involvement more precisely and deep primary tumor infiltration more easily. The use of MRI caused dramatic changes in the results of the T stage and clinical staging and should be preferred to CT in staging NPC. Patients would benefit from changes in treatment strategies resulting from the use of MRI.
Nasopharyngeal carcinoma: The impact of CT-scan and of MRI on staging, radiotherapy treatment planning, and outcome of the disease
2005, Clinical Imaging
The present study is a critical review of the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis and therapy of nasopharyngeal cancer. It is estimated that following CT-scan/MRI, T,N staging of the disease changes in about half of cases, which results in important adjustments of the radiotherapy treatment planning, both in terms of radiation field dimensions and of dose specifications. The development of novel technology with CT-scan-simulated 3-D conformal or intensity-modulated radiotherapy (IMRT) planning is gradually becoming the standard therapy for nasopharyngeal carcinoma (NPC). CT-scan/MRI is also of value in detecting massive parapharyngeal involvement, low-neck lymphadenopathy or fixation of nodes onto adjacent structures, which are important features indicating the necessity to integrate chemotherapy or surgical neck dissection in the overall treatment policy. CT–positron emission tomography (PET) scan is recently under evaluation for the identification of the most active tumor regions, which will allow a biological radiotherapy planning (RTP) using IMRT techniques.
Nasopharyngeal Cancer
2003, Head and Neck Cancer: Emerging Perspectives
Nasopharyngeal cancer (NPC) is an epithelial tumor. There are several factors that can lead to nasopharyngeal cancer, such as the Epstein–Barr virus, genetics, environmental factors, anatomy, pathology, and the natural history of the disease. Chemotherapy plays a very important part in the treatment and improvement in patients with nasopharyngeal carcinoma. In patients with recurrent or metastatic disease, effective and adequate chemotherapy alone and other calming treatments are highly recommended. In patients with locally advanced NPC, combination chemotherapy given neoadjuvantly, concomitant with, or after curative total radiotherapy, can improve local control, decrease the systemic metastasis, and improve disease-free survival. Concurrent chemoradiotherapy, followed by adjuvant chemotherapy, significantly improves local control, systemic control, progression-free survival, and overall survival in a phase III prospective randomized trial. Different sequencing of induction chemotherapy followed by concomitant chemoradiotherapy, new agents, and combinations needs to be investigated in patients with locally advanced NPC.
Locally advanced nasopharyngeal carcinoma: Computed tomography findings, clinical evaluation, and treatment outcome
2000, International Journal of Radiation Oncology Biology Physics
Purpose: We present our experience with computed tomography (CT) for delineating the extent of bone erosion in nasopharyngeal carcinoma (NPC) and propose that a new subdivision of Stage T4 disease be added to the staging criteria for cases of minimal bone disease, defined as erosion of the base of the sphenoid or the pterygoid without cranial nerve (CN) involvement.
Methods and Materials: We retrospectively reviewed the clinical findings, radiological findings, and treatment outcome in 64 patients with Stage T4 NPC, diagnosed according to the American Joint Committee on Cancer 4th edition criteria. The median follow-up was 34 months (range, 3–118 months). Statistical analyses were performed using the chi-square test, the Kaplan-Meier method, and the log-rank test.
Results: Local control was achieved in 19 (46%) of 41 patients with CN deficits and 18 (78%) of 23 patients without CN deficits (p = 0.01). Overall 5-year survival with and without CN deficits was 25% and 58%, respectively (p = 0.01). When the 16 patients with minimal bone disease were compared to the remaining 48 patients, there were significant differences in local control rates (87% vs. 48%, p = 0.006) and 5-year survival rates (68% vs. 28%, p = 0.008).
Conclusion: Among patients with Stage T4 NPC, a subgroup of patients with only minimal bone disease may have a more favorable prognosis, which may have a considerable bearing on our approach to this patient group.
What is the significance of nasal involvement in nasopharyngeal carcinoma?
1999, International Journal of Radiation Oncology Biology Physics
Purpose: The purpose of this study was to differentiate the patterns of nasal fossa involvement in nasopharyngeal carcinoma (NPC) and to clarify its prognostic influence on local control and survival after radiation therapy.
Methods and Materials: Between November 1989 and July 1991, 218 patients with histologically proven local–regional NPC were treated with radiotherapy following the protocol at the Department of Radiation Oncology, Cancer Hospital, Shantou University School of Medicine. All patients had pretreatment CT scans. Fiberoptic endoscopic examination was performed every week during treatment and at the time of every follow-up visit to define the initial extent of disease and to evaluate treatment response. No chemotherapy or brachytherapy was given.
Results: Of the 218 patients, 87 had nasal involvement. Sixty of them had a pattern of mucosal infiltration (MI), another 27 had an exophytic protruding (EP) component. The likelihood of residual disease after irradiation, the local relapse rate, 5-year freedom from progression rate (FFP), and death rate associated with local relapse (DRALR) of MI and EP were 36.7% vs. 3.7%, 30.0% vs. 7.4%, 26.7% vs. 51.8%, and 25.0% vs. 3.7% with p < 0.004, p < 0.005, p < 0.02, and p < 0.03, respectively. Multivariate analysis in this selected group demonstrated that infiltration of nasal fossa mucosa was an independent prognostic factor on primary control and freedom from progression.
Conclusion: Differentiation of nasal fossa involvement according to MI or EP is of value in predicting the outcome of treatment. We suggest that only the MI group should be considered as nasal involvement in the staging of NPC.
Nasopharyngeal carcinoma
1997, Lancet

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^∗: Department of Radiotherapy.

^†: Imaging Department.

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Original contributionComputed tomography in nasopharyngeal carcinoma: Part I: T-stage conversion with CT-staging

Abstract

Radiol. Clin. N. Am.

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Int. J. Radiat. Oncol. Biol. Phys.

Imaging modalities for the study of the paranasal sinuses and nasopharynx

Otolaryngol. Clin. N. Am.

Nasopharynx and paranasopharyngeal space

Criteri diagnostici tomodensitometrici nella patologia neoplastica dei seni paranasali e della rinofaringe

Radiol. Med.

La TC nell' anatomica e patologia neoplastica della faringe

It. Curr. Rad.

Magnetic resonance imaging of the nasopharynx

Radiology

Magnetic resonance imaging of the lymph nodes: comparison with CT

Radiology

Computed tomography of the infratemporal fossa

Radiology

Diagnostica per immagini

Nasopharynx

Detection and assessment of cervical lymph node metastases in head and neck tumors. A comparison of methods

Laryngorhinootologie

Differential diagnosis of nasopharyngeal tumors by computed tomography scanning

Arch. Otolaryngol.

Head and neck: high field magnetic resonance imaging versus computed tomography

Otolaryngol. Clin. N. Am.

Original contribution
Computed tomography in nasopharyngeal carcinoma: Part I: T-stage conversion with CT-staging