Prognostic Value of Subclassification Using MRI in the T4 Classification Nasopharyngeal Carcinoma Intensity-Modulated Radiotherapy Treatment

• Published in: International journal of radiation oncology, biology, physics Vol. 84; no. 1; pp. 196 - 202
• Main Authors: Chen, Lei, M.D, Liu, Li-Zhi, M.D, Chen, Mo, M.D, Li, Wen-Fei, M.D, Yin, Wen-Jing, M.D, Lin, Ai-Hua, M.D., Ph.D, Sun, Ying, M.D., Ph.D, Li, Li, M.D., Ph.D, Ma, Jun, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Analysis of Variance; Biological and medical sciences; CARCINOMAS; Chemoradiotherapy - methods; Chemotherapy, Adjuvant - methods; CLASSIFICATION; Female; HEALTH HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Karnofsky Performance Status; Magnetic Resonance Imaging; Male; Medical sciences; METASTASES; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Neoplasms - classification; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Neoplasm Invasiveness; Neoplasm Staging; NERVES; NMR IMAGING; Otorhinolaryngology. Stomatology; PATIENTS; Prognosis; Prognostic value; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Intensity-Modulated; Subclassification; T4 classification; The seventh edition of American Joint Committee on Cancer staging system; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult; Nasopharyngeal carcinoma; Subclassification; Prognostic value; The seventh edition of American Joint Committee on Cancer staging system; T4 classification; Prognosis; Nasopharynx cancer; Malignant tumor; Nasopharynx carcinoma; Nuclear magnetic resonance imaging; Intensity modulated radiotherapy; Cancerology; Treatment; Medical imagery; ENT disease; Pharynx disease; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.11.021

Purpose To subclassify patients with the T4 classification nasopharyngeal carcinoma (NPC), according to the seventh edition of the American Joint Committee on Cancer staging system, using magnetic resonance imaging (MRI), and to evaluate the prognostic value of subclassification after intensity-modulated radiotherapy (IMRT). Methods and Materials A total of 140 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated classification T4 NPC received IMRT as their primary treatment and were included in this retrospective study. T4 patients were subclassified into two grades: T4a was defined as a primary nasopharyngeal tumor with involvement of the masticator space only; and T4b was defined as involvement of the intracranial region, cranial nerves, and/or orbit. Results The 5-year overall survival (OS) rate and distant metastasis-free survival (DMFS) rate for T4a patients (82.5% and 87.0%, respectively), were significantly higher than for T4b patients (62.6% and 66.8%; p = 0.033 and p = 0.036, respectively). The T4a/b subclassification was an independent prognostic factor for OS (hazard ratio = 2.331, p = 0.032) and DMFS (hazard ratio = 2.602, p = 0.034), and had no significant effect on local relapse-free survival. Conclusions Subclassification of T4 patients, as T4a or T4b, using MRI according to the site of invasion, has prognostic value for the outcomes of IMRT treatment in NPC.