Dan Yue1, Ya-Fei Xu1, Fan Zhang1, Li Lin1, Yan-Ping Mao1, Wen-Fei Li1, Lei Chen1, Ying Sun1, Li-Zhi Liu2, Ai-Hua Lin3, Li Li2, Jun Ma4. 1. Department of Radiation Oncology, Sun Yat-sen University, Guangzhou, People's Republic of China. 2. Imaging Diagnosis and Interventional Center, Sun Yat-sen University, Guangzhou, People's Republic of China. 3. Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, People's Republic of China. 4. Department of Radiation Oncology, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address: majun2@mail.sysu.edu.cn.
Abstract
PURPOSE AND OBJECTIVES: To investigate the pattern of lymph node metastasis and treatment outcome after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC), and assess the possibility of replacing Ho's supraclavicular fossa (SCF) with the lower level (LL; cervical extension below caudal edge of cricoid cartilage) based on magnetic resonance imaging (MRI) as a criterion for N3 disease. METHODS AND MATERIALS: We retrospectively reviewed 749 patients with biopsy-proven non-metastatic NPC treated with IMRT. Lymph node metastasis was mapped using the 2013 International Consensus Guidelines. RESULTS: Cervical lymph node (CLN) laterality, CLN greatest dimension (>60 vs. ⩽60 mm) and Ho's SCF were independent prognostic factors for disease-free survival (DFS) and distant metastasis-free survival (DMFS; P<0.01) in multivariate analysis. Replacing Ho's SCF with the LL was also predictive for DFS and DMFS (P<0.01). Compared to the 7th UICC/AJCC, N-categories based on the LL provided more satisfactory distinction between hazard ratios for distant and disease failure for each N-category. N3a and N3b as defined by the 7th UICC/AJCC had similar DMFS (P=0.31) and DFS (P=0.21). CONCLUSIONS: Replacing Ho's SCF with the LL is simple and practical. The N-category staging system could be further simplified by merging N3 subcategories.
PURPOSE AND OBJECTIVES: To investigate the pattern of lymph node metastasis and treatment outcome after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC), and assess the possibility of replacing Ho's supraclavicular fossa (SCF) with the lower level (LL; cervical extension below caudal edge of cricoid cartilage) based on magnetic resonance imaging (MRI) as a criterion for N3 disease. METHODS AND MATERIALS: We retrospectively reviewed 749 patients with biopsy-proven non-metastatic NPC treated with IMRT. Lymph node metastasis was mapped using the 2013 International Consensus Guidelines. RESULTS: Cervical lymph node (CLN) laterality, CLN greatest dimension (>60 vs. ⩽60 mm) and Ho's SCF were independent prognostic factors for disease-free survival (DFS) and distant metastasis-free survival (DMFS; P<0.01) in multivariate analysis. Replacing Ho's SCF with the LL was also predictive for DFS and DMFS (P<0.01). Compared to the 7th UICC/AJCC, N-categories based on the LL provided more satisfactory distinction between hazard ratios for distant and disease failure for each N-category. N3a and N3b as defined by the 7th UICC/AJCC had similar DMFS (P=0.31) and DFS (P=0.21). CONCLUSIONS: Replacing Ho's SCF with the LL is simple and practical. The N-category staging system could be further simplified by merging N3 subcategories.
Authors: Qi-Yong Ai; Ann D King; Benjamin King Hong Law; David Ka-Wai Yeung; Kunwar S Bhatia; Jing Yuan; Anil T Ahuja; Lok Yiu Sheila Wong; Brigette B Ma; Frankie Kwok Fai Mo; Michael K M Kam Journal: Eur Arch Otorhinolaryngol Date: 2016-10-08 Impact factor: 2.503
Authors: Jian Ji Pan; Wai Tong Ng; Jing Feng Zong; Lucy L K Chan; Brian O'Sullivan; Shao Jun Lin; Henry C K Sze; Yun Bin Chen; Horace C W Choi; Qiao Juan Guo; Wai Kuen Kan; You Ping Xiao; Xu Wei; Quynh Thu Le; Christine M Glastonbury; A Dimitrios Colevas; Randal S Weber; Jatin P Shah; Anne W M Lee Journal: Cancer Date: 2015-11-20 Impact factor: 6.860