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Primary tumor volume (PTV) is known to be a significant prognostic factor in malignant tumor. There have been several studies of nasopharyngeal carcinoma (NPC) relating tumor volume to treatment outcome. Our study was designed to evaluate the effect of PTV on treatment outcomes in NPC treated with radiotherapy (RT)/concurrent chemoradiotherapy (CCR...
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Background:
Our previous dosimetric study showed that for locally advanced non-small cell lung cancer (LA-NSCLC), radiotherapy with intensity-modulated radiotherapy (IMRT) technique could deliver sufficient dose coverage to subclinical regions and reduce the dose to normal tissues with the omission of clinical target volume (CTV). To further clini...
Purpose
The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).
Methods
We performed...
Although previous studies have documented correlations between pre-treatment or post-treatment primary tumour volumes and local outcome following definitive concomitant chemoradiotherapy (CCRT) in head and neck squamous cell carcinoma (HNSCC), no study has included and compared tumour volumes during CCRT. We reviewed the MRIs of 69 HNSCC patients t...
Purpose
To validate and propose revision of the 8th edition American Joint Committee on Cancer (AJCC) clinical staging system for esophageal squamous cell cancer (ESCC) patients treated with definitive intensity-modulated radiation therapy combined with concurrent chemotherapy (Chemo-IMRT) based on computed tomography (CT) imaging.
Methods
The cli...
Purpose
The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).
Methods
We performed...
Citations
... Most experts postulated that volumes greater than 50-60 cc are associated with higher chances of recurrence and poorer survival [4,[41][42][43]. However Chu et al. and Zhou et al. have suggested that tumor volumes as small as 15 cc and 31 cc, respectively, could be indicators of advanced disease and worse outcomes [44,45]. Ni et al. reported that the volume of retropharyngeal node was even superior prognostic indicator for local control in NPC than primary tumor volume, based on their results [46]. ...
Purpose
We aimed to analyze patterns of failure and disease volume-treatment outcomes in patients with Nasopharyngeal carcinoma (NPC) treated with definitive radiation with or without concurrent chemotherapy at a tertiary cancer centre in northeast India.
Methods
From February 2018 to February 2022, 99 histopathologically proved non-metastatic NPC patients treated with curative-intent RT with or without chemotherapy were retrospectively analyzed. Locally advanced patients received neoadjuvant or adjuvant chemotherapy. The Cox proportional hazards model was used to investigate the impact of various prognostic factors on locoregional free survival (LRFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). The log-rank test and Kaplan–Meir curves compared outcome variables based on ROC analysis-classified tumor volume.
Results
During a median follow up of 25.4 months (17.3–39.2), 35(35.4%) patients developed recurrence. Twenty-three patients developed locoregional failures, of which 11 were in-field; 12 patient showed an out-field failure. The 3-year LRFS, DMFS, PFS and OS was 71.10%, 70.90%, 64.10% and 74.10% respectively. There was statistically significant difference in LRFS according to T staging (p < 0.0001). Gross tumor volume (GTVp) and gross nodal volume (GTVn) were an independent prognostic factor for OS, PFS, LRFS and DMFS. The cut-off volumes for GTVp and GTVn for distant metastases and locoregional failure, respectively, were found to be 13 and 22.7 mL and 3.7 and 39.2 mL, respectively, by ROC curve analysis. Based on this, 99 patients were divided into three subgroups. OS demonstrated significant differences among patients in different volume subgroups for GTVp (p = 0.03) and GTVn (p = 0.00024).
Conclusions
For NPC patients who undergo curative IMRT, primary tumour and nodal volumes are independent prognostic indicators. GTVp and GTVn are highly predictive of local control, distant metastases, disease-free survival, and overall survival. This justifies their use as quantitative prognostic indicator for NPC.
... Advanced N stage and tumor volume have been identified as important prognostic factors for NPC patients by many published data from endemic areas. 2,[15][16][17][18][19][20][21] There is a general consensus that patients with advanced N stage had a trend to develop distant metastases and further adversely effect on OS. In our study, advanced N stage was significantly associated with death and distant metastasis. ...
Few studies were conducted to explore the prognostic factors for nonendemic nasopharyngeal carcinoma (NPC) in the era of 3-dimensional conformal radiation therapy (3DCRT)/intensity-modulated radiation therapy (IMRT). The aim of this study was to evaluate the potential prognostic factors for nonendemic NPC.
Between January 2004 and December 2011, a total of 393 nonendemic NPC patients receiving 3DCRT/IMRT were reviewed according to the inclusion and exclusion criteria. The prognostic factors we analyzed included age, T stage, N stage, lymph node diameter, primary tumor volume, WHO histology types, and cranial nerve related symptoms. All patients were staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) system. The factors found to be associated with the endpoints by univariate analyses were then entered into multivariate Cox proportional hazards regression analysis.
The median follow-up time was 61.4 months (range: 4–130 months). The 5-year local recurrent-free survival (LRFS), nodal relapse-free survival (NRFS), distant metastasis free survival (DMFS), and disease-specific survival (DSS) for all patients were 89.3%, 96.4%, 73.5%, and 74.3%, respectively. Multivariate analysis indicated that N stage (N2–3), WHO pathologic type II, and primary tumor volume (>23 mL) were 3 independent prognostic factors for DSS and DMFS. According to the number of prognostic factors, patients were divided into 3 risk groups: low-risk group (patients without any risk factors); intermediate-risk group (patients with only 1 risk factor); and high-risk group (patients with more than 2 risk factors). The 5-year DSS for low, intermediate, and high-risk groups were 91.5%, 75.2%, and 49.3%, respectively (P < 0.001). The 5-year DMFS for low, intermediate, and high-risk groups were 89.4%, 77.9%, and 49.4%, respectively (P < 0.001).
Advanced N stage (N2–3), larger tumor volume (>23 mL), and histological WHO type II are independently prognostic factors for nonendemic NPC patients in China.
... This is consistent with the previous study by Liang et al. [21] in which local disease spread stepwise from proximal sites to distal sites in NPC is observed. Several investigators have also reported that a larger tumor volume is associated with an increased rate of tumor recurrence and poor patient survival rates [22,23]. The reason no MSI pattern influenced LRFS or DFS might be due to the intensive use of MRI with high- Figure 5 Survival analyses for MSI pattern C. (A) Overall survival, (B) local relapse-free survival, (C) metastasis-free survival and (D) disease-free survival for different groups of MSI in pattern C. MSI, masticator space involvement. ...
Background
The aim of this study was to investigate the prognostic significance and various classifications for anatomic masticator space involvement (MSI) in patients with nasopharyngeal carcinoma (NPC).
Methods
This study retrospectively analyzed 742 patients with untreated nondisseminated NPC who underwent magnetic resonance imaging (MRI) scan of the nasopharynx and neck. The MSI was graded according to different anatomic features. The overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) of the patients with different MSI grades were analyzed using the Kaplan-Meier method and log-rank tests.
Results
The frequency of MSI was 24.1% (179/742). The 5-year OS, LRFS, DMFS, DFS for NPC patients with versus without MSI were 70.9% versus 82.5% (P = 0.001), 94.1% versus 91.4% (P = 0.511), 81.4% versus 88.7% (P = 0.021), and 78.0% versus 83.5% (P = 0.215), respectively. Significant differences in OS were also found among different MSI groups. In the patients with MSI, the OS of the group with medial and/or lateral pterygoid involvement (MLPI) NPC was 73.9% compared to 51.3% (P < 0.0001) in the patients with infratemporal fossa involvement (IFI).
Conclusions
MSI was an independent prognostic factor for OS and DMFS. NPCs invading the masticator space should be separately categorized into MLPI and IFI prognostic groups. We suggest that MLPI should be staged as T3 while IFI is staged as T4 disease in future TNM staging revision.
... The cut-off point to categorize patients into good and poor prognostic groups is still controversial. Chu et al. (15) reported that the large tumor volume (primary tumor volume .15 ml) was associated with more recurrence and a poor survival rate. ...
The aim of this study was to evaluate the effect of the primary tumor volume on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy.
Between August 2003 and April 2005, 112 patients with Stage I-IVB nasopharyngeal carcinoma treated by intensity-modulated radiation therapy were included. Measurement of the primary tumor volume was based on contrast-enhanced computed tomography scans before treatment. A receiver operating characteristics curve was used to determine the best cut-off point of the primary tumor volume.
The mean primary tumor volume for 112 patients with nasopharyngeal carcinoma was 33.9 ± 28.7 ml. Within the framework of UICC T-staging, all patients were divided into four groups according to the primary tumor volume. We call it the volume stage (V1 <15.65 ml, V2 = 15.65-24.25 ml, V3 = 24.25-50.55 ml and V4 >50.55 ml). The 5-year overall survival rates for V1, V2, V3 and V4 were 88.5, 83.3, 82.4 and 54.5% (P = 0.014), respectively. The cumulative survival curves for V1, V2 and V3 were very close, but clearly separated from V4. In addition, Cox proportional hazards regression model analysis showed that a primary tumor volume >50 ml was an independent risk factor for radiotherapy (risk ratio = 3.485, P = 0.025).
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.
... Several authors also reported that GTV obtained from CT scan was a significant predictor for clinical outcome in the treatment of HNSCC [10,[30][31][32]. A few articles suggested that the larger MR-derived GTV was associated with higher recurrence and poorer survival rates [33,34]. In 2005, Chong et al. [35] demonstrated that MRI was superior to CT for depicting the gross extent of tumor infiltration, and positive correlation between MR-derived tumor volume and pT stage was demonstrated. ...
Purpose We assessed the prognostic value of metabolic tumor volume (MTV) measured using18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) inpatients with locally advanced head
and neck squamous cell carcinoma (HNSCC).
Methods We retrospectively reviewed 56 patients (51 men, five women; mean age 56.0 ± 8.8years) who had locally advanced HNSCC and
underwent FDG PET/CT for initial evaluation. All patients had surgical resection and radiotherapy with or without concurrent
chemotherapy. The peak standardized uptake value (SUVpeak) and MTV of the target lesion, including primary HNSCC andmetastatic cervical lymph nodes, were measured from FDG PET/CT
images. We compared SUVpeak, MTV, and clinicopathologic variables such as age, Eastern Cooperative Oncology Group (ECOG) performance status, pN stage,
pT stage, TNM stage, histologic grade and treatment modality to disease-free survival (DFS) and overall survival (OS).
Results On the initial FDG PET/CT scans, the median SUVpeak was 7.8 (range, 1.8-19.0) and MTV was17.0 cm3 (range, 0.1-131.0 cm3). The estimated 2-year DFS and OS rates were 67.2% and 81.8%. The cutoff points of SUVpeak 6.2 and MTV 20.7 cm3 were the best discriminative values for predicting clinical outcome. MTV and ECOG performance status were significantly related
to DFS and OS on univariate and multivariate analyses (p
Introduction: Nasopharyngeal carcinoma is very uncommon in the southern part of India, the age-adjusted incidence rate is less than 1 per 1,00,000 population. This study is undertaken to evaluate the outcome of nasopharyngeal carcinoma and its correlation with Primary tumor volume. Material and methods: Total of 50 non-metastatic nasopharyngeal carcinoma patients treated with concurrent chemo radiation between January 2013 and December 2015 were included in the study. All patients were treated via IMRT with dose of 66-70Gy, along with concurrent chemotherapy. Initial tumour volume was measured from CT based contouring and mean dose delivered was calculated. All patients were followed up for survival, relapse and metastasis. Results: The median follow up for the group was 24 months. The median Gross tumor volume of primary disease and nodal disease was 61.6 cubic centimetres and 35.4 cubic centimeters respectively. The 2 year Disease free survival and Overall survival for the entire group was 64% and 68% respectively. There was significant difference (p-0.018) between disease free survival of low volume disease group (LVD) which was 78 % as compared to high volume disease (HVD) group 52 % at 24 months, similarly Overall survival was also significantly better (p-0.015) in LVD group as compared to HVD group 80% vs 55% at 24 months. Among the treatment related factors adjuvant chemotherapy significantly improved the outcome in HVD group but no difference was seen in LVD group. Conclusion: Our patients had large volume primary disease, the OS and DFS was significantly better in LVD patients, adjuvant chemotherapy after concurrent chemoradiotherapy had no additional benefit for LVD patients but improved DFS and MFS in HVD Patients.
Primary tumour volume evaluation has predictive value for estimating survival outcomes. Using volumetric data acquired by MRI in patients undergoing induction chemotherapy (IC) these outcomes were estimated before the radiotherapy course in head and neck cancer (HNC) patients. MRI performed before and after IC in 36 locally advanced HNC patients were analysed to measure primary tumour volume. The two volumes were correlated using the linear-log ratio (LLR) between the volume in the first MRI and the volume in the second. Cox's proportional hazards models (CPHM) were defined for loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS). Strict evaluation of the influence of volume delineation uncertainties on prediction of final outcomes has been defined. LLR showed good predictive value for all survival outcomes in CPHM. Predictive models for LRC and DFS at 24 months showed optimal discrimination and prediction capability. Evaluation of primary tumour volume variations in HNC after IC provides an example of modelling that can be easily used even for other adaptive treatment approaches. A complete assessment of uncertainties in covariates required for running models is a prerequisite to create reliable clinically models.
© Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale.
To identify the prognostic value and staging categories of masticator space involvement in nasopharyngeal carcinoma (NPC) as determined with anatomic criteria ("anatomic masticator space involvement") to determine whether it is necessary for the masticator space described with criteria of the American Joint Committee on Cancer to exclude the medial and lateral pterygoid muscles.
This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. NPC was diagnosed in 924 patients with magnetic resonance (MR) imaging, and medical records and imaging studies were retrospectively analyzed. The overall survival, local relapse-free survival, and distant metastasis-free survival of these patients were analyzed by using the Kaplan-Meier method; differences were compared by using the log-rank test.
The frequency of anatomic masticator space involvement was 19.7% (182 of 924 patients). With use of multivariate analysis, anatomic masticator space involvement was identified as an independent prognostic factor for overall survival (P = .02). In addition, anatomic masticator space involvement was associated with a marginally significant decrease in local relapse-free survival (P = .05); however, it had no effect on distant metastasis-free survival. There were no statistically significant differences between different degrees of anatomic masticator space involvement with regard to overall survival and local relapse-free survival in NPC (P = .34 and P = .54, respectively) or between T3 or T4 disease and anatomic masticator space involvement with regard to overall survival and local relapse-free survival (P = .63 and P = .44, respectively).
Anatomic masticator space involvement affects the overall survival and local relapse-free survival of patients with NPC. When masticator space involvement includes the medial and lateral pterygoid muscles, the disease should be classified as stage T4.
We investigated the effects of hyperbaric oxygen (HBO2) and/or 5-fluorouracil (5-FU) on the proliferation and metastasis of human nasopharyngeal carcinoma (NPC) cell line CNE2Z and the underlying mechanisms involved.
Nasopharyngeal carcinoma (NPC) CNE2Z cells were randomly divided into four groups: Group A: control group; Group B: 5-FU group; Group C: HBO2 group; Group D: 5-FU plus HBO2 group. The inhibitory effects on CNE2Z cells proliferation in the four groups after 24, 48 and 72 hours of treatment were measured by MTT-colorimetric method. Transwell chamber assay was performed to determine the effects of HBO2 and/or 5-FU on the metastasis of CNE2Z cells; Expressions of MMP-9 and VEGF in CNE2Z cells were detected by immunocytochemical staining.
A significant difference was observed in the inhibitory effects on CNE2Z cell proliferation (OD values) between the 5-FU group (Group B) and the control group (Group A) after 24, 48, and 72 hours of treatment (p<0.01); between the HBO2 group (group C) and the control group (Group A) after 48 and 72 hours of treatment (p<0.01); and between the HBO2 plus 5-FU group (Group D) and the control group (Group A) as well as the HBO2 plus 5-FU group (Group D) and the HBO2 group (Group C) after 24, 48, and 72 hours of treatment (p<0.01). But a significant difference between the HBO2 plus 5-FU group (Group D) and the 5-FU group (Group B) was observed only after 48 hours of treatment (p=0.030). As for metastasis, as well as MMP-9 and VEGF expression OD values, significant difference was observed between the 5-FU group (Group B) and the control group (Group A) with p<0.05, but not between the HBO2 group (Group C) and the control group (Group A). Although effects on metastasis as well as MMP-9 and VEGF expression OD values were significantly different between the 5-FU plus HBO group (group D) and group A (p<0.01), no difference was observed between Group D and Group B as well as Group D and Group C.
Simple HBO2 treatment after 48 and 72 hours could inhibit the proliferation of nasopharyngeal carcinoma CNE2Z cells. The combination of HBO2 with 5-FU exhibited significant synergism in the suppression of NE2Z cell proliferation only after 48 hours of treatment compared to 5-FU. Simple HBO2 treatment could not reduce the high expressions of MMP-9 and VEGF and inhibit the metastasis of human NPC CNE2Z cells, and no synergistic effect was observed for the combination of HBO2 with 5-FU compared to 5-FU alone.
