Pathologic study of tumour extension for clinically localized unilateral nasopharyngeal carcinoma: Should the contralateral side be included in the clinical target volume?

Li, An Chuan; Zhang, Ying Ying; Zhang, Chi; Wang, De sheng; Xu, Boming

doi:10.1111/1754-9485.12741

Cited by 5 publications

(7 citation statements)

References 33 publications

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“…However, it should be noted that they used plain CT and an electronic nasopharyngoscopy to diagnose unilateral NPC. Li et al performed biopsies of the posterior wall of the contralateral pharyngeal roof as well as the contralateral pharyngeal crypt in 20 unilateral NPC cases judged by MRI [ 11 ]. Their result showed that five patients had subclinical lesions on the posterior wall of the contralateral pharyngeal roof and pharyngeal crypt biopsies were also positive for two patients.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Zheng

Zhang

et al. 2022

Radiat Oncol

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Background To summarize the characteristics of local invasion and distribution of metastatic lymph nodes in unilateral nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) to provide references for the optimization of clinical target volume. Methods MRI and clinical data of 176 cases of unilateral NPC admitted to the Hunan Cancer Hospital from January 2019 to December 2019 were collected. Unilateral NPC was defined as a lesion confined to the one side of the nasopharynx and had not exceeded the midline as judged by MRI. Results Ipsilateral levator veli muscle (63.1%, 111/176), tensor veli palatini muscle (55.7%, 98/176), parapharyngeal space (50.0%, 88/176), and prevertebral muscle (43.7%, 77/176) were more likely to be invaded. Contralateral parapharyngeal space and skull base foramina were not invaded. All local invasions presented as continuous invasion from gross lesions and discontinuous invasions were not observed. The overall lymph node metastatic rate was 89.8% (158/176), of which bilateral metastasis accounted for 56.3% (89/158), and ipsilateral metastasis accounted for 88.1% (155/176), which was higher than the contralateral metastatic rate (55.4%, 94/176) (P < 0.001). The most common regions of lymph node metastasis were level IIb (82.4%), VIIa (69.9%), IIa (54.0%), and III (54.0%). Only one patient had skipping lymph node metastasis (0.6%). Conclusion Local invasion of unilateral NPC was characterized by continuous invasion from proximal to distal sites, and lymph node metastasis occurred from the upper to lower neck. Contralateral parapharyngeal space and skull base foramina had a very low probability of invasion, and routine prophylactic radiation may not be necessary.

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Section: Discussionmentioning

confidence: 99%

“…Unilateral NPCs constitute about 10% of all NPC cases [ 10 , 11 ]. At present, data are limited regarding the characteristics of locoregional extension of this subtype of NPC.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Zheng

Zhang

et al. 2022

Radiat Oncol

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“…Based on the cumulative incidence of tumor invasion, anatomical sites around the nasopharynx can be divided into 3 risk levels to evaluate the locoregional extension and failure patterns of NPC and then improve CTV delineation ( 39 , 40 ). The CTV can be reduced on the basis of the contralateral expansion of NPC in patients with unilateral tumors ( 41 ). Consensus guidelines on CTV definition include geometric expansion beyond the visible gross tumor volume ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

Chen¹,

Li²,

Yang³

et al. 2023

Quant Imaging Med Surg

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Background: Tumor invasion risk (TIR) is an important prognostic factor in nasopharyngeal carcinoma (NPC). We propose a novel prognostic analytic method for NPC based on a voxelwise analysis of TIR in a coordinate system of the nasopharynx.Methods: A stable nasopharynx coordinate system was constructed based on anatomical landmarks to obtain an accurate TIR profile for NPC. The coordinate system was validated by image registration of the lateral pterygoid muscle (LPM). The tumors were registered to the coordinate system through shift, scale, and rotation transformations. The voxelwise TIR map for NPC was obtained by superposition of all registered and mirrored tumor regions of interest. The minimum risk (MinR) point of the tumor region was used as an independent prognostic factor for NPC. The cutoff value was calculated with density plot and validated with restricted cubic splines (RCSs), and then the patients were divided into 2 groups for overall survival (OS) analysis. Results:The first voxelwise TIR map of NPC was obtained based on 778 patients. The OS of patients with a low TIR was 76.8% and was 92.6% for patients with a high TIR [P<0.001; hazard ratio (HR) =1/0.45; 95% CI: 0.27-0.77; adjusted P=0.004]. Thus, patients with a low TIR had a poor prognosis, whereas patients with a high TIR had a good prognosis. The MinR may be better at grading the prognosis of patients compared to the American Joint Committee on Cancer (AJCC) staging or tumor/node (T/N) classification systems. Conclusions:The voxelwise TIR map provides a new method for the prognostic analysis of NPC.Potential clinical applications of voxelwise TIR mapping are clinical target volume (CTV) delineation and dose-painting for NPC.

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“…One area of active research is the selected sparing of the contralateral structures in patients presenting with unilateral disease. As the fossa of Rosenmüller is the most common site of origin, early NPC typically presents unilaterally and may remain so as the tumor advances, constituting approximately 10% of all NPC at presentation [ 8 , 9 ]. An endoscopic biopsy study has revealed a low incidence of occult microscopic disease in the contralateral nasopharyngeal mucosa in unilateral NPC which did not cross the midline [ 8 ].…”

Section: Target Delineationmentioning

confidence: 99%

“…As the fossa of Rosenmüller is the most common site of origin, early NPC typically presents unilaterally and may remain so as the tumor advances, constituting approximately 10% of all NPC at presentation [ 8 , 9 ]. An endoscopic biopsy study has revealed a low incidence of occult microscopic disease in the contralateral nasopharyngeal mucosa in unilateral NPC which did not cross the midline [ 8 ]. The risk of skipped discontinuous invasion to the contralateral parapharyngeal space and skull base is also exceedingly low in unilateral NPC, making unilateral irradiation an attractive option to reduce radiation side effects, such as trismus and xerostomia [ 10 ].…”

Section: Target Delineationmentioning

confidence: 99%

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

Chow

Beitler³

et al. 2022

Cancers

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Radiotherapy is the primary treatment modality for nasopharyngeal carcinoma (NPC). Successful curative treatment requires optimal radiotherapy planning and precise beam delivery that maximizes locoregional control while minimizing treatment-related side effects. In this article, we highlight considerations in target delineation, radiation dose, and the adoption of technological advances with the aim of optimizing the benefits of radiotherapy in NPC patients.

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Pathologic study of tumour extension for clinically localized unilateral nasopharyngeal carcinoma: Should the contralateral side be included in the clinical target volume?

Cited by 5 publications

References 33 publications

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

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