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MRI-detected skull-base invasion

Prognostic value and therapeutic implication in intensity-modulated radiotherapy treatment for nasopharyngeal carcinoma

MRT-ermittelte Invasion in die Schädelbasis

Prognostischer Wert und therapeutische Implikation bei intensitätsmodulierter Strahlentherapie des nasopharyngealen Karzinoms

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Abstract

Purpose

With advances in imaging and radiotherapy, the prognostic value of skull-base invasion in nasopharyngeal carcinoma (NPC) needs to be reassessed. We aimed to define a classification system and evaluate the prognostic value of the classification of magnetic resonance imaging (MRI)-detected skull-base invasion in NPC treated with intensity-modulated radiotherapy (IMRT).

Patients and materials

We retrospectively reviewed 749 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated NPC and treated with IMRT.

Results

MRI-detected skull-base invasion was not found to be an independent prognostic factor for overall survival (OS), distant metastasis-free survival (DMFS), local relapse-free survival (LRFS), or disease-free survival (DFS; p > 0.05 for all). Skull-base invasion was classified according to the incidence of each site (type I sites inside pharyngobasilar fascia and clivus vs. type II sites outside pharyngobasilar fascia). The 5-year OS, DMFS, LRFS, and DFS rates in the classification of skull-base invasion in NPC were 83 vs. 67 %, 85 vs.75 %, 95 vs. 88 %, and 76 vs. 62 %, respectively (p < 0.05 for all). Multivariate analysis indicated the classification of skull-base invasion was an independent prognostic factor.

Conclusion

MRI-detected skull-base invasion is not an independent prognostic factor in patients with NPC treated with IMRT. However, classification according to the site of invasion has prognostic value. Therefore, patients with various subclassifications of stage T3 disease may receive treatment with different intensities; however, further studies are warranted to prove this.

Zusammenfassung

Hintergrund

Aufgrund der Fortschritte der bildgebenden Verfahren und der Strahlentherapie muss der prognostische Wert der Invasion des nasopharyngealen Karzinoms (NPC) in die Schädelbasis erneut bewertet werden. Unser Ziel ist die Definition eines Klassifikationssystems und die Untersuchung des prognostischen Werts der Klassifikation der MRT-ermittelten Invasion des mit intensitätsmodulierter Strahlentherapie (IMRT) behandelten NPC in die Schädelbasis.

Patienten und Methodik

Insgesamt wurden 749 mit IMRT behandelte Patienten, bei denen MRT-Aufnahmen angefertigt wurden und die anschließend die histologische Diagnose eines nichtdisseminierten NPC erhielten, retrospektiv untersucht.

Ergebnisse

Die MRT-ermittelte Invasion in die Schädelbasis war kein unabhängiger prognostischer Faktor für das Gesamtüberleben (OS), das fernmetastasenfreie Überleben (DMFS), das lokal rezidivfreie Überleben (LRFS) oder das krankheitsfreie Überleben (DFS; p > 0,05 für alle). Die Schädelbasisinvasion wurde nach Inzidenz einer jeden Stelle klassifiziert (Typ I: Stellen in der pharyngobasilaren Faszie und Clivus vs. Typ II: Stellen außerhalb der pharyngobasilaren Faszie). Die 5-Jahres-Raten für OS, DMFS, LRFS und DFS bei Klassifikation der Schädelbasisinvasion des NPC betrugen jeweils 83 vs. 67 %, 85 vs.75 %, 95 vs. 88 % bzw. 76 vs. 62 % (p < 0,05 für alle). Die multivariate Analyse ergab, dass die Klassifikation der Schädelbasisinvasion ein unabhängiger prognostischer Faktor war.

Schlussfolgerungen

Die MRT-ermittelte Invasion in die Schädelbasis ist kein unabhängiger prognostischer Faktor bei Patienten mit NPC, die mit IMRT behandelt werden. Die Klassifikation gemäß der Invasionsstelle hat jedoch einen prognostischen Wert. Daher müssen verschiedene Subklassifikationen des T3-Stadiums möglicherweise mit Therapien von unterschiedlicher Intensität behandelt werden. Allerdings sind weitere Studien gerechtfertigt, um dies zu beweisen.

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Acknowledgments

This work was supported by grants from the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2010), the Science Foundation of Key Hospital Clinical Program of Ministry of Health P.R. China (No.2012-178), the Fundamental Research Funds for the Central Universities (No. 10ykjc08), and the National Natural Science Foundation of China (No. 81230056).

Compliance with ethical guidelines

Conflict of interest

Y.-K. Cheng, L.-Z. Liu, N. Jiang, D. Yue, L.-L. Tang, F. Zhang, L. Lin, X. Liu, L. Chen, and J. Ma state that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P.R. China

    Yi-Kan Cheng M.D., Ning Jiang M.D., Dan Yue M.D., Ling-Long Tang M.D., Fan Zhang M.D., Li Lin M.D., Xu Liu M.D., Lei Chen & Jun Ma M.D.

  2. Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China

    Li-Zhi Liu M.D.

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  1. Yi-Kan Cheng M.D.
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  2. Li-Zhi Liu M.D.
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  3. Ning Jiang M.D.
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  4. Dan Yue M.D.
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  5. Ling-Long Tang M.D.
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  6. Fan Zhang M.D.
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  7. Li Lin M.D.
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  8. Xu Liu M.D.
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  9. Lei Chen
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  10. Jun Ma M.D.
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Corresponding authors

Correspondence to Lei Chen or Jun Ma M.D..

Additional information

Yi-Kan Cheng and Li-Zhi Liu contributed equally to this study.

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Cheng, YK., Liu, LZ., Jiang, N. et al. MRI-detected skull-base invasion. Strahlenther Onkol 190, 905–911 (2014). https://doi.org/10.1007/s00066-014-0656-7

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  • DOI: https://doi.org/10.1007/s00066-014-0656-7

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