Staging and follow-up of nasopharyngeal carcinoma: magnetic resonance imaging versus computerized tomography.

Radiotherapy Department of the University, Firenze, Italy.
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.52). 07/1995; 32(3):795-800. DOI: 10.1016/0360-3016(94)00535-S
Source: PubMed

ABSTRACT To compare computerized tomography (CT) and magnetic resonance (MR) in relation to their accuracy in the staging of nasopharyngeal carcinoma (NPC); to compare CT and MR in postirradiation follow-up of NPC.
Staging: From 1985 to 1993, 53 patients affected with NPC were studied with MR and CT. All cases were biopsy-proved epithelial carcinoma. Plain and contrast-enhanced CT scans were performed with third-generation scanners. Magnetic resonance were obtained with 0.5 and 1.5 Tesla units in sagittal, axial, and coronal planes. Computerized tomography was chosen as reference method and findings obtained with MR were compared to those obtained with CT. Follow-up: From 1985 to 1993, 53 patients irradiated with radical intent were followed up with both CT and MR; 71 examinations were performed in all. The baseline follow-up scan was performed, in general, no sooner than 2 months after the end of radiotherapy. All patients were submitted to unlimited clinical follow-up.
Staging: Magnetic resonance showed retropharyngeal adenopathies in 6 of 14 cases in which oropharyngeal involvement had been reported after CT; in 3 other patients, adenopathies were recognized on MR, while primary extent to parapharyngeal space had been diagnosed on CT initially. Infiltration of long muscles of the neck was revealed with MR in 14 cases. On the other hand, CT showed bone invasion in 12 patients vs. 8 on MR. Upstaging to T4 occurred in four cases on the basis of CT; no upstaging occurred after MR. Follow-up: Findings on CT were uncertain in 10 out of 53 patients, disease recurrence was excluded by MR in nine cases, whereas progressive disease was confirmed in one patient.
Staging: Our series shows that either CT and MR can provide essential information in the staging of NPC. Magnetic resonance, however, seems to provide the most detailed imaging of soft tissue invasion outside the nasopharynx and of retropharyngeal node involvement. Nonetheless, its limitations in evaluating bone details suggest that CT should be always performed when the status of base of skull is uncertain on MR. General reasons and our data indicate that CT can still be considered a valuable tool in routine NPC staging. Follow up: Magnetic resonance may be the modality of choice because it seems to solve, more often than CT, the problems of differentiation between postradiation changes and recurring tumor, apart from those cases showing subtle bone erosions on initial CT scan.

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    ABSTRACT: Nasopharyngeal carcinoma (NPC) is a head and neck neoplasm that occurs in endemic numbers among people of southern Chinese descent. External beam radiation to the nasopharyngeal bed and primary draining lymph node echelons is the mainstay of treatment with concurrent cisplatin-based chemotherapy for more advanced disease. Detection of residual and/or recurrent NPC has important clinical implications, as salvage protocols are available. The review aims to increase awareness of the imaging features of NPC recurrences at local and distant sites using computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET). Important changes in imaging seen in patients after nasopharyngectomy are also discussed.
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    ABSTRACT: Current standard treatment of nasopharyngeal carcinoma (NPC) is either radiotherapy alone or combined chemoradiotherapy. Surgery in the form of nasopharyngectomy is usually only offered when there is evidence of local recurrence or persistent disease. Recurrent NPC (rNPC) can be detected earlier with the utilization of Epstein-Barr virus molecular diagnosis. This may result in early management with salvage surgery and hence improved survival. The facial translocation approach enhanced our ability to access the nasopharynx. Through a multidisciplinary approach with the collaboration of neurosurgeons, the surgical indication of salvage surgery is extended. This allowed improved respectability in locally advanced disease and involved the skull base and intracranial extension with reasonable morbidity and mortality. Endoscopic nasopharyngectomy is a choice for recurrent NPC with central roof or floor lesions with minimal lateral extension. Multivariate analysis indicated that gender, parapharyngeal space involvement, surgical margin, and the modality of adjuvant therapy impact significantly on local control. The impact on survival is indicated by the dura or brain involvement, local recurrence and modality of adjuvant therapy. It is apparent that recurrent NPC patients who underwent surgery had a significantly better survival rate than the re-radiation therapy group.
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    ABSTRACT: BACKGROUND: The purpose of this study was to summarize the treatment outcomes and evaluate the feasibility of partial neck irradiation in patients with nasopharyngeal carcinoma (NPC) with only retropharyngeal lymph nodes (RLNs) metastasis. METHODS: Between January 2003 and December 2007, 54 patients with NPC who received partial neck irradiation to levels II, III, and VA and 100 patients who received whole neck irradiation were reviewed. RESULTS: The 5-year disease free survival (DFS), disease metastasis-free survival, (DMFS) local relapse-free survival (LRFS), and regional relapse-free survival (RRFS) rates were 81.8%, 87.7%, 94.8%, and 98.1%, respectively. The 5-year RRFS and DFS rates for the partial neck irradiation group and whole neck irradiation group were 98.1% versus 98.0% (p = .882), 87.0% vs 77.0% (p = .117), respectively. Partial neck irradiation was not considered a significant prognostic factor for any endpoint in univariate and multivariate analyses. CONCLUSION: Partial irradiation of neck levels II, III, and VA might be acceptable for patients with NPC with only RLN metastasis. Head Neck, 2013.
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