l Oncology Imaging
Int. J. Radiation Oncology Biol. Phys.,
Vol. 32, No.
in the USA.
3, 795-800, 1995
$9.50 + 00
STAGING AND FOLLOW-UP
PATRIZIA OLMI, M.D.,* CARLO FALLAI, M.D.,+ STEFANO COLAGRANDE, M.D.’
AND GIANFRANCO GIANNARDI,
*Radiotherapy Department of the University, Firenze, Italy, +Radiotherapy Department of the Hospital, Firenze, Italy,
*Imaging Department of the University, Firenze, Italy
and CT. All cases were biopsy-proved
performed with third-generation
in sagittal, axial,
findings obtained with
performed in all. The baseline
the end of radiotherapy.
on MR, while primary
long muscles of the neck was revealed
in 12 patients vs. 8 on MR.
occurred after MR. Follow-up:
was excluded by MR in nine cases, whereas
staging of NPC. Magnetic
invasion outside the nasopharynx
evaluating bone details
uncertain on MR. General
routine NPC staging.
solve, more often than CT, the problems
tumor, apart from those cases showing
in the staging
tomography (CT) and magnetic
resonance (MR) in relation to their
carcinoma to compare CT and MR in postirradiation
Staging: From 1985 to 1993,53
MR were compared
All patients were submitted
had been reported
extent to parapharyngeal
patients affected with NPC were studied
Plain and contrast-enhanced
resonance were obtained
tomography was chosen
to those obtained with CT. Follow-up:
were followed up with both
scan was performed, in general,
to unlimited clinical
showed retropharyngeal adenopathies
after CT; in 3 other patients,
space had been diagnosed
with MR in 14 cases. On the other hand, CT showed
to T4 occurred in four cases on the basis of CT; no upstaging
on CT were uncertain in 10 out of 53 patients,
progressive disease was confirmed
Our series shows that either CT and MR can provide
resonance, however, seems to provide
and of retropharyngeal node involvement.
suggest that CT should be always performed
reasons and our data indicate that CT can still be considered
Follow up: Magnetic resonance may be the modality
of differentiation between
subtle bone erosions on initial
carcinoma. CT scans were
with 0.5 and 1.5 Tesla units
From 1985 to 1993, 53
CT and MR; 71 examinations
no sooner than 2 months
in 6 of 14 cases in which
on CT initially.
and coronal method and
Findings disease recurrence
in one patient.
the most detailed imaging
when the status of base of skull is
of soft tissue
its limitations in
a valuable tool in
of choice because it seems to
Nasopharyngeal carcinoma, Computerized tomography, Magnetic resonance.
Accuracy in pretreatment staging of patients affected with
nasopharyngeal carcinoma (NPC) represents the basic
step to successful treatment; since the mid-70s, computer-
ized tomography (CT) has led to far better staging than
conventional politomography and, following, to more re-
fined treatment planning. Improved ‘j-year local failure-
free rates reported in the international literature (1, 7, 12)
in comparison with older series may be ascribed, at least
partially, to the incorporation of data provided by CT in
treatment planning. When we reviewed our series in 1991,
a group of 143 patients staged without CT was compared
with a group of 165 patients staged with CT; 5-year local
control was significantly higher in the latter group (72%
vs. 47%) (13).
With the advent of magnetic resonance imaging (MR)
in the mid-80s a new extraordinary tool was added to
the diagnostic paraphernalia. Its role in the initial assess-
ment of head and neck tumor extent is still under evalua-
tion; MR may be the method of choice in NPC staging
according to some authors (8, 9, 22). However, the deci-
Reprint requests to: Patrizia Olrni, Sezione di Radioterapia,
Dipartimento di Fisiopatologia Clinica dell’universita’, ViaIe
Morgagni 85, 50134 Firenze, Italy.
Accepted for publication 6 October 1994.
800 I. J. Radiation Oncology 0 Biology 0 Physics Volume 32, Number 3, 1995
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D.; Gu, X. Analysis of 1379 patients with nasopharyngeal
carcinoma treated by radiation.
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Marubini, E.; Nava, M.; Morandi,
S.; Grandi, C. Adjuvant chemotherapy
clophosphamide and doxorubicin
multicenter randomized study. J. Clin.
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chemotherapy and radiation.
17. Sham, J. S.; Choy, D.; Choi, P. H. Nasopharyngeal
noma: The significance of neck node involvement
tion to the pattern of distant failure. Br. J. Radiol. 63:108-
18. Teo, P.; Shiu, W.; Leung,
factors in nasopharyngeal carcinoma
Cancer 61: 1117- 1124;
P.; Del Vecchio,
cancer: Results of a 4-year
S. F.; Lee, W. Y. Prognostic
investigated by com-
diother. Oncol. 23:79-93;
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modification of the Ho stage-Classification
ryngeal carcinoma. Radiother.
20. Teresi, L. M.; Lufkin, R. B.; Vinuela,
Wilson, G. H.; Bentson J. R.; Hanafee, W. N. MR imaging
of the nasopharynx and floor of the middle cranial fossa.
Part II. Malignant tumors. Radiology
21. Virapongse, C.; Mancuso,
magnetic resonance imaging
in head and neck lesions. Laryngoscope
22. Vogl, T. Diseases of the aerodigestive
tissues of the neck: Comparison
blatter 42: 199-209; 1989.
23. Vogl, T.; Dresel, S.; Bilaniuk,
K.; Lissner, J. Tumors of the nasopharynx
areas: MR imaging with GD-DTPA.
of 659 patients. Ra-
1991. Oncol. 21:l l-23;
F.; Dietrich, R. B.;
in assessing bone destruction
tract and of the soft
of MRI and CT. Rontgen-
J. Value of
L. T.; Grevers, G.; Kang,