Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Tumor volume/metabolic information can improve the prognostication of anatomy based staging system for nasopharyngeal cancer? Evaluation of the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer

  • Jeong, Yuri (Department of Radiation Oncology, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • Lee, Sang-wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.09.18
  • Accepted : 2018.12.17
  • Published : 2018.12.31
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Abstract

Purpose: We evaluated prognostic value of the 8th edition of the American Joint Committee on Cancer/International Union for Cancer Control (AJCC/UICC) staging system for nasopharyngeal cancer and investigated whether tumor volume/metabolic information refined prognostication of anatomy based staging system. Materials and Methods: One hundred thirty-three patients with nasopharyngeal cancer who were staged with magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT) between 2004 and 2013 were reviewed. Multivariate analyses were performed to evaluate prognostic value of the 8th edition of the AJCC/UICC staging system and other factors including gross tumor volume and maximum standardized uptake value of primary tumor (GTV-T and SUV-T). Results: Median follow-up period was 63 months. In multivariate analysis for overall survival (OS), stage group (stage I-II vs. III-IVA) was the only significant prognostic factor. However, 5-year OS rates were not significantly different between stage I and II (100% vs. 96.2%), and between stage III and IVA (80.1% vs. 71.7%). Although SUV-T and GTV-T were not significant prognostic factors in multivariate analysis, those improved prognostication of stage group. The 5-year OS rates were significantly different between stage I-II, III-IV (SUV-T ≤ 16), and III-IV (SUV-T > 16) (97.2% vs. 78% vs. 53.8%), and between stage I, II-IV (GTV-T ≤ 33 mL), and II-IV (GTV-T > 33 mL) (100% vs. 87.3% vs. 66.7%). Conclusion: Current anatomy based staging system has limitations on prognostication for nasopharyngeal cancer despite the most accurate assessment of tumor extent by MRI. Tumor volume/metabolic information seem to improve prognostication of current anatomy based staging system, and further studies are needed to confirm its clinical significance.

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References

  1. Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002;53:12-22.
  2. Wolden SL, Chen WC, Pfister DG, Kraus DH, Berry SL, Zelefsky MJ. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys 2006;64:57-62.
  3. Tham IW, Hee SW, Yeo RM, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy: the National Cancer Centre Singapore experience. Int J Radiat Oncol Biol Phys 2009;75:1481-6.
  4. Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2004;60:1440-50.
  5. Wong FC, Ng AW, Lee VH, et al. Whole-field simultaneous integrated-boost intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2010;76:138-45.
  6. Pan JJ, Ng WT, Zong JF, et al. Proposal for the 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer 2016;122:546-58.
  7. Lee SW, Nam SY, Im KC, et al. Prediction of prognosis using standardized uptake value of 2-[(18)F] fluoro-2-deoxy-d-glucose positron emission tomography for nasopharyngeal carcinomas. Radiother Oncol 2008;87:211-6.
  8. Jeong Y, Baek S, Park JW, Joo JH, Kim JS, Lee SW. Lymph node standardized uptake values at pre-treatment (18) F-fluorodeoxyglucose positron emission tomography as a valuable prognostic factor for distant metastasis in nasopharyngeal carcinoma. Br J Radiol 2017;90:20160239.
  9. Chen YP, Tang LL, Zhang WN, et al. Prognostic value and grading of MRI-based T category in patients with nasopharyngeal carcinoma without lymph node metastasis undergoing intensity-modulated radiation therapy. Medicine (Baltimore) 2015;94:e1624.
  10. Chen L, Mao YP, Xie FY, et al. The seventh edition of the UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensitymodulated radiotherapy from an endemic area in China. Radiother Oncol 2012;104:331-7.
  11. Zong J, Lin S, Lin J, et al. Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system. Oral Oncol 2015;51:254-9.
  12. Kang M, Long J, Li G, et al. A new staging system for nasopharyngeal carcinoma based on intensity-modulated radiation therapy: results of a prospective multicentric clinical study. Oncotarget 2016;7:15252-61.
  13. Liang ZG, Chen XQ, Niu ZJ, et al. Recommendations for updating T and N staging systems for nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy. PLoS One 2016;11:e0168470.
  14. Zhou Q, He Y, Zhao Y, Wang Y, Kuang W, Shen L. A study of 358 cases of locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiation therapy: improving the seventh edition of the American Joint Committee on Cancer T-staging system. Biomed Res Int 2017;2017:1419676.
  15. Guo R, Sun Y, Yu XL, et al. Is primary tumor volume still a prognostic factor in intensity modulated radiation therapy for nasopharyngeal carcinoma? Radiother Oncol 2012;104:294-9.
  16. Chen C, Fei Z, Pan J, Bai P, Chen L. Significance of primary tumor volume and T-stage on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Jpn J Clin Oncol 2011;41:537-42.
  17. Feng M, Wang W, Fan Z, et al. Tumor volume is an independent prognostic indicator of local control in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Radiat Oncol 2013;8:208.
  18. Wu Z, Su Y, Zeng RF, Gu MF, Huang SM. Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensitymodulated radiotherapy. J Cancer Res Clin Oncol 2014;140:69-76.
  19. He YX, Wang Y, Cao PF, et al. Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy. Chin J Cancer 2016;35:96.
  20. Pan JJ, Ng WT, Zong JF, et al. Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer 2016;122:3307-15.
  21. Lee CC, Chu ST, Ho HC, Lee CC, Hung SK. Primary tumor volume calculation as a predictive factor of prognosis in nasopharyngeal carcinoma. Acta Otolaryngol 2008;128:93-7.
  22. Sze WM, Lee AW, Yau TK, et al. Primary tumor volume of nasopharyngeal carcinoma: prognostic significance for local control. Int J Radiat Oncol Biol Phys 2004;59:21-7.
  23. Shen C, Lu JJ, Gu Y, Zhu G, Hu C, He S. Prognostic impact of primary tumor volume in patients with nasopharyngeal carcinoma treated by definitive radiation therapy. Laryngoscope 2008;118:1206-10.
  24. Chen MK, Chen TH, Liu JP, Chang CC, Chie WC. Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume. Cancer 2004;100:2160-6.
  25. Lin J, Xie G, Liao G, et al. Prognostic value of 18F-FDG-PET/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis. Oncotarget 2017;8:33884-96.