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

An chuan Li, Ying ying Zhang, Chi Zhang, De sheng Wang, Ben hua Xu

Research output: Contribution to journalArticle

Abstract

Introduction: The clinical target volume (CTV) delineation is crucial for tumour control and normal tissue protection. This study investigated the contralateral extension of nasopharyngeal carcinoma (NPC) in patients with a clinically diagnosed unilateral tumour to pursue the possibility of CTV reduction. Methods: Twenty NPC patients with localized tumours confined to only one side of the nasopharynx as shown by magnetic resonance imaging and fibreoptic endoscopy were selected for biopsy. The tissues of the contralateral pharyngeal recess (CPR) and the contralateral posterosuperior wall (CPSW) of the nasopharynx were obtained in each case and prepared for pathological examination. The factors associated with contralateral tumour infiltration were analysed. Results: Five of 20 (25.0%) patients were pathologically confirmed to have carcinoma cell infiltration in the CPSW, including 2 (10.0%) that had carcinoma cell infiltration in the CPR. The T classification (P = 0.014) and primary tumour volume (P = 0.033) were positively associated with the infiltration of the CPSW, but none of the primary tumour factors affected the involvement of the CPR. The contralateral retropharyngeal lymph node (LN) metastasis (P = 0.016), but not the contralateral cervical LN, was significantly associated with the infiltration of the CPR. Positive Epstein–Barr virus DNA (EBV-DNA) was another factor that increased the probability of CPR invasion (P = 0.044). Conclusions: Contralateral pharyngeal recess infiltration is rare in patients with clinically diagnosed unilateral primary NPC. Reduced CTV coverage, including the CPSW but not CRP, is feasible for patients with unilateral cancer of the nasopharynx without contralateral LN metastasis or positive EBV-DNA. Further large-sample studies are needed.

Original languageEnglish (US)
Pages (from-to)540-547
Number of pages8
JournalJournal of Medical Imaging and Radiation Oncology
Volume62
Issue number4
DOIs
StatePublished - Aug 2018

Fingerprint

DNA Viruses
Nasopharynx
Lymph Nodes
Neoplasms
Nasopharyngeal Neoplasms
Neoplasm Metastasis
Carcinoma
Tumor Burden
Endoscopy
Magnetic Resonance Imaging
Nasopharyngeal carcinoma
Biopsy

Keywords

  • clinical target volume
  • endoscopic biopsy
  • magnetic resonance imaging
  • nasopharyngeal carcinoma
  • unilateral cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

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, Ben hua.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 62, No. 4, 08.2018, p. 540-547.

Research output: Contribution to journalArticle

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T1 - Pathologic study of tumour extension for clinically localized unilateral nasopharyngeal carcinoma

T2 - Should the contralateral side be included in the clinical target volume?

AU - Li, An chuan

AU - Zhang, Ying ying

AU - Zhang, Chi

AU - Wang, De sheng

AU - Xu, Ben hua

PY - 2018/8

Y1 - 2018/8

N2 - Introduction: The clinical target volume (CTV) delineation is crucial for tumour control and normal tissue protection. This study investigated the contralateral extension of nasopharyngeal carcinoma (NPC) in patients with a clinically diagnosed unilateral tumour to pursue the possibility of CTV reduction. Methods: Twenty NPC patients with localized tumours confined to only one side of the nasopharynx as shown by magnetic resonance imaging and fibreoptic endoscopy were selected for biopsy. The tissues of the contralateral pharyngeal recess (CPR) and the contralateral posterosuperior wall (CPSW) of the nasopharynx were obtained in each case and prepared for pathological examination. The factors associated with contralateral tumour infiltration were analysed. Results: Five of 20 (25.0%) patients were pathologically confirmed to have carcinoma cell infiltration in the CPSW, including 2 (10.0%) that had carcinoma cell infiltration in the CPR. The T classification (P = 0.014) and primary tumour volume (P = 0.033) were positively associated with the infiltration of the CPSW, but none of the primary tumour factors affected the involvement of the CPR. The contralateral retropharyngeal lymph node (LN) metastasis (P = 0.016), but not the contralateral cervical LN, was significantly associated with the infiltration of the CPR. Positive Epstein–Barr virus DNA (EBV-DNA) was another factor that increased the probability of CPR invasion (P = 0.044). Conclusions: Contralateral pharyngeal recess infiltration is rare in patients with clinically diagnosed unilateral primary NPC. Reduced CTV coverage, including the CPSW but not CRP, is feasible for patients with unilateral cancer of the nasopharynx without contralateral LN metastasis or positive EBV-DNA. Further large-sample studies are needed.

AB - Introduction: The clinical target volume (CTV) delineation is crucial for tumour control and normal tissue protection. This study investigated the contralateral extension of nasopharyngeal carcinoma (NPC) in patients with a clinically diagnosed unilateral tumour to pursue the possibility of CTV reduction. Methods: Twenty NPC patients with localized tumours confined to only one side of the nasopharynx as shown by magnetic resonance imaging and fibreoptic endoscopy were selected for biopsy. The tissues of the contralateral pharyngeal recess (CPR) and the contralateral posterosuperior wall (CPSW) of the nasopharynx were obtained in each case and prepared for pathological examination. The factors associated with contralateral tumour infiltration were analysed. Results: Five of 20 (25.0%) patients were pathologically confirmed to have carcinoma cell infiltration in the CPSW, including 2 (10.0%) that had carcinoma cell infiltration in the CPR. The T classification (P = 0.014) and primary tumour volume (P = 0.033) were positively associated with the infiltration of the CPSW, but none of the primary tumour factors affected the involvement of the CPR. The contralateral retropharyngeal lymph node (LN) metastasis (P = 0.016), but not the contralateral cervical LN, was significantly associated with the infiltration of the CPR. Positive Epstein–Barr virus DNA (EBV-DNA) was another factor that increased the probability of CPR invasion (P = 0.044). Conclusions: Contralateral pharyngeal recess infiltration is rare in patients with clinically diagnosed unilateral primary NPC. Reduced CTV coverage, including the CPSW but not CRP, is feasible for patients with unilateral cancer of the nasopharynx without contralateral LN metastasis or positive EBV-DNA. Further large-sample studies are needed.

KW - clinical target volume

KW - endoscopic biopsy

KW - magnetic resonance imaging

KW - nasopharyngeal carcinoma

KW - unilateral cancer

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