Locally advanced nasopharyngeal cancer

The 9th Version of the AJCC Staging System for Nasopharyngeal Carcinoma: A Guide for Radiologists

The 9th version of the AJCC staging system for nasopharyngeal carcinoma introduces important refinements, emphasizing improved prognostic accuracy, clarity, and clinical relevance. Building on the 8th version, it refines TNM classifications to address limitations in survival outcome stratification and incorporates new criteria. Specifically, the 9th version clarifies the criteria for T3 disease by requiring unequivocal evidence of bone involvement, namely of the skull base (including pterygoid plates), cervical vertebrae, or paranasal sinuses. It additionally introduces advanced radiologic extranodal extension as a criterion for the N3 category and subclassifies M1 disease into M1a (3 or fewer metastatic lesions) versus M1b (more than 3 metastatic lesions) disease to enhance risk stratification. Developed through extensive multicenter studies and validated by international panels, the 9th version redefines NPC stage groups, aligning clinical management with evidence-based practices and improving prognostic accuracy. This review highlights key modifications in the 9th version that are relevant to radiologists, providing imaging examples and considering implications for clinical practice, prognosis, and treatment planning.

Pedunculated Nasopharyngeal Mass: A Case of Squamous Cell Carcinoma

Nasopharyngeal carcinoma (NPC) is one of the rarest malignancies and carries a high risk of morbidity and mortality. The presentation of the disease depends on the stage and the anatomical relation of the lesion. In this case report, we present a case of a young female patient, who was found to have a pedunculated nasopharyngeal mass upon examination. The patient presented with nasal obstruction, which improved after surgical removal of the lesion. A histopathological examination of the resected mass revealed an undifferentiated squamous cell carcinoma type, which usually arises as an exophytic raised mass and not a pedunculated mass as in this case.

The Primary Tumor and Regional Lymph Node Clinical Status of Distant Metastasis in Nasopharyngeal Carcinoma

Background: Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma derived from nasopharyngeal epithelium. NPC characteristic is highly invasive and can metastasize rapidly. The presence of distant metastasis is a major factor in determining the patient’s management and prognosis. The magnitude of radiologic and molecular costs encouraging the need to know the clinical variables associated with distant metastasis of NPC. Methods: Cross-sectional analytical retrospective studies of undifferentiated NPC (WHO type III) patients at initial diagnosis in the ORL-HNS Department of Dr. Sardjito Hospital Yogyakarta from January 2014 to December 2016. Results: At 276 NPC patients with the ratio of 197 men (71.4%) and 79 women (28.6%) was 2.5:1, mean age 48.5 years, distant metastasis was found in 37 patients (13.4%). There was no significant difference in the frequency of sex (p = 0.346), age (p = 0.784), and primary tumor clinical status (p = 0.297) between NPC with distant metastasis and without distant metastasis. There was significant difference in the frequency of regional lymph node clinical status between NPC with distant metastasis and without distant metastasis (p = 0.004; PR = 3.866). Conclusions: There is no statistically significant difference of primary tumor clinical status between NPC with and without distant metastasis. There is statistically significant difference of lymph node clinical status between NPC with and without distant metastasis.

Phase I/II study of induction chemotherapy plus concurrent chemotherapy and SMART-IMRT-based radiotherapy in locoregionally-advanced nasopharyngeal cancer

This study aimed to evaluate the efficacy, toxicity and tolerability of simultaneous modulated accelerated radiation therapy (SMART)-intensity modulated radiotherapy (IMRT) plus cisplatin and 5-fluorouracil (5-FU) chemotherapy for patients with advanced nasopharyngeal cancer (NPC). Forty-five patients with stage II–IV NPC, determined by the American Joint Committee on Cancer system, were treated with prescribed doses of 72 Gy total to the gross tumor volume, 60 Gy to the clinical target volume and metastatic nodal station, and 54 Gy to the clinically-negative neck region. Before radiotherapy, two cycles of cisplatin (30 mg/m²/day on days 1–3) plus 5-FU (400 mg/m²/day on days 1–5) were delivered every three weeks for two cycles. Patients received two cycles of cisplatin (30 mg/m² day on days 1–3) every three weeks during radiotherapy. In addition, two cycles of cisplatin and 5-FU were given after radiation. All patients completed the prescribed radiotherapy and all scheduled cycles of chemotherapy. Thirty of the 45 patients (66.6%) had a complete response at the end of treatment. Grade 3 mucositis occurred in 4/45 patients (8.8%) and grade 3 dermatitis occurred in 5/45 (11.1%) during radiotherapy. Grade 3 neutropenia occurred in 6/45 (13.3%) during concurrent chemotherapy. There was no treatment-related mortality. After a median follow-up time of 51 months, only three patients’ treatments had failed. Local and distant failure rates were 1.5 and 3.0%, respectively. SMART-IMRT plus cisplatin and 5-FU chemotherapy showed promising activity with manageable toxicity. It is a feasible regimen and improves locoregional disease control.