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Huang YY, Deng YS, Liu Y, Qiang MY, Qiu WZ, Xia WX, Jing BZ, Feng CY, Chen HH, Cao X, Zhou JY, Huang HY, Zhan ZJ, Deng Y, Tang LQ, Mai HQ, Sun Y, Xie CM, Guo X, Ke LR, Lv X, Li CF. A deep learning-based semiautomated workflow for triaging follow-up MR scans in treated nasopharyngeal carcinoma. iScience 2023; 26:108347. [PMID: 38125021 PMCID: PMC10730347 DOI: 10.1016/j.isci.2023.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
It is imperative to optimally utilize virtues and obviate defects of fully automated analysis and expert knowledge in new paradigms of healthcare. We present a deep learning-based semiautomated workflow (RAINMAN) with 12,809 follow-up scans among 2,172 patients with treated nasopharyngeal carcinoma from three centers (ChiCTR.org.cn, Chi-CTR2200056595). A boost of diagnostic performance and reduced workload was observed in RAINMAN compared with the original manual interpretations (internal vs. external: sensitivity, 2.5% [p = 0.500] vs. 3.2% [p = 0.031]; specificity, 2.9% [p < 0.001] vs. 0.3% [p = 0.302]; workload reduction, 79.3% vs. 76.2%). The workflow also yielded a triaging performance of 83.6%, with increases of 1.5% in sensitivity (p = 1.000) and 0.6%-1.3% (all p < 0.05) in specificity compared to three radiologists in the reader study. The semiautomated workflow shows its unique superiority in reducing radiologist's workload by eliminating negative scans while retaining the diagnostic performance of radiologists.
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Affiliation(s)
- Ying-Ying Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yi-Shu Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Information, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
- School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, China
| | - Yang Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Meng-Yun Qiang
- Department of Radiation Oncology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou 310005, China
| | - Wen-Ze Qiu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China
| | - Wei-Xiong Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Bing-Zhong Jing
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Information, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chen-Yang Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Information, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hao-Hua Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Information, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xun Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jia-Yu Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hao-Yang Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ze-Jiang Zhan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ying Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chuan-Miao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Liang-Ru Ke
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xing Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chao-Feng Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
- Department of Information, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Tian Y, Huang WZ, Zeng L, Bai L, Han F, Lan Y. The Failure Patterns of Nasopharygeal Carcinoma After Intensity-Modulated Radiotherapy and Implications for Surveillance. Cancer Manag Res 2022; 14:2813-2823. [PMID: 36221292 PMCID: PMC9548296 DOI: 10.2147/cmar.s347864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the treatment outcomes, failure patterns and surveillance strategy in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). Methods A cohort of patients with NPC who had received the full course of IMRT between 2008 and 2012 were retrospectively analyzed. The failure patterns, time to recurrence, and detection methods were recorded. The survival was calculated using the Kaplan–Meier method. Multivariate proportional hazard regression models were used to test the prognostic factors. Results In total, 2607 patients with NPC treated with IMRT were recruited. After the median follow-up of 112 months, 402 (15.4%) patients experienced distant metastasis, 225 (8.6%) patients had local recurrence, and 77 (3.0%) patients had regional recurrences. The 10-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 74.5%, 90.1%, and 79.3%, respectively. The factors of male sex, age >50 years, lactate dehydrogenase >245 IU/L, advanced T classification, and advanced N classification were associated with poor OS. The N disease classification was the most important factor in predicting distant metastasis, and advanced T disease classification for high risk of local recurrence. For patients with T1 disease, the incidence of local recurrence was less than 2%, and the incidence of distant metastasis was less than 5% for patients with N0 disease. About 83% of the recurrence occurred in the first 5 years, and 20% of the recurrences showed no symptoms. Conclusion High rate of local-regional control can be achieved for patients with NPC after IMRT, while distant metastasis remains as the major cause of failures. Patients with advanced N classification has high risk to develop distant metastasis, and most occurred within 5 years. Developing rational and individualized surveillance strategies based on the high risk factors of recurrence is helpful to balance the survival benefit and medical cost.
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Affiliation(s)
- Yunming Tian
- Department of Radiation Oncology, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Wei-Zeng Huang
- Department of Medical Oncology, Huizhou First Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Lei Zeng
- Department of Medical Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jixiang Province, People’s Republic of China
| | - Li Bai
- Department of Radiation Oncology, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People’s Republic of China,Correspondence: Fei Han, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, People’s Republic of China, Email
| | - Yuhong Lan
- Department of Radiation Oncology, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, People’s Republic of China,Yuhong Lan, Department of Radiation Oncology, Hui Zhou Municipal Central Hostpital, Huizhou, Guangdong Province, People’s Republic of China, Email
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Liu Y, Han G, Liu X. Lightweight Compound Scaling Network for Nasopharyngeal Carcinoma Segmentation from MR Images. SENSORS (BASEL, SWITZERLAND) 2022; 22:5875. [PMID: 35957432 PMCID: PMC9371217 DOI: 10.3390/s22155875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
Nasopharyngeal carcinoma (NPC) is a category of tumours with a high incidence in head-and-neck. To treat nasopharyngeal cancer, doctors invariably need to perform focal segmentation. However, manual segmentation is time consuming and laborious for doctors and the existing automatic segmentation methods require large computing resources, which makes some small and medium-sized hospitals unaffordable. To enable small and medium-sized hospitals with limited computational resources to run the model smoothly and improve the accuracy of structure, we propose a new LW-UNet network. The network utilises lightweight modules to form the Compound Scaling Encoder and combines the benefits of UNet to make the model both lightweight and accurate. Our model achieves a high accuracy with a Dice coefficient value of 0.813 with 3.55 M parameters and 7.51 G of FLOPs within 0.1 s (testing time in GPU), which is the best result compared with four other state-of-the-art models.
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Affiliation(s)
- Yi Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
- Sun Yat-sen University, Guangzhou 510275, China
| | - Guanghui Han
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
- Sun Yat-sen University, Guangzhou 510275, China
- School of Information Engineering, North China University of Water Resources and Electric Power, Zhengzhou 450046, China
| | - Xiujian Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
- Sun Yat-sen University, Guangzhou 510275, China
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Chen Y, Han G, Lin T, Liu X. CAFS: An Attention-Based Co-Segmentation Semi-Supervised Method for Nasopharyngeal Carcinoma Segmentation. SENSORS (BASEL, SWITZERLAND) 2022; 22:5053. [PMID: 35808548 PMCID: PMC9269783 DOI: 10.3390/s22135053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023]
Abstract
Accurate segmentation of nasopharyngeal carcinoma is essential to its treatment effect. However, there are several challenges in existing deep learning-based segmentation methods. First, the acquisition of labeled data are challenging. Second, the nasopharyngeal carcinoma is similar to the surrounding tissues. Third, the shape of nasopharyngeal carcinoma is complex. These challenges make the segmentation of nasopharyngeal carcinoma difficult. This paper proposes a novel semi-supervised method named CAFS for automatic segmentation of nasopharyngeal carcinoma. CAFS addresses the above challenges through three mechanisms: the teacher-student cooperative segmentation mechanism, the attention mechanism, and the feedback mechanism. CAFS can use only a small amount of labeled nasopharyngeal carcinoma data to segment the cancer region accurately. The average DSC value of CAFS is 0.8723 on the nasopharyngeal carcinoma segmentation task. Moreover, CAFS has outperformed the state-of-the-art nasopharyngeal carcinoma segmentation methods in the comparison experiment. Among the compared state-of-the-art methods, CAFS achieved the highest values of DSC, Jaccard, and precision. In particular, the DSC value of CAFS is 7.42% higher than the highest DSC value in the state-of-the-art methods.
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Affiliation(s)
- Yitong Chen
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China; (Y.C.); (G.H.); (T.L.)
| | - Guanghui Han
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China; (Y.C.); (G.H.); (T.L.)
- School of Information Engineering, North China University of Water Resources and Electric Power, Zhengzhou 450046, China
| | - Tianyu Lin
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China; (Y.C.); (G.H.); (T.L.)
| | - Xiujian Liu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China; (Y.C.); (G.H.); (T.L.)
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Zhang J, Gu L, Han G, Liu X. AttR2U-Net: A Fully Automated Model for MRI Nasopharyngeal Carcinoma Segmentation Based on Spatial Attention and Residual Recurrent Convolution. Front Oncol 2022; 11:816672. [PMID: 35155206 PMCID: PMC8832031 DOI: 10.3389/fonc.2021.816672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Radiotherapy is an essential method for treating nasopharyngeal carcinoma (NPC), and the segmentation of NPC is a crucial process affecting the treatment. However, manual segmentation of NPC is inefficient. Besides, the segmentation results of different doctors might vary considerably. To improve the efficiency and the consistency of NPC segmentation, we propose a novel AttR2U-Net model which automatically and accurately segments nasopharyngeal carcinoma from MRI images. This model is based on the classic U-Net and incorporates advanced mechanisms such as spatial attention, residual connection, recurrent convolution, and normalization to improve the segmentation performance. Our model features recurrent convolution and residual connections in each layer to improve its ability to extract details. Moreover, spatial attention is fused into the network by skip connections to pinpoint cancer areas more accurately. Our model achieves a DSC value of 0.816 on the NPC segmentation task and obtains the best performance compared with six other state-of-the-art image segmentation models.
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Affiliation(s)
- Jiajing Zhang
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
| | - Lin Gu
- RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
| | - Guanghui Han
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
- School of Information Engineering, North China University of Water Resources and Electric Power, Zhengzhou, China
- *Correspondence: Xiujian Liu, ; Guanghui Han,
| | - Xiujian Liu
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, China
- *Correspondence: Xiujian Liu, ; Guanghui Han,
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Posttreatment Magnetic Resonance Imaging Surveillance of Head and Neck Cancers. Magn Reson Imaging Clin N Am 2021; 30:109-120. [PMID: 34802574 DOI: 10.1016/j.mric.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Treatment strategies and recommended surveillance imaging differ for head and neck cancers depending on subsite and neoplasm type, and pose confusion for referring physicians and interpreting radiologists. The superior soft tissue resolution offered by magnetic resonance imaging is most useful in the surveillance of cancers with high propensities for intraorbital, intracranial, or perineural disease spread, which most commonly include those arising from the sinonasal cavities, nasopharynx, orbits, salivary glands, and the skin. This article discusses recommended surveillance protocoling and reviews treatment approaches, common posttreatment changes, and pearls for identifying disease recurrence in a subsite-based approach.
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The evolution of bone marrow signal changes at the skull base in nasopharyngeal carcinoma patients treated with radiation therapy. Radiol Med 2021; 126:818-826. [PMID: 33788155 DOI: 10.1007/s11547-021-01342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clival infiltration is frequently seen in nasopharyngeal carcinoma (NPC) and the resultant bone marrow signal changes (BMSC) can persist even after complete tumor response to the radiation therapy (RT). The differentiation of those residual BMSC from recurrent/persistent disease may be challenging. We performed serial analysis of the clival BMSC after RT, to define an expected temporal evolution of those signal changes during the follow-up. MATERIALS AND METHODS Serial MRI studies of 50 NPC patients (with or without initial clival infiltration) who had undergone RT were retrospectively examined. Abnormal clival BMSC and contrast enhancement (CE) were evaluated on each follow-up scan. Duration of BMSC/CE was correlated with the degree of baseline clival involvement (BCID), RT dose, and primary mass volume (PMV). RESULTS Clival BMSC persisted without any evidence of recurrence, for a mean of 66.5 (max. 137) months (with accompanying CE for up to 125 months) in 26 patients with clival infiltration at diagnosis. Duration of BMSC and CE showed statistical correlations with PMW (p < 0.05), but not with RT dose or BCID. The rate of recurrence in clivus was 14%. New clival lesions that occurred within the first 12 months after RT (in six patients) did not develop recurrence suggesting radiation osteitis (12%). CONCLUSION After RT, residual clival medullary signal change/enhancement is seen in most NPC patients and can persist even years without recurrence.
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Lee CC, Lee JC, Huang WY, Juan CJ, Jen YM, Lin LF. Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be a phantom tumor phenomenon. Medicine (Baltimore) 2021; 100:e24555. [PMID: 33663063 PMCID: PMC7909123 DOI: 10.1097/md.0000000000024555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Some nasopharyngeal carcinoma (NPC) patients may present convincing radiological evidence mimicking residual or recurrent tumor after radiotherapy. However, by means of biopsies and long term follow-up, the radiologically diagnosed residuals/recurrences are not always what they appear to be. We report our experience on this "phantom tumor" phenomenon. This may help to avoid the unnecessary and devastating re-irradiation subsequent to the incorrect diagnosis.In this longitudinal cohort study, we collected 19 patients of image-based diagnosis of residual/recurrent NPC during the period from Feb, 2010 to Nov. 2016, and then observed them until June, 2019. They were subsequently confirmed to have no residual/recurrent lesions by histological or clinical measures. Image findings and pathological features were analyzed.Six patients showed residual tumors after completion of radiotherapy and 13 were radiologically diagnosed to have recurrences based on magnetic resonance imaging (MRI) criteria 6 to 206 months after radiotherapy. There were 3 types of image patterns: extensive recurrent skull base lesions (10/19); a persistent or residual primary lesion (3/19); lesions both in the nasopharynx and skull base (6/19). Fourteen patients had biopsy of the lesions. The histological diagnoses included necrosis/ inflammation in 10 (52.7%), granulation tissue with inflammation in 2, and reactive epithelial cell in 1. Five patients had no pathological proof and were judged to have no real recurrence/residual tumor based on the absence of detectable plasma EB virus DNA and subjective judgment. These 5 patients have remained well after an interval of 38-121 months without anti-cancer treatments.Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be unreliable. False positivity, the "phantom tumor phenomenon", is not uncommon in post-radiotherapy MRI. This is particularly true if the images show extensive skull base involvement at 5 years or more after completion of radiotherapy. MRI findings compatible with NPC features must be treated as a real threat until proved otherwise. However, the balance between under- and over-diagnosis must be carefully sought. Without a pathological confirmation, the diagnosis of residual or recurrent NPC must be made taking into account physical examination results, endoscopic findings and Epstein-Barr virus viral load. A subjective medical judgment is needed based on clinical and laboratory data and the unique anatomic complexities of the nasopharynx.
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Affiliation(s)
| | - Jih-Chin Lee
- Department of Otolaryngology Head & Neck Surgery
| | | | - Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital National Defense Medical Center, 323 Section 2 Cheng-Kong Road, Nei-Hu, Taipei
| | - Yee-Min Jen
- Department of Radiation Oncology
- Radiation Oncology Department, Yee Zen General Hospital, Yang Mei, Taiwan
| | - Li-Fan Lin
- Department of Nuclear Medicine, Tri-Service General Hospital National Defense Medical Center
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Shu C, Zheng W, Lin K, Lim C, Huang Z. Label-Free Follow-Up Surveying of Post-Treatment Efficacy and Recurrence in Nasopharyngeal Carcinoma Patients with Fiberoptic Raman Endoscopy. Anal Chem 2021; 93:2053-2061. [PMID: 33406834 DOI: 10.1021/acs.analchem.0c03778] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Recurrent nasopharyngeal carcinoma (NPC) is the main cause of poor prognosis for NPC patients after chemo- and radiotherapies. Subsequent long-term follow-ups of post-treatment patients are crucial for the early discovery of tumor recurrence with timely intervention. Current clinical imaging methods based on tissue morphology encounter difficulties in differentiating recurrent tumors from post-treatment inflammation and fibrosis. In this work, we apply a unique fiberoptic Raman endoscopy technique to address the challenges for label-free follow-up surveying of post-treatment NPC patients and accurate detection of tumor recurrence. Significant Raman spectral differences can be observed among normal, NPC, and nonrecurring post-treatment patients. Raman endoscopy provides diagnostic accuracy of 100% for detecting recurrent NPC from early post-treatment inflammation and diagnostic accuracy of 98.21% for separating recurrent NPC from long-term post-treatment fibrosis. Further quantitative Raman modeling on in vivo nasopharyngeal tissue Raman data acquired unveils the changes of major tissue biochemicals (e.g., triolein, elastin, keratin, fibrillar collagen, and type IV collagen) associated with primary NPC and post-treatment recurrent NPC tissue compared to normal nasopharyngeal tissue. This work demonstrates that fiberoptic Raman endoscopy can be a clinically powerful diagnostic tool for rapid, label-free post-treatment surveying and recurrent tumor detection in NPC patients at the molecular level.
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Affiliation(s)
- Chi Shu
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576
| | - Wei Zheng
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576
| | - Kan Lin
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576
| | - Chweeming Lim
- Department of Otolaryngology, Singapore General Hospital, Duke-NUS Graduate Medical School, Singapore 169608
| | - Zhiwei Huang
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576
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Lee C, Park SH, Yoon SY, Park KS, Hwang JH, Hwang SK. Gamma Knife Radiosurgery Using Co-Registration with PET-CT and MRI for Recurrent Nasopharyngeal Carcinoma with Previous Radiotherapy : A Single Center 14-Year Experience. J Korean Neurosurg Soc 2019; 63:397-405. [PMID: 31775216 PMCID: PMC7218195 DOI: 10.3340/jkns.2019.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/04/2019] [Indexed: 02/03/2023] Open
Abstract
Objective We retrospectively evaluated the efficacy of Gamma Knife radiosurgery (GKS) for recurrent nasopharyngeal carcinoma (NPC) in patients who previously underwent radiotherapy, and analyzed the treatment outcomes over 14 years.
Methods Ten patients with recurrent NPC who had previously received radiotherapy underwent stereotactic radiosurgery using a Gamma Knife® (Elekta Inc, Atlanta, GA, USA) between 2005 and 2018. The median target volume was 8.2 cm3 (range, 1.7–17.8), and the median radiation dose to the target was 18 Gy (range, 12–30). The median follow-up period was 18 months (range, 6–76 months). Overall and local failure-free survival rates were determined using the Kaplan-Meier method.
Results The NPCs recurred at the primary cancer site in seven patients (70%), as distant brain metastasis in two (20%), and as an extension into brain in one (10%). The recurrent tumors in seven of the 10 patients (70%) were found on the routine follow-up imaging studies. Two patients presented with headache and one with facial pain. Local failure after GKS occurred in five patients (50%) : two of whom died eight and 6 months after GKS, respectively. No adverse radiation effects were noted after GKS. The 1- and 3-year overall survival rates after GKS were 90% and 77%, respectively. The local failure-free survival rates at 6 months, 1 year, and 3 years after GKS were 80%, 48%, and 32%, respectively. The median interval from GKS to local failure was 8 months (range, 6–12). Univariate analysis revealed that using co-registration with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) was associated with a lower local failure rate of recurrent NPC (p=0.027).
Conclusion GKS is an acceptable salvage treatment option for patients with recurrent NPC who previously received radiation therapy. PET-CT and MRI co-registration for dose planning can help achieve local control of recurrent NPC.
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Affiliation(s)
- Chaejin Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Youl Yoon
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ki-Su Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sung-Kyoo Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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11
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Zhou GQ, Wu CF, Zhang J, Mao YP, Tang LL, Chen L, Guo R, Ma J, Sun Y. Cost-Effectiveness Analysis of Routine Magnetic Resonance Imaging in the Follow-Up of Patients With Nasopharyngeal Carcinoma After Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1382-1391. [DOI: 10.1016/j.ijrobp.2018.01.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
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12
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Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with head and neck tumors, a systematic review and meta-analysis. PLoS One 2017; 12:e0177986. [PMID: 28542474 PMCID: PMC5443521 DOI: 10.1371/journal.pone.0177986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/06/2017] [Indexed: 12/30/2022] Open
Abstract
Background Novel advanced MRI techniques are investigated in patients treated for head and neck tumors as conventional anatomical MRI is unreliable to differentiate tumor from treatment related imaging changes. Purpose As the diagnostic accuracy of MRI techniques to detect tumor residual or recurrence during or after treatment is variable reported in the literature, we performed a systematic meta-analysis. Data sources Pubmed, EMBASE and Web of Science were searched from their first record to September 23th 2014. Study selection Studies reporting diagnostic accuracy of anatomical, ADC, perfusion or spectroscopy to identify tumor response confirmed by histology or follow-up in treated patients for head and neck tumors were selected by two authors independently. Data analysis Two authors independently performed data extraction including true positives, false positives, true negatives, false negatives and general study characteristics. Meta-analysis was performed using bivariate random effect models when ≥5 studies per test were included. Data synthesis We identified 16 relevant studies with anatomical MRI and ADC. No perfusion or spectroscopy studies were identified. Pooled analysis of anatomical MRI of the primary site (11 studies, N = 854) displayed a sensitivity of 84% (95%CI 72–92) and specificity of 82% (71–89). ADC of the primary site (6 studies, N = 287) showed a pooled sensitivity of 89% (74–96) and specificity of 86% (69–94). Limitations Main limitation are the low, but comparable quality of the included studies and the variability between the studies. Conclusions The higher diagnostic accuracy of ADC values over anatomical MRI for the primary tumor location emphases the relevance to include DWI with ADC for response evaluation of treated head and neck tumor patients.
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Chee J, Ting Y, Ong YK, Chao SS, Loh KS, Lim CM. Relapse status as a prognostic factor in patients receiving salvage surgery for recurrent or residual nasopharyngeal cancer after definitive treatment. Head Neck 2016; 38:1393-400. [PMID: 27043448 DOI: 10.1002/hed.24451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/01/2016] [Accepted: 02/08/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prognostic value of relapse status (recurrent vs residual disease) in patients receiving surgical salvage for nasopharyngeal carcinoma (NPC). METHODS Retrospective review was conducted on 52 patients who underwent salvage surgery for locoregional relapse of NPC. Univariate and multivariate analyses were used to investigate the prognostic value of relapse status. RESULTS Median follow-up duration was 44.4 months. Mean overall survival (OS) and disease-free survival (DFS) for patients with NPC with residual and recurrent disease after surgical salvage were 107.4 and 54.4 months, and 83.6 and 34.6 months, respectively (p < .001). This improved survival was demonstrated regardless whether the relapse was at the primary or nodal site. Multivariate analysis revealed that recurrent disease status and nodal disease relapse were independent poor prognostic factors for survival in patients receiving salvage surgery for NPC. CONCLUSION In patients undergoing surgical salvage for NPC relapse, residual disease carries a better prognosis than recurrent disease. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1393-1400, 2016.
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Affiliation(s)
- Jeremy Chee
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Yohanes Ting
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Yew Kwang Ong
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Siew Shuen Chao
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
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14
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Zhou H, Shen G, Zhang W, Cai H, Zhou Y, Li L. 18F-FDG PET/CT for the Diagnosis of Residual or Recurrent Nasopharyngeal Carcinoma After Radiotherapy: A Metaanalysis. J Nucl Med 2015; 57:342-7. [PMID: 26541775 DOI: 10.2967/jnumed.115.165407] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/21/2015] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED The aim of this work was to assess the overall value of (18)F-FDG PET/CT in the diagnosis of residual or recurrent nasopharyngeal carcinoma using a metaanalysis. METHODS The literature published between January 1990 and September 2014 was searched in the PubMed, EMBASE, Cochrane Library, EBSCO, VIP, CNKI, and Wanfang databases to identify eligible studies on PET/CT of residual or recurrent lesions. The methodologic quality of the included studies was evaluated using the "quality assessment for studies of diagnostic accuracy" tool. Summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and receiver-operating characteristic curve were obtained using Meta-DiSc freeware. Subgroups were also analyzed. RESULTS A total of 23 studies, involving 1,253 subjects, were included in the metaanalysis. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, with 95% confidence intervals in parentheses, for (18)F-FDG PET or PET/CT were 0.93 (0.91-0.95), 0.87 (0.84-0.89), 5.52 (3.96-7.71), 0.12 (0.09-0.15), and 55.31 (34.94-87.57), respectively. The area under the receiver-operating characteristic curve and Q* index estimate of PET/CT were 0.9473 and 0.8869, respectively. There was no significant difference between the area under the curve of PET and PET/CT (P > 0.05). CONCLUSION Our study has confirmed that (18)F-FDG PET/CT has high sensitivity and specificity but significant heterogeneity in the diagnosis of residual or recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- Huijun Zhou
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Guohua Shen
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wenjie Zhang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huawei Cai
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yue Zhou
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lin Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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15
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Tian YM, Xiao WW, Bai L, Liu XW, Zhao C, Lu TX, Han F. Impact of primary tumor volume and location on the prognosis of patients with locally recurrent nasopharyngeal carcinoma. CHINESE JOURNAL OF CANCER 2015; 34:247-53. [PMID: 26063113 PMCID: PMC4593352 DOI: 10.1186/s40880-015-0019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Abstract
Introduction The properties of a tumor itself were considered the main factors determining the survival of patients with locally recurrent nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). However, recurrent tumors were mainly evaluated by using the American Joint Committee on Cancer staging system, which was modeled on primary tumors and did not incorporate the tumor volume. This study aimed to investigate the prognostic values of the primary tumor location and tumor volume, and to determine whether evaluating these parameters could improve the current staging system. Methods Magnetic resonance (MR) images for 229 patients with locally recurrent NPC who underwent IMRT were analyzed retrospectively. Results The skull base, parapharyngeal space, and intracranial cavity were the most common sites of tumors. There was a difference in the survival between patients with T1 and T2 diseases (77.6 % vs. 50.0 %, P < 0.01) and those with T3 and T4 diseases (33.0 % vs. 18.0 %, P = 0.04) but no difference between patients with T2 and T3 diseases (50.0 % vs. 33.0 %, P = 0.18). Patients with a tumor volume ≤38 cm3 had a significantly higher survival rate compared with those with a tumor volume >38 cm3 (48.7 % vs. 15.2 %, P < 0.01). Conclusions A new staging system has been proposed, with T3 tumors being down-staged to T2 and with the tumor volume being incorporated into the staging, which may lead to an improved evaluation of these tumors. This new system can be used to guide the treatment strategy for different risk groups of recurrent NPC.
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Affiliation(s)
- Yun-Ming Tian
- Huizhou Municipal Central Hospital, Huizhou, Guangdong, 516001, People's Republic of China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Wei-Wei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Li Bai
- Huizhou Municipal Central Hospital, Huizhou, Guangdong, 516001, People's Republic of China.
| | - Xue-Wen Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Chong Zhao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Tai-Xiang Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, 510060, People's Republic of China.
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16
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Shen G, Zhang W, Jia Z, Li J, Wang Q, Deng H. Meta-analysis of diagnostic value of 18F-FDG PET or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma. Br J Radiol 2014; 87:20140296. [PMID: 25348201 DOI: 10.1259/bjr.20140296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We performed this meta-analysis to comprehensively assess the diagnostic performance of positron emission tomography (PET) or PET/CT for detecting lymph node and distant metastases in patients with nasopharyngeal carcinoma (NPC). METHODS Through a search of four English and three Chinese databases (January 1990 to June 2013), pooled estimated sensitivity, specificity and diagnostic odds ratio (DOR) were calculated based on the data extracted from the included studies. We also constructed summary receiver operating characteristic curves, with the area under the curve (AUC) and obtained the Q* index. Heterogeneity and subgroup analysis were also performed. RESULTS In total, 18 articles consisting 20 studies were included in this meta-analysis. On a per-patient basis, the overall pooled estimates for sensitivity and specificity of PET or PET/CT in N and M staging of NPC were 0.89 [95% confidence interval (CI), 0.86-0.91] and 0.96 (95% CI, 0.95-0.96), respectively. The overall DOR, AUC and Q* index were 162.07 (95% CI, 90.72-289.55), 0.9689 and 0.9181, respectively. Subgroup analysis showed that AUC and Q* index were 0.9734 and 0.9255 for N staging and 0.9715 and 0.9223 for M staging, respectively. CONCLUSION The present meta-analysis showed that PET or PET/CT has excellent diagnostic performance for detecting lymph node and distant metastases in patients with NPC. ADVANCES IN KNOWLEDGE To provide evidence to assess the role of PET or PET/CT in staging of NPC.
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Affiliation(s)
- G Shen
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Sichuan, China
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17
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Updates on MR imaging and 18F-FDG PET/CT imaging in nasopharyngeal carcinoma. Oral Oncol 2014; 50:539-48. [DOI: 10.1016/j.oraloncology.2013.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/08/2013] [Accepted: 05/12/2013] [Indexed: 02/06/2023]
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18
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Simo R, Bradley P, Chevalier D, Dikkers F, Eckel H, Matar N, Peretti G, Piazza C, Remacle M, Quer M. European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer. Eur Arch Otorhinolaryngol 2014; 271:2469-79. [PMID: 24609733 DOI: 10.1007/s00405-014-2966-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 02/13/2014] [Indexed: 11/30/2022]
Abstract
It is accepted that the follow-up of patients who had treatment for laryngeal cancer is a fundamental part of their care. The reasons of post-treatment follow-up include evaluation of treatment response, early identification of recurrence, early detection of new primary tumours, monitoring and management of complications, optimisation of rehabilitation, promotion smoking and excessive alcohol cessation, provision of support to patients and their families, patient counselling and education. Controversies exist in how these aims are achieved. Increasing efforts are being made to rationalise the structure and timing of head and neck cancer follow-up clinics. The aim of this document is to analyse the current evidence for the need to follow up patients who have been treated for LC and provide an up to date, evidence-based statement which is meaningful and applicable to all European Health Care Systems. A working group of the Head and Neck Cancer Committee of the ELS was constituted in 2009. A review of the current published literature on the management and follow-up of laryngeal cancer was undertaken and statements are made based on critical appraisal of the literature and best current evidence. Category recommendations were based on the Oxford Centre for Evidence-Based Medicine. Statements include: length, frequency, setting, type of health professional, clinical assessment, screening investigations, patient's education, second primary tumours, and mode of treatment considerations including radiotherapy, chemo-radiation therapy, transoral surgery and open surgery. It also addresses specific recommendations regarding patients with persistent pain, new imaging techniques, tumour markers and narrow band imaging.
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Affiliation(s)
- Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK,
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Lin GW, Wang LX, Ji M, Qian HZ. The use of MR imaging to detect residual versus recurrent nasopharyngeal carcinoma following treatment with radiation therapy. Eur J Radiol 2013; 82:2240-6. [DOI: 10.1016/j.ejrad.2013.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/06/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
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20
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Imaging appearances for recurrent nasopharyngeal carcinoma and post-salvage nasopharyngectomy. Clin Radiol 2013; 68:e629-38. [PMID: 23937825 DOI: 10.1016/j.crad.2013.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/27/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022]
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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Lai V, Li X, Lee VHF, Lam KO, Chan Q, Khong PL. Intravoxel incoherent motion MR imaging: comparison of diffusion and perfusion characteristics between nasopharyngeal carcinoma and post-chemoradiation fibrosis. Eur Radiol 2013; 23:2793-801. [DOI: 10.1007/s00330-013-2889-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 03/30/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022]
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23
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Lin YC, Wang WH, Tsai WC, Chen CC, Chen WC, Lee KF. Predicting the early invasiveness of nasopharyngeal mucosal neoplasia after radiotherapy by narrow-band imaging: A pilot study. Head Neck 2012; 35:46-51. [DOI: 10.1002/hed.22912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2011] [Indexed: 11/12/2022] Open
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24
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The Accuracy of Computed Tomographic Perfusion in Detecting Recurrent Nasopharyngeal Carcinoma After Radiation Therapy. J Comput Assist Tomogr 2011; 35:26-30. [DOI: 10.1097/rct.0b013e3181f01b93] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Sullivan BP, Parks KA, Dean NR, Rosenthal EL, Carroll WR, Magnuson JS. Utility of CT surveillance for primary site recurrence of squamous cell carcinoma of the head and neck. Head Neck 2010; 33:1547-50. [DOI: 10.1002/hed.21636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2010] [Indexed: 11/10/2022] Open
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26
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Lee JS, Huang CM, Yeh IC, Chen HHW, Lin JC, Chen HH. Isolated osteoradionecrosis of the dens mimicking metastasis of nasopharyngeal carcinoma after radiotherapy. J Clin Neurosci 2010; 17:1064-6. [DOI: 10.1016/j.jocn.2009.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 10/25/2009] [Indexed: 10/19/2022]
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27
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Ng SH, Chan SC, Yen TC, Liao CT, Chang JTC, Ko SF, Wang HM, Lin CY, Chang KP, Lin YC. Comprehensive imaging of residual/recurrent nasopharyngeal carcinoma using whole-body MRI at 3 T compared with FDG-PET-CT. Eur Radiol 2010; 20:2229-40. [DOI: 10.1007/s00330-010-1784-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 02/07/2010] [Accepted: 03/13/2010] [Indexed: 11/24/2022]
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Wang CH, Liang JA, Ding HJ, Yang SN, Yen KY, Sun SS, Kao CH. Utility of TL-201 SPECT in clarifying false-positive FDG-PET findings due to osteoradionecrosis in head and neck cancer. Head Neck 2010; 32:1648-54. [DOI: 10.1002/hed.21377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Joshi A, Calman F, O'Connell M, Jeannon JP, Pracy P, Simo R. Current Trends in the Follow-up of Head and Neck Cancer Patients in the UK. Clin Oncol (R Coll Radiol) 2010; 22:114-8. [DOI: 10.1016/j.clon.2009.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 10/12/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
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30
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Shih C, Ko JY, Wang CP, Ting LL, Hsiao JK. Recurrent Nasopharyngeal Carcinoma Presenting as a Positron Emission Tomography False-negative Scan. Tzu Chi Med J 2009. [DOI: 10.1016/s1016-3190(09)60064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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31
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Yen RF, Ting LL, Cheng MF, Wu YW, Tzen KY, Hong RL. Usefulness of201TL SPECT/CT relative to18F-FDG PET/CT in detecting recurrent skull base nasopharyngeal carcinoma. Head Neck 2009; 31:717-24. [DOI: 10.1002/hed.21026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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32
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Ozbayrak M, Kantarci F, Olgun DC, Akman C, Mihmanli I, Kadioglu P. Riedel thyroiditis associated with massive neck fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:267-271. [PMID: 19168779 DOI: 10.7863/jum.2009.28.2.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Mustafa Ozbayrak
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.
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Yen RF, Yen MF, Hong RL, Tzen KY, Chien CR, Chen THH. The cost-utility analysis of 18-fluoro-2-deoxyglucose positron emission tomography in the diagnosis of recurrent nasopharyngeal carcinoma. Acad Radiol 2009; 16:54-60. [PMID: 19064212 DOI: 10.1016/j.acra.2008.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 05/29/2008] [Accepted: 06/19/2008] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES 18-Fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is effective but costly in the early detection of recurrence for nasopharyngeal carcinoma (NPC) in patients after treatment. In this study, we developed a decision tree model to analyze the cost utility of 18F-FDG PET in detecting loco-regional recurrences for NPC patients after therapy. MATERIALS AND METHODS The analysis for cost utility is based on the decision-tree model for three different strategies: 1) magnetic resonance imaging (MRI)-only, 2) PET-only, and 3) MRI-PET (performing PET if MRI result is uncertain). Sensitivity analyses have been performed to examine changes in the cost ratio of PET/MRI and the probability of uncertain MRI. RESULTS After inputting the data for utilities and life expectancies into the decision tree model, the quality-adjusted life expectancies turn out to be 16.16 quality-adjusted life-years (QALYs) for strategy 1, 16.70 QALYs for strategy 2, and 17.35 QALYs for strategy 3. The additional cost per additional QALYs for strategy 3 relative to strategy 1 is calculated to be US $462. Strategy 3 dominates over strategy 2 because strategy 3 costs less and yields more QALYs than strategy 2. If the cost ratio of PET/MRI is less than 1.85 or the probability of uncertain MRI is greater than 73%, then the PET-only strategy becomes more cost-effective than the MRI-PET strategy. CONCLUSION Our analysis shows that the MRI-PET strategy is the most cost-effective for now. It is likely the PET-only strategy will become the most cost-effective for recurrent NPC in patients in the near future as the cost of PET has decreased in a faster rate than the cost of MRI.
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Abstract
This article describes the use of 18F-fluorodeoxyglucose PET in patients who have head and neck cancer for assessment of therapy response, detection of locoregional recurrence and distant metastasis, and surveillance.
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Affiliation(s)
- Rathan M Subramaniam
- Department of Radiology, Mayo Clinic College of Medicine and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic College of Medicine and Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Comoretto M, Balestreri L, Borsatti E, Cimitan M, Franchin G, Lise M. Detection and Restaging of Residual and/or Recurrent Nasopharyngeal Carcinoma after Chemotherapy and Radiation Therapy: Comparison of MR Imaging and FDG PET/CT. Radiology 2008; 249:203-11. [DOI: 10.1148/radiol.2491071753] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Mabille L. [Role of PET-CT in the follow-up of treated tumors of the head and neck]. ACTA ACUST UNITED AC 2008; 89:1037-40. [PMID: 18772780 DOI: 10.1016/s0221-0363(08)73906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
F-18 FDG PET-CT is a well established medical imaging technique used routinely for the follow-up of treated head and neck tumors. Currently, PET-CT is performed 4 months after the end of therapy to assess its efficacy. More recently it has been suggested that this delay could be reduced to one month with major therapeutic implications. During follow-up, PET-CT could improve sensitivity and specificity compared to other imaging techniques. Moreover, since PET-CT is a "whole body technique", it allows restaging in a single procedure.
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Affiliation(s)
- L Mabille
- TEP Paris Nord, 10 avenue Charles Péguy, 95200 Sarcelles.
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Chong VFH, Ong CK. Nasopharyngeal carcinoma. Eur J Radiol 2008; 66:437-47. [PMID: 18485650 DOI: 10.1016/j.ejrad.2008.03.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Revised: 03/24/2008] [Accepted: 03/28/2008] [Indexed: 12/27/2022]
Abstract
Imaging plays an important role in the staging of nasopharyngeal carcinoma. Accurate staging is necessary, as the treatment is directly dependent on stage. Clinical examination provides information on mucosal involvement but is unable to determine the deep extension or the presence of skull base invasion or intracranial spread. The intent of this manuscript is to provide information of the specific imaging findings that will directly affect the stage and treatment of nasopharyngeal carcinoma as well as post-treatment complications.
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Affiliation(s)
- V F H Chong
- Department of Diagnostic Radiology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial. The Journal of Laryngology & Otology 2008; 122:1230-4. [PMID: 18371235 DOI: 10.1017/s0022215108002016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose. METHODS Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy. RESULTS Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001). CONCLUSIONS Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.
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Zhou JY, Fang W, Chan KL, Chong VFH, Khoo JBK. Extraction of metastatic lymph nodes from MR images using two deformable model-based approaches. J Digit Imaging 2008; 20:336-46. [PMID: 17203334 PMCID: PMC3043914 DOI: 10.1007/s10278-006-1037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We presented and evaluated two deformable model-based approaches, region plus contour deformation (RPCD), and level sets to extract metastatic cervical nodal lesions from pretreatment T2-weighted magnetic resonance images. The RPCD method first uses a region deformation to achieve a rough boundary of the target node from a manually drawn initial contour, based on signal statistics. After that, an active contour deformation is employed to drive the rough boundary to the real node-normal tissue interface. Differently, the level sets move a manually drawn initial contour toward the desired nodal boundary under the control of the evolvement speed function, which is influenced by image gradient force. The two methods were tested by extracting 33 metastatic cervical nodes from 18 nasopharyngeal carcinoma patients. Experiments on a basis of pixel matching to reference standard showed that RPCD and level sets achieved averaged percentage matching at 82-84% and 87-88%, respectively. In addition, both methods had significantly lower interoperator variances than the manual tracing method. It was suggested these two methods could be useful tools for the evaluation of metastatic nodal volume as an indicator of classification and treatment response, or be alternatives for the delineation of metastatic nodal lesions in radiation treatment planning.
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Affiliation(s)
- Jia-Yin Zhou
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.
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FDG-PET, CT, MRI for diagnosis of local residual or recurrent nasopharyngeal carcinoma, which one is the best? A systematic review. Radiother Oncol 2007; 85:327-35. [DOI: 10.1016/j.radonc.2007.11.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 11/02/2007] [Accepted: 11/03/2007] [Indexed: 11/17/2022]
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Gordin A, Golz A, Daitzchman M, Keidar Z, Bar-Shalom R, Kuten A, Israel O. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in patients with carcinoma of the nasopharynx: diagnostic accuracy and impact on clinical management. Int J Radiat Oncol Biol Phys 2007; 68:370-6. [PMID: 17324532 DOI: 10.1016/j.ijrobp.2006.12.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 12/06/2006] [Accepted: 12/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma as compared with PET and conventional imaging (CI) alone, and to assess the impact of PET/CT on further clinical management. METHODS AND MATERIALS Thirty-three patients with nasopharyngeal carcinoma had 45 PET/CT examinations. The study was a retrospective analysis. Changes in patient care resulting from the PET/CT studies were recorded. RESULTS Positron emission tomography/computed tomography had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 92%, 90%, 90%, 90%, and 91%, respectively, as compared with 92%, 65%, 76%, 86%, and 80% for PET and 92%, 15%, 60%, 60%, and 60% for CI. Imaging with PET/CT altered further management of 19 patients (57%). Imaging with PET/CT eliminated the need for previously planned diagnostic procedures in 11 patients, induced a change in the planned therapeutic approach in 5 patients, and guided biopsy to a specific metabolically active area inside an edematous region in 3 patients, thus decreasing the chances for tissue sampling errors and avoiding damage to nonmalignant tissue. CONCLUSIONS In cancer of the nasopharynx, the diagnostic performance of PET/CT is better than that of stand-alone PET or CI. Positron emission tomography/computed tomography had a major impact on further clinical management in 57% of patients.
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Affiliation(s)
- Arie Gordin
- Department of Otolaryngology, Rambam Health Care Campus, Haifa, Israel.
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Fuwa N, Ariji Y, Daimon T, Wakisaka M, Matsumoto A, Kodaira T, Tachibana H, Nakamua T, Satou Y. Relationship between the growth pattern of nasopharyngeal cancer and the cervical lymph nodes based on MRI findings: can the cervical radiation field be reduced in patients with nasopharyngeal cancer? Br J Radiol 2006; 79:725-9. [PMID: 16940373 DOI: 10.1259/bjr/27870658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To identify patients with nasopharyngeal cancer in whom the cervical radiation field can be reduced, we classified the growth patterns of nasopharyngeal cancer based on MRI findings into 4 types and performed an evaluation. Based on MRI findings, we classified the growth patterns of primary cancer in 94 patients with nasopharyngeal cancer into Type 1 (superficial type), Type 2 (lateral invasive type), Type 3 (upward invasive type), and Type 4 (anterior extension type), and further classified Type 2, based upon nasopharyngoscopic findings, into Type 2a (unilateral invasive type) and Type 2b (bilateral invasive type). The cervical lymph node metastasis areas were evaluated according to these types. Type 2 showed a significantly higher incidence of cervical lymph node metastasis only on the ipsilateral side than the other types (p = 0.0024). In particular, all patients with Type 2a had cervical lymph node metastasis only on the ipsilateral side (p = 0.0212). This study suggests that the distribution of metastasised cervical lymph nodes depends on the pattern of tumour extent of the primary site.
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Affiliation(s)
- N Fuwa
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusaku, Nagoya 464-8681
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Yen TC, Lin CY, Wang HM, Huang SF, Liao CT, Kang CJ, Ng SH, Chan SC, Fan KH, Chen IH, Lin WJ, Cheng AJ, Chang JTC. 18F-FDG-PET for evaluation of the response to concurrent chemoradiation therapy with intensity-modulated radiation technique for Stage T4 nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2006; 65:1307-14. [PMID: 16863922 DOI: 10.1016/j.ijrobp.2006.02.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 02/22/2006] [Accepted: 02/22/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE This article evaluates [18F] fluorodeoxyglucose positron emission tomography (18F-FDG-PET) findings as a predictor for local responders (R) vs. nonresponders (NR) in nasopharyngeal carcinoma (NPC) patients with Stage T4 lesions, before and at 3 months after completion of concurrent chemotherapy and radiation therapy (CCRT). METHODS AND MATERIALS From January 2002 to November 2003, 39 T4 NPC patients were enrolled. All had magnetic resonance imaging and 18F-FDG-PET, both before and 3 months after CCRT. Any residual/recurrent lesions were confirmed histopathologically. RESULTS Of the 39 eligible patients, after a follow-up of 24.2 +/- 9.5 months, 35 became disease-free and 4 had residual or recurrent disease. Marginal differences in standard uptake values (SUV) were observed (10.9 +/- 5.3 vs. 15.6 +/- 3.4, p = 0.058) between R and NR before treatment, and value changes of SUV before and after CCRT were not significantly different. However, highly significantly lower values of SUV were noted for R than for NR 3 months after completion of CCRT (2.1 +/- 0.8 vs. 5.5 +/- 3.2, p = 0.001). One hundred percent positive and negative predictive values were observed for SUV values of 4.0, set 3 months after completion of CCRT. CONCLUSIONS Neither the pretreatment SUV nor the changes of SUV between pretreatment and posttreatment were significant predictors for local response. SUV at 3 months after completion of CCRT was a significant determinator for local response. The cutoff of 4.0 for SUV at 3 months after completion of CCRT was useful to be offered as a diagnostic reference for recurrent or residual tumor for NPC treatment.
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Affiliation(s)
- Tzu-Chen Yen
- Molecular Imaging Center, Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
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Semiz Oysu A, Ayanoglu E, Kodalli N, Oysu C, Uneri C, Erzen C. Dynamic contrast-enhanced MRI in the differentiation of posttreatment fibrosis from recurrent carcinoma of the head and neck. Clin Imaging 2006; 29:307-12. [PMID: 16153535 DOI: 10.1016/j.clinimag.2005.01.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 01/02/2005] [Accepted: 01/24/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the differentiation of posttreatment fibrosis from recurrent carcinoma, by comparing the dynamic contrast-enhancement characteristics of the lesions. MATERIALS AND METHODS Twenty-six patients with previously treated carcinoma of the head and neck are studied by conventional and dynamic contrast-enhanced MRI at least 6 months after treatment by radiotherapy and/or surgery. Patients are divided into tumor-positive or -negative groups according to the radiological and clinical follow-up and biopsy. Lesion enhancement ratios at each dynamic sequence are calculated. RESULTS The tumor-positive group consisted of 11 patients, while the tumor-negative group included 15 patients. Between the two groups, lesion enhancement ratios are found to be significantly different (P<.05). CONCLUSION Dynamic contrast-enhanced MRI may be a valuable modality in the differentiation of recurrent tumor from posttreatment fibrotic changes of the head and neck.
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Chan SC, Ng SH, Chang JTC, Lin CY, Chen YC, Chang YC, Hsu CL, Wang HM, Liao CT, Yen TC. Advantages and pitfalls of 18F-fluoro-2-deoxy-D-glucose positron emission tomography in detecting locally residual or recurrent nasopharyngeal carcinoma: comparison with magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2006; 33:1032-40. [PMID: 16622711 DOI: 10.1007/s00259-005-0054-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This prospective study was designed to elucidate the advantages and pitfalls of (18)F-FDG PET in detecting locally residual/recurrent nasopharyngeal carcinoma (NPC) in comparison with MRI. METHODS We recruited NPC patients from two ongoing prospective trials. One is being performed to evaluate suspected local recurrence (group A) and the other to assess local treatment response 3 months after therapy (group B). Both groups received (18)F-FDG PET and head and neck MRI. The gold standard was histopathology or clinical/imaging follow-up. An optimal cut-off standardised uptake value (SUV) was retrospectively determined. RESULTS From January 2002 to August 2004, 146 patients were eligible. Thirty-four were from group A and 112 from group B. In all, 26 had locally recurrent/residual tumours. Differences in detection rate between (18)F-FDG PET and MRI were not statistically significant in either group. However, (18)F-FDG PET showed significantly higher specificity than MRI in detecting residual tumours among patients with initial T4 disease (p=0.04). In contrast, the specificity of (18)F-FDG PET for patients with an initial T1-2 tumour treated with intracavitary brachytherapy (ICBT) was significantly lower than that for patients not treated by ICBT (72.2% vs 98.1%, p=0.003). At an SUV cut-off of 4.2, PET showed an equal and a higher accuracy compared with MRI in groups A and B, respectively. CONCLUSION (18)F-FDG PET is superior to MRI in identifying locally residual NPC among patients with initial T4 disease but demonstrates limitations in assessing treatment response in patients with initial T1-2 disease after ICBT. A cut-off SUV is a useful index for aiding in the visual detection of locally residual/recurrent NPC.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin St, Kueishan, Taoyuan, Taiwan, 333, Republic of China
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Hung GU, Tsai SC, Lin WY. Extraordinarily high F-18 FDG uptake caused by radiation necrosis in a patient with nasopharyngeal carcinoma. Clin Nucl Med 2005; 30:558-9. [PMID: 16024955 DOI: 10.1097/01.rlu.0000170039.14351.0b] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A false-positive F-18 FDG PET scan caused by osteoradionecrosis and inflammation in patients with nasopharyngeal carcinoma (NPC) has been reported. The standard uptake values (SUVs) in these false-positive cases are always below 6 and decrease with time. This report is concerned with a false-positive result with extraordinarily high F-18 FDG uptake, which increased on the delayed 3-hour image. A 63-year-old man with NPC underwent surgical removal and radiotherapy (7400 cGy) in July 2003. In October 2003, the CT scan showed a large soft tissue mass over the nasopharynx. Tumor recurrence was suspected. F-18 FDG PET scan showed an FDG-avid lesion over the nasopharyngeal region with a maximum SUV of 28.8 at 1 hour that increased to 30.4 at 3 hours. Biopsy was performed and the histopathologic examination showed only necrotic tissue and no evidence of tumor cells. Radiation necrosis was diagnosed. No evidence of tumor recurrence was noted during the 10-month follow-up period.
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Affiliation(s)
- Guang-Uei Hung
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
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Wang CT, Young YH. Potential usefulness of Tl-201 SPECT for differentiating radionecrosis in an irradiated nasopharyngeal carcinoma patient. Eur Arch Otorhinolaryngol 2005; 263:135-8. [PMID: 16003552 DOI: 10.1007/s00405-005-0964-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 02/25/2005] [Indexed: 10/25/2022]
Abstract
Differentiation between cerebral radionecrosis and intracranial relapse in irradiated nasopharyngeal carcinoma (NPC) patients challenges the clinicians, especially when clinical manifestation and MRI findings are inconclusive. A 63-year-old NPC patient had intermittent dizziness and unsteady gait 3 years after irradiation. An ice water caloric test revealed absent response on the right ear, which was compatible with an enhanced lesion at the right temporal lobe on MRI scan. Furthermore, abnormal focally increased uptake over the anteriomedial aspect of the right temporal lobe was disclosed on 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET), which suggested intracranial relapse. Conversely, serological study for Epstein-Barr viral titer was within normal limits, arguing against either recurrent or metastatic NPC. Hence, thallium (Tl)-201 single photon emission computed tomography (SPECT) was subsequently conducted, which failed to demonstrate abnormal thallium accumulation in the corresponding area. Accordingly, radiation necrosis of the temporal lobe rather than intracranial relapse is considered. The patient was rather well without locoregional recurrence or distant metastasis 2 years after presentation.
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Affiliation(s)
- Chi-Te Wang
- Department of Otolaryngology, National Taiwan University Hospital of the National Taiwan University College of Medicine, 1 Chang-Te St, Taipei, Taiwan
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Collins R, Flynn A, Melville A, Richardson R, Eastwood A. Effective health care: management of head and neck cancers. Qual Saf Health Care 2005; 14:144-8. [PMID: 15805462 PMCID: PMC1743991 DOI: 10.1136/qshc.2005.013961] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The management of head and neck cancer, published in a recent issue of Effective Health Care, is reviewed.
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Affiliation(s)
- R Collins
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
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Abstract
Incidence of nasopharyngeal carcinoma has remained high in endemic regions. Diagnosing the disease in the early stages requires a high index of clinical acumen and, although most cross-sectional imaging investigations show the tumour with precision, confirmation is dependent on histology. Epstein-Barr virus (EBV)-encoded RNA signal is present in all nasopharyngeal carcinoma cells, and early diagnosis of the disease is possible through the detection of raised antibodies against EBV. The quantity of EBV DNA detected in blood indicates the stage and prognosis of the disease. Radiotherapy with concomitant chemotherapy has increased survival, and improved techniques (such as intensity-modulated radiotherapy), early detection of recurrence, and application of appropriate surgical salvage procedures have contributed to improved therapeutic results. Screening of high-risk individuals in endemic regions together with developments in gene therapy and immunotherapy might further improve outcome.
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Affiliation(s)
- William I Wei
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.
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