Department of Radiation Oncology, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Department of Radiation Oncology, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Oral Oncol. 2018 Apr;79:27-32. doi: 10.1016/j.oraloncology.2018.02.004. Epub 2018 Feb 22.
To evaluate the locoregional extension and patterns of failure for nasopharyngeal carcinoma (NPC) with intracranial extension to improve clinical target volume (CTV) delineation.
A total of 205 NPC patients with intracranial extension by magnetic resonance imaging (MRI) were retrospectively reviewed.
According to the cumulative incidence rates of tumor invasion, we initially classified anatomic sites surrounding the nasopharynx into three risk grades: high risk (≥35%), medium risk (≥10-35%), and low risk (<10%). It was concluded that the anatomic sites at high risk of tumor invasion were the middle/posterior skull base and the anatomic sites adjacent to the nasopharynx. The rate of lymph node (LN) metastasis was 90.2% (185/205). Retropharyngeal region (RP) and level IIb were the most frequently involved regions. Skip metastasis occurred in only 1.6% (3/185). At their last follow-up visit, 53 patients (25.9%) had developed treatment failure. Of the 18 local failures, 12 were considered in-field failure; the other 5 were marginal; one of the patients had outside-field failure. Among the 5 patients with marginal failures, 4 occurred mainly intracranially, and 1 occurred in the floor and the left lateral wall of the nasopharynx. Of the 11 regional failures, 10 were considered in-field failures and most of them (8/10) occurred in the unilateral upper neck.
For NPC with intracranial extension, primary disease and regional LN spread follow an orderly pattern and LN skipping was unusual. Clinical target volume reduction may be feasible for selected patients.
评估有颅内侵犯的鼻咽癌（NPC）的局部区域扩展和失败模式，以改善临床靶区（CTV）勾画。
回顾性分析 205 例经磁共振成像（MRI）证实有颅内侵犯的 NPC 患者。
根据肿瘤侵犯的累积发生率，我们最初将鼻咽周围的解剖部位分为高风险（≥35%）、中风险（≥10-35%）和低风险（<10%）。高风险肿瘤侵犯的解剖部位为中/后颅底和毗邻鼻咽的解剖部位。淋巴结（LN）转移率为 90.2%（185/205）。咽后区（RP）和 IIb 区是最常受累的区域。跳跃性转移仅占 1.6%（3/185）。在最后一次随访时，53 例患者（25.9%）出现治疗失败。18 例局部失败中，12 例为场内失败；5 例为边缘性失败；1 例为场外失败。在 5 例边缘性失败中，4 例主要发生在颅内，1 例发生在鼻咽底部和左侧壁。11 例区域失败中，10 例为场内失败，其中大部分（8/10）发生在单侧上颈部。
对于有颅内侵犯的 NPC，原发疾病和区域 LN 扩散遵循有序模式，且 LN 跳跃转移不常见。对于某些患者，CTV 缩小可能是可行的。
