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Prognostic value of parotid lymph node metastasis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

Zhang Y, Li WF, Chen L, Mao YP, Guo R, Zhang F, Peng H, Liu LZ, Li L, Liu Q, Ma J - Sci Rep (2015)

Bottom Line: Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses.PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease.In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.

ABSTRACT
The prognostic value and staging category of parotid lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) remain unknown. We retrospectively reviewed MRI scans and medical records for 1811 NPC patients who received intensity-modulated radiotherapy. The diagnosis of PLN metastasis was mainly based on MRI follow-up. Twenty-five positive PLNs in 21/1811 patients were identified; the incidence of PLN metastasis was 1.2%. PLN metastasis was significantly associated with advanced N-category and stage. Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses. PLN metastasis was associated with significantly poorer progression-free survival, overall survival and distant metastasis-free survival (DMFS), but not regional or local relapse-free survival, in univariate analysis. In multivariate analysis, PLN metastasis was also significantly associated with poor DMFS. PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease. In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease. PLN metastasis should be suspected in advanced nodal disease, but diagnosed with care before administering aggressive treatment.

No MeSH data available.


Related in: MedlinePlus

Imaging of parotid lymph node involvement in the right parotid gland in a 29-year-old male with NPC.(A) Pretreatment transverse T1-weighted spin-echo MRI image showing a 10 mm nonspecific hypointense nodule within the right parotid gland. (B) Isodose curves for intensity-modulated radiotherapy: red, 70 Gy; green, 60 Gy; light blue, 45 Gy; blue 23 Gy. (C) Transverse T1-weighted spin-echo MRI image 3 months after radiotherapy showing the lesion within the right parotid gland was controlled. (D) Transverse T1-weighted spin-echo MRI image 32 months after radiotherapy showing a 12 mm nonspecific hypointense nodule within the right parotid gland, which was pathologically confirmed as squamous carcinoma after surgery.
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f2: Imaging of parotid lymph node involvement in the right parotid gland in a 29-year-old male with NPC.(A) Pretreatment transverse T1-weighted spin-echo MRI image showing a 10 mm nonspecific hypointense nodule within the right parotid gland. (B) Isodose curves for intensity-modulated radiotherapy: red, 70 Gy; green, 60 Gy; light blue, 45 Gy; blue 23 Gy. (C) Transverse T1-weighted spin-echo MRI image 3 months after radiotherapy showing the lesion within the right parotid gland was controlled. (D) Transverse T1-weighted spin-echo MRI image 32 months after radiotherapy showing a 12 mm nonspecific hypointense nodule within the right parotid gland, which was pathologically confirmed as squamous carcinoma after surgery.

Mentions: Median follow-up was 38.3 months (range, 1.3–60.2 months). The 3-year OS, PFS, DMFS, LRFS, and RRFS rates for the entire cohort were 94.2%, 84.7%, 90.7%, 95.7%, and 96.6%, respectively. Of the 21 patients with PLN metastasis, 10 patients (47.6%) experienced locoregional failure or distant metastasis and five (23.8%) died. Among the 10 patients with irradiated PLNs, there was no PLN recurrence during follow-up; however, four (36.4%) of the other 11 patients whose PLNs were not irradiated experienced PLN recurrence (P = 0.03). Typical pretreatment and recurrence MRI imaging and the isodose curves are shown in Fig. 2. The 11/21 patients who did not receive radical treatment for the PLNs were excluded from the prognostic analyses.


Prognostic value of parotid lymph node metastasis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

Zhang Y, Li WF, Chen L, Mao YP, Guo R, Zhang F, Peng H, Liu LZ, Li L, Liu Q, Ma J - Sci Rep (2015)

Imaging of parotid lymph node involvement in the right parotid gland in a 29-year-old male with NPC.(A) Pretreatment transverse T1-weighted spin-echo MRI image showing a 10 mm nonspecific hypointense nodule within the right parotid gland. (B) Isodose curves for intensity-modulated radiotherapy: red, 70 Gy; green, 60 Gy; light blue, 45 Gy; blue 23 Gy. (C) Transverse T1-weighted spin-echo MRI image 3 months after radiotherapy showing the lesion within the right parotid gland was controlled. (D) Transverse T1-weighted spin-echo MRI image 32 months after radiotherapy showing a 12 mm nonspecific hypointense nodule within the right parotid gland, which was pathologically confirmed as squamous carcinoma after surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4561956&req=5

f2: Imaging of parotid lymph node involvement in the right parotid gland in a 29-year-old male with NPC.(A) Pretreatment transverse T1-weighted spin-echo MRI image showing a 10 mm nonspecific hypointense nodule within the right parotid gland. (B) Isodose curves for intensity-modulated radiotherapy: red, 70 Gy; green, 60 Gy; light blue, 45 Gy; blue 23 Gy. (C) Transverse T1-weighted spin-echo MRI image 3 months after radiotherapy showing the lesion within the right parotid gland was controlled. (D) Transverse T1-weighted spin-echo MRI image 32 months after radiotherapy showing a 12 mm nonspecific hypointense nodule within the right parotid gland, which was pathologically confirmed as squamous carcinoma after surgery.
Mentions: Median follow-up was 38.3 months (range, 1.3–60.2 months). The 3-year OS, PFS, DMFS, LRFS, and RRFS rates for the entire cohort were 94.2%, 84.7%, 90.7%, 95.7%, and 96.6%, respectively. Of the 21 patients with PLN metastasis, 10 patients (47.6%) experienced locoregional failure or distant metastasis and five (23.8%) died. Among the 10 patients with irradiated PLNs, there was no PLN recurrence during follow-up; however, four (36.4%) of the other 11 patients whose PLNs were not irradiated experienced PLN recurrence (P = 0.03). Typical pretreatment and recurrence MRI imaging and the isodose curves are shown in Fig. 2. The 11/21 patients who did not receive radical treatment for the PLNs were excluded from the prognostic analyses.

Bottom Line: Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses.PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease.In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.

ABSTRACT
The prognostic value and staging category of parotid lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) remain unknown. We retrospectively reviewed MRI scans and medical records for 1811 NPC patients who received intensity-modulated radiotherapy. The diagnosis of PLN metastasis was mainly based on MRI follow-up. Twenty-five positive PLNs in 21/1811 patients were identified; the incidence of PLN metastasis was 1.2%. PLN metastasis was significantly associated with advanced N-category and stage. Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses. PLN metastasis was associated with significantly poorer progression-free survival, overall survival and distant metastasis-free survival (DMFS), but not regional or local relapse-free survival, in univariate analysis. In multivariate analysis, PLN metastasis was also significantly associated with poor DMFS. PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease. In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease. PLN metastasis should be suspected in advanced nodal disease, but diagnosed with care before administering aggressive treatment.

No MeSH data available.


Related in: MedlinePlus