Development and Validation of Radiologic Scores for Guiding Individualized Induction Chemotherapy in T3N1M0 Nasopharyngeal Carcinoma

Overview

Journal Eur Radiol

Specialty Radiology

Date 2022 Jan 6

PMID 34989842

Citations 1

Authors

Shan-shan Yang

Yi-Shan Wu

Ya-Jun Pang

Su-Ming Xiao

Bao-Yu Zhang

Zhi-Qiao Liu

En-Ni Chen

Xu Zhang

Pu-Yun OuYang

Fang-Yun Xie

Affiliations

Soon will be listed here.

Abstract

Objectives: We aimed to develop and validate radiologic scores from [F]FDG PET/CT and MRI to guide individualized induction chemotherapy (IC) for patients with T3N1M0 nasopharyngeal carcinoma (NPC).

Methods: A total of 542 T3N1M0 patients who underwent pretreatment [F]FDG PET/CT and MRI were enrolled in the training cohort. A total of 174 patients underwent biopsy of one or more cervical lymph nodes. Failure-free survival (FFS) was the primary endpoint. The radiologic score, which was calculated according to the number of risk factors from the multivariate model, was used for risk stratification. The survival difference of patients undergoing concurrent chemoradiotherapy (CCRT) with or without IC was then compared in risk-stratified subgroups. Another cohort from our prospective clinical trial (N = 353, NCT03003182) was applied for validation.

Results: The sensitivity of [F]FDG PET/CT was better than that of MRI (97.7% vs. 87.1%, p < 0.001) for diagnosing histologically proven metastatic cervical lymph nodes. Radiologic lymph node characteristics were independent risk factors for FFS (all p < 0.05). High-risk patients (n = 329) stratified by radiologic score benefited from IC (5-year FFS: IC + CCRT 83.5% vs. CCRT 70.5%; p = 0.0044), while low-risk patients (n = 213) did not. These results were verified again in the validation cohort.

Conclusions: T3N1M0 patients were accurately staged by both [F]FDG PET/CT and MRI. The radiologic score can correctly identify high-risk patients who can gain additional survival benefit from IC and it can be used to guide individualized treatment of T3N1M0 NPC.

Key Points: • [F]FDG PET/CT was more accurate than MRI in diagnosing histologically proven cervical lymph nodes. • Radiologic lymph node characteristics were reliable independent risk factors for FFS in T3N1M0 nasopharyngeal carcinoma patients. • High-risk patients identified by the radiologic score based on [F]FDG PET/CT and MRI could benefit from the addition of induction chemotherapy.

Citing Articles

[F]FDG PET/CT versus [F]FDG PET/MRI in the diagnosis of lymph node metastasis in nasopharyngeal carcinoma: a systematic review and meta-analysis.

Lei J, Li X, Xue W, Qian X, Wang T, Xiang Y Front Med (Lausanne). 2024; 11:1450526.

PMID: 39478819 PMC: 11521955. DOI: 10.3389/fmed.2024.1450526.

References

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Chen Y, Chan A, Le Q, Blanchard P, Sun Y, Ma J . Nasopharyngeal carcinoma. Lancet. 2019; 394(10192):64-80. DOI: 10.1016/S0140-6736(19)30956-0. View

Pan J, Ng W, Zong J, Lee S, Choi H, Chan L . Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2016; 122(21):3307-3315. PMC: 5524130. DOI: 10.1002/cncr.30198. View

Sun X, Su S, Chen C, Han F, Zhao C, Xiao W . Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiother Oncol. 2013; 110(3):398-403. DOI: 10.1016/j.radonc.2013.10.020. View

Cao S, Yang Q, Guo L, Mai H, Mo H, Cao K . Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017; 75:14-23. DOI: 10.1016/j.ejca.2016.12.039. View

Sun Y, Li W, Chen N, Zhang N, Hu G, Xie F . Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016; 17(11):1509-1520. DOI: 10.1016/S1470-2045(16)30410-7. View

Zhang Y, Chen L, Hu G, Zhang N, Zhu X, Yang K . Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma. N Engl J Med. 2019; 381(12):1124-1135. DOI: 10.1056/NEJMoa1905287. View

Lan X, Xiao Y, Zou X, Zhang X, OuYang P, Xie F . Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0-1 nasopharyngeal carcinoma: a propensity-matched study. Onco Targets Ther. 2017; 10:3853-3860. PMC: 5546817. DOI: 10.2147/OTT.S133917. View

Xu C, Zhang S, Li W, Chen L, Mao Y, Guo Y . Selection and Validation of Induction Chemotherapy Beneficiaries Among Patients With T3N0, T3N1, T4N0 Nasopharyngeal Carcinoma Using Epstein-Barr Virus DNA: A Joint Analysis of Real-World and Clinical Trial Data. Front Oncol. 2019; 9:1343. PMC: 6896227. DOI: 10.3389/fonc.2019.01343. View

10.

Tang L, Chen Q, Fan W, Liu H, Zhang L, Guo L . Prospective study of tailoring whole-body dual-modality [18F]fluorodeoxyglucose positron emission tomography/computed tomography with plasma Epstein-Barr virus DNA for detecting distant metastasis in endemic nasopharyngeal carcinoma at initial.... J Clin Oncol. 2013; 31(23):2861-9. DOI: 10.1200/JCO.2012.46.0816. View

11.

Cho H, Kim S, Kim H, Koh Y, Kim S, Choi E . Lymph Node With the Highest FDG Uptake Predicts Distant Metastasis-Free Survival in Patients With Locally Advanced Nasopharyngeal Carcinoma. Clin Nucl Med. 2018; 43(7):e220-e225. DOI: 10.1097/RLU.0000000000002145. View

12.

Xie P, Yue J, Fu Z, Feng R, Yu J . Prognostic value of 18F-FDG PET/CT before and after radiotherapy for locally advanced nasopharyngeal carcinoma. Ann Oncol. 2009; 21(5):1078-82. DOI: 10.1093/annonc/mdp430. View

13.

Hung T, Fan K, Kang C, Huang S, Lin C, Ho A . Lymph node-to-primary tumor standardized uptake value ratio on PET predicts distant metastasis in nasopharyngeal carcinoma. Oral Oncol. 2020; 110:104756. DOI: 10.1016/j.oraloncology.2020.104756. View

14.

Lin P, Min M, Lee M, Holloway L, Forstner D, Bray V . Prognostic utility of (18)F-FDG PET-CT performed prior to and during primary radiotherapy for nasopharyngeal carcinoma: Index node is a useful prognostic imaging biomarker site. Radiother Oncol. 2016; 120(1):87-91. DOI: 10.1016/j.radonc.2016.05.021. View

15.

Li W, Sun Y, Mao Y, Chen L, Chen Y, Chen M . Proposed lymph node staging system using the International Consensus Guidelines for lymph node levels is predictive for nasopharyngeal carcinoma patients from endemic areas treated with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2012; 86(2):249-56. DOI: 10.1016/j.ijrobp.2012.09.003. View

16.

Prabhu R, Magliocca K, Hanasoge S, Aiken A, Hudgins P, Hall W . Accuracy of computed tomography for predicting pathologic nodal extracapsular extension in patients with head-and-neck cancer undergoing initial surgical resection. Int J Radiat Oncol Biol Phys. 2013; 88(1):122-9. DOI: 10.1016/j.ijrobp.2013.10.002. View

17.

Mao Y, Wang S, Lydiatt W, Shah J, Colevas A, Lee A . Unambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems. Radiother Oncol. 2021; 157:114-121. DOI: 10.1016/j.radonc.2021.01.015. View

18.

Ai Q, King A, Poon D, Mo F, Hui E, Tong M . Extranodal extension is a criterion for poor outcome in patients with metastatic nodes from cancer of the nasopharynx. Oral Oncol. 2019; 88:124-130. DOI: 10.1016/j.oraloncology.2018.11.007. View

19.

Lu T, Hu Y, Xiao Y, Guo Q, Huang S, OSullivan B . Prognostic value of radiologic extranodal extension and its potential role in future N classification for nasopharyngeal carcinoma. Oral Oncol. 2019; 99:104438. DOI: 10.1016/j.oraloncology.2019.09.030. View

20.

Hu Y, Lu T, Huang S, Lin S, Chen Y, Fang Y . High-grade radiologic extra-nodal extension predicts distant metastasis in stage II nasopharyngeal carcinoma. Head Neck. 2019; 41(9):3317-3327. DOI: 10.1002/hed.25842. View