Prognostic Value of Cavernous Sinus Invasion in Patients with Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy.

Abstract

PURPOSE:

To investigate the prognostic value of cavernoussinus invasion (CSI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).

PATIENTS AND METHODS:

Retrospective review of data from 1,087 patients with biopsy-proven, non-metastatic NPC. All patients were diagnosed using magnetic resonance imaging (MRI) scans and received IMRT as the primary treatment.

RESULTS:

The incidence of cavernoussinus invasion in this cohort was 12.1%. In univariate analysis, 5-year overall survival (OS) (70.6% vs. 88.5%, P < 0.001) and distant metastasis-free survival (DMFS) (71.4% vs. 87.7%, P < 0.001), but not locoregional relapse-free survival (LRFS) (93.9% vs. 93.7%, P = 0.341), were significantly different between patients with and without cavernoussinus invasion. In the T4 subgroup, the 5-year OS, DMFS, and LRFS of patients with and without cavernoussinus extension were 70.6% vs. 81.9% (P = 0.011), 71.4% vs. 84.1% (P = 0.011), and 91.2% vs. 89.7% (P = 0.501), respectively. In multivariate analysis, cavernoussinus invasion was an independent prognostic factor for poorer OS (HR = 1.782; P = 0.013) and DMFS (HR = 1.771; P = 0.016), but not LRFS (HR = 0.632; P = 0.294). In patients with lymph node metastasis, the DMFS rates of patients with and without cavernoussinus invasion were significantly different (P < 0.001). Preliminaryanalysis indicated that neoadjuvant chemotherapy led to better DMFS and OS in patients with cavernoussinus invasion than concurrent chemotherapy or radiotherapy alone; however, the differences were not significant.

CONCLUSIONS:

In the IMRT era, cavernoussinus invasion remains a prognostic factor for poor DMFS and OS in NPC, even in patients with T4 disease.

• Authors: Jun-Fang Liao, Li Ma, Xiao-Jing Du, Mei Lan, Ying Guo, Lie Zheng, Yun-Fei Xia, Wei Luo
• Journal: PloS one (PLoS One) Vol. 11 Issue 1 Pg. e0146787 ( 2016) ISSN: 1932-6203 [Electronic] United States
• PMID: 26824230 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Carcinoma (pathology, radiotherapy)
• Cavernous Sinus (pathology)
• Disease-Free Survival
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms (pathology, radiotherapy)
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Prognosis
• Radiotherapy, Intensity-Modulated (methods)
• Retrospective Studies