Elsevier

Cancer/Radiothérapie

Volume 8, Issue 4, August 2004, Pages 230-233
Cancer/Radiothérapie

Original article
Influence of MRI abnormality in skull base bone on prognosis of nasopharyngeal carcinomaInfluence de l'atteinte osseuse de la base du crâne par IRM sur le pronostic des carcinomes nasopharyngés

https://doi.org/10.1016/j.canrad.2004.04.005Get rights and content

Abstract

Purpose. – To evaluate the influence of skull base bone (SBB) abnormality showed by MRI on prognosis of nasopharyngeal carcinoma (NPC).

Patients and methods. – From March 1993 to December 1998, 122 NPC patients received prime radiotherapy treatment. All of them were proved pathologically and checked by magnetic resonance imaging (MRI). Every patient received radiation through conjoint facio-cervical field and conventional dose-fractionation schedules. The total dose to the primary tumor was 60–75 Gy (median, 70 Gy). The Kaplan–Meier method, the Log-rank test and the Cox regression model were used to evaluate the significance of prognostic factors on NPC patient survival.

Results. – The overall median survival period was 50 (6–92) months, and the 1, 3 and 5 year-survival rates were, respectively, 99.2%, 87.9%, and 73.3%. The 1, 3, and 5 year-survival rates of abnormality and normality of the SBB on MRI were 98.9%, 87.2%, 71.9%, and 100.0%, 89.8%, 77.0%, respectively (P = 0.4233). Gender, age, head pain, SBB abnormality, cranial nerve palsy, cervical lymphadenopathy and primary tumor extent were analyzed with the Cox regression model and SBB abnormality on MRI did not prove to have statistical significance (P = 0.6934). According to the analysis of regrouping, patients with SBB abnormalities ≥2 sites have a worse prognosis (P = 0.0427). Then, the above seven factors are analyzed by Cox regression model and the result had statistical significance (P = 0.0385).

Conclusion. – The SBB abnormality on MRI is of no obvious influence on prognosis of NPC. However, when SBB abnormality sites were ≥2, there is obvious statistical significance on the prognosis.

Résumé

Objectif de l'étude. – Évaluer l'influence de l'atteinte osseuse de la base du crâne objective par IRM sur le pronostic des carcinomes nasopharyngés.

Patients et méthodes. – De mars 1993 à décembre 1998, 122 patients atteints de cancer du cavum ont été traités par irradiation de première intention. Le diagnostic a toujours été confirmé par biopsie et tous les patients ont eu une IRM. La technique d'irradiation était classique. La dose totale délivrée à la tumeur primitive était de 60–75 Gy (médiane : 70 Gy). La méthode de Kaplan-Meier, le test du Log-rank et le modèle de Cox ont été utilisés pour évaluer la signification des facteurs pronostiques sur la survie.

Résultats. – La durée médiane de survie globale était de 50 mois (6–92) et les taux de survie à un, trois et cinq ans respectivement de 99,2, 87,9 et 73,3 %. Les taux de survie à un, trois et cinq ans avec et sans atteinte osseuse à l'IRM étaient respectivement de 98,9, 87,2, 71,9 % et 100, 89,8, 77 % (p = 0,4233). Le sexe, l'âge, les céphalées, l'atteinte osseuse, les paralysies des nerfs crâniens, les adénopathies cervicales et l'extension de la tumeur primitive ont été analysés dans un modèle de régression multiple de Cox ; l'atteinte de la base du crâne sur l'IRM n'atteignait pas le seuil de signification (p = 0,6934). Le pronostic était cependant significativement défavorable s'il y avait des anomalies de la base du crâne dans au moins deux sites (p = 0,0427). L'analyse multifactorielle montrait alors que ce facteur était significativement pronostique (p = 0,0385).

Conclusion. – L'atteinte de la base du crâne sur l'IRM n'a pas d'influence significative sur la survie, sauf si elle intéresse au moins deux sites.

Introduction

It was generally thought that skull base bone (SBB) infiltration was one of the major factors of bad prognosis of nasopharyngeal carcinoma (NPC) patients in the past. With magnetic resonance imaging (MRI) having an increasing extensive application in NPC patients, the detection rate of SBB abnormality is increasing. However, this MRI SBB abnormality is different from the computed tomography (CT) SBB destruction, and its influence on the prognosis of NPC was unknown, as few articles report it [8], [13], [14]. On the basis of our former study [6], [7], [8], further research on this problem has been carried out.

Section snippets

Patients

Between March 1993 and December 1998, 122 biopsy-proven NPC (102 males and 20 females; aged from 15 to 78 years, mean 46, median 50) were treated in the Department of Radiotherapy, Jiangsu Cancer Hospital, Nanjing, China. The patients’ characteristics are summarized in Table 1. All of them were examined with MRI prior to radiation therapy. In the pathological types, 119 cases were low differentiated squamous cell carcinomas, one was a squamous cell carcinoma that did not grade, one was an

Results

Four cases were lost in the follow-up of the cohort, and so the follow-up rate was 96.7%. The median follow-up time was 46 months (range 24–92 months). There were 35 patients dead, including 16 cases dying from relapse (nine cases of primary tumor, five cases of cervical node, two cases of both), 11 from lung metastasis, eight from bone metastasis, six from liver metastasis, four of abdominal cavity metastasis and nine from other reasons. In seven cases, the causes of death had more than two

Discussion

NPC is a rare neoplasm, constituting approximately 0.3–2.0% of all malignancies in most geographic areas of the world. It is one of the most common types of cancer in Southeast Asia (Southern China, Hong Kong, Malaysia, Borneo, and the Philippines), Alaska, Greenland, and the Mediterranean basin. In Southern China, the annual incidence is 2550/100 000 persons [3], [4]. SBB invasion is reported to be a poor prognostic factor of NPC. However, these reports were mainly from retrospective studies

References (16)

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