Post-radiation CT changes and recurrent nasopharyngeal carcinoma

• Published in: Chinese medical journal 2008-05, Vol.121 (10), p.916-922
• Main Authors: Luo, De-hong, Zhou, Chun-wu, Li, Er-ni, Wen, Bi-xiu
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - radiotherapy; Nasopharynx - diagnostic imaging; Nasopharynx - pathology; Nasopharynx - radiation effects; Neoplasm Recurrence, Local; Tomography, X-Ray Computed - methods; Treatment Outcome; X线断层摄影术; 淋巴转移; 肿瘤复发; 辐射疗法; 鼻咽癌
• ISSN: 0366-6999; 2542-5641
• DOI: 10.1097/00029330-200805020-00010

Background Nasopharyngeal carcinoma （NPC） is endemic in Southern Asia. Radiation therapy remains the mainstay of treatment strategies for NPC. Although approximately 19%-56% of patients develop a recurrent disease 5 years after their primary treatment, recognition of post-radiation changes and early detection of relapse are important in improving the outcome of NPC. Our aim was to analyze the post-radiation changes and recurrent diseases related to NPC using computed tomography （CT） scans and to investigate their relationship. Methods CT scans of 510 pathologically proven NPC patients who have been followed up for more than 2 years after radiation were reviewed. The tumor＇s response to the radiation therapy and its relevance to recurrence were evaluated. Results For patients who were followed up for more than 2 years, their CT scans-obtained within 3 months, during the 4th to the 6th month, and beyond 7 months after radiation therapy, showed a normal nasopharyngeal cavity with a slight thickening in the wall in 93.5%, 95.0% and 84.8% of the patients respectively. The degree of tumor regression had no significant relevance to the risk of recurrence within the initial 3 months （P=0.094）. During this term, the relapse rates in the cases in which the nasopharyngeal walls were displayed as normal, slightly or moderately thickening, or with obvious residual masses on CT scans were 7.1%, 11.7%, 23.5% and 23.1% respectively. The degree of tumor regression beyond 3 months after radiation therapy had a considerable reverse relevance to the risk of recurrence （P=-0.000）. The relapse rates were 13.2%, 14.1%, 10.2% and 2.1%, respectively, in the cases with a normal and a slightly thickening nasopharyngeal wall during the 4th to the 6th month, the 7th to the 12th month, the 13th to the 24th month, and beyond 25 months after radiation. In contrast, the percents in cases with moderate or more aggressive thickening walls in the corresponding periods were 62.5%, 88.9%, 100% and 100%. Within 6 months after radiation therapy, shown by CT scans the metastatic lymph nodes disappeared, markedly decreased, slightly decreased, or enlarged in 37.4%, 51.8%, 4.7%, and 0.4%, respectively, of the patients. During 6 to 12 months after radiation therapy, the proportions were 78.5%, 19.2%, 0.6% and 1.7% correspondingly. Beyond 12 months, the proportions were 83.7%, 7.9%, 0%, and 8.4%. The regression degree of the malignant nodes after radiation therapy showed a remarkable reverse relevanc