Patterns of Primary Tumor Invasion and Regional Lymph Node Spread Based on Magnetic Resonance Imaging in Early-Stage Nasal NK/T-cell Lymphoma: Implications for Clinical Target Volume Definition and Prognostic Significance

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• 作者：Run-Ye Wu ; MD^&lowast ; ; Kang Liu ; MD^&dagger ; ; Wei-Hu Wang ; MD^&lowast ; ; Jing Jin ; MD^&lowast ; ; Yong-Wen Song ; MD^&lowast ; ; Shu-Lian Wang ; MD^&lowast ; ; Yue-Ping Liu ; MD^&lowast ; ; Hua Ren ; MD^&lowast ; ; Hui Fang ; MD^&lowast ; ; Qing-Feng Liu ; MD^&lowast ; ; Yong Yang ; MD^&lowast ; ; Bo Chen ; MD^&lowast ; ; Shu-Nan Qi ; MD^&lowast ; ; Ning-Ning Lu ; MD^&lowast ; ; Yu Tang ; MD^&lowast ; ; Yuan Tang ; MD^&lowast ; ; Ning Li ; MD^&lowast ; ; Han Ouyang ; MD^&dagger ; ; ; Ye-Xiong Li ; MD^&lowast ; ; ^{yexiong12@163.com} ; ^{yexiong@yahoo.com}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2017
• 出版时间：1 January 2017
• 年：2017
• 卷：97
• 期：1
• 页码：50-59
• 全文大小：1247 K
• 卷排序：97

文摘

This study aimed to determine the pathways of primary tumor invasion (PTI) and regional lymph node (LN) spread based on magnetic resonance imaging (MRI) in early-stage nasal NK/T-cell lymphoma (NKTCL), to improve clinical target volume (CTV) delineation and evaluate the prognostic value of locoregional extension patterns.Methods and MaterialsA total of 105 patients with newly diagnosed early-stage nasal NKTCL who underwent pretreatment MRI were retrospectively reviewed. All patients received radiation therapy with or without chemotherapy.ResultsThe incidences of PTI and regional LN involvement were 64.7% and 25.7%, respectively. Based on the incidence of PTI, involved sites surrounding the nasal cavity were classified into 3 risk subgroups: high-risk (>20%), intermediate-risk (5%-20%), and low-risk (<5%). The most frequently involved site was the nasopharynx (35.2%), followed by the maxillary (21.9%) and ethmoid (21.9%) sinuses. Local disease and regional LN spread followed an orderly pattern without LN skipping. The retropharyngeal nodes (RPNs) were most frequently involved (19.0%), followed by level II (11.4%). The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for all patients were 72.8%, 65.2%, and 90.0%, respectively. The presence of PTI and regional LN involvement based on MRI significantly and negatively affected PFS and OS.ConclusionsEarly-stage nasal NKTCL presents with a high incidence of PTI but a relatively low incidence of regional LN spread. Locoregional spread followed an orderly pattern, and PTI and regional LN spread are powerful prognostic factors for poorer survival outcomes. CTV reduction may be feasible for selected patients.