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To investigate the prognostic significance of prevertebral space involvement (PSI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).A retrospective review of data from 506 biopsy-proven, nonmetastatic NPCs was performed. Patients underwent magnetic resonance imaging examinations and received IMRT as their primary treatment.In this series, 161 NPC patients (31.8%) had PSI. Parapharyngeal space (p0.001), skull base (p0.001), and paranasal sinuses (p = 0.009) were associated with PSI after multivariate analysis. The 4-year overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS) for NPC patients with and without PSI was 69.1% and 89.2% (p0.0001), 83.9% and 96.4% (p0.0001), and 71.6% and 89.6% (p0.0001), respectively. Multivariate analysis identified PSI as an independent negative prognostic factor for both OS (HR = 1.478-4.380; p = 0.001) and DMFS (HR = 1.389-4.174; p = 0.002). Patients with PSI had similar survival rates in OS and DMFS (p = 0.241 and p = 0.493, respectively) to that of T4 disease, while the differences between PSI and T3 disease in both OS and DMFS were distinctly significant (p = 0.029 and p = 0.029, respectively).For NPC patients treated with IMRT, PSI was found to be an independent prognostic factor for both OS and DMFS. It seems reasonable that PSI should be classified as a T4 disease on the basis of the current American Joint Committee on Cancer staging classification criteria.

Purpose To evaluate the 7th edition of the International Union against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC) in patients treated with intensity-modulated radiotherapy. Methods and materials We performed a retrospective data review from 512 patients with biopsy-proven, nonmetastatic NPC in our cancer center (South China) between January 2003 and December 2006. Results The local relapse-free survival rates (LRFS) and disease failure-free survival rates (DFS) in the 6th edition system T1 and T2a stages were not significantly different (P = 0.629 and P = 0.820), while the LRFS and DFS of T1 and T2 using the 7th edition system were significantly different (P = 0.019 and P = 0.009). The LRFS and DFS between T2 and T3 in the 7th edition systems were lack of significance (P = 0.874 and P = 0.589). The total difference in distant metastasis-free survival rate and DFS between N0 and N3 was slightly larger using the 7th edition system than the 6th edition. The nodal dimension of a cervical lymph node was not a significant prognostic factor. Conclusions We observed a better segregation of survival curves by using the 7th edition system. It seems reasonable to downstage T3 as T2 and reject nodal greatest dimension from the N-staging system in the future revised edition.

To determine the appropriate radiologic criteria of metastatic retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC).After institutional review board approval and informed consent, 303 consecutive NPC patients treated with definitive radiation therapy were examined after completion of therapy. RLNs were classified as metastatic on the basis of the results of magnetic resonance (MR) imaging follow-up.The receiver operating characteristic curve and area under the curve were determined to assess the accuracy of different size criteria in the diagnosis of RLN metastasis.Initial MR images revealed 523 RLNs in 265 patients. Two hundred sixty-four (50.5%) RLNs positive for malignant involvement were confirmed in 177 patients. The remaining 259 (49.5%) nodes were classified as negative for benign process at follow-up. The minimal axial diameter was found to be more accurate than the maximal axial diameter for assessing metastatic RLNs. The most accurate size criterion of metastatic RLNs was a minimal axial diameter of 6 mm or larger, resulting in an accuracy of 87.5% (457 of 522). Central necrosis or groups of two or more of RLNs had a 100% specificity for diagnosis of RLN metastases.The radiologic criteria that should be used for assessment of RLN metastases in NPC patients are nodes with a minimal axial diameter 6 mm or larger, any node with central necrosis, groups of two or more RLNs, or any medial RLN; these criteria may be useful in tumor staging and treatment planning.

Although it is rare in other parts of world, nasopharyngeal carcinoma (NPC) is endemic in certain regions, especially in Southeast Asia. The incidence is 30-80 of 100,000 people per year in Southern China (Muir et al. 1987). Nasopharyngeal carcinoma has a higher incidence of cervical lymph node metastasis compared with other head and neck cancers. There is a well-developed network of lymphatics in the nasopharynx (Sham et al. 1990). The retropharyngeal lymph node (RLN) is regarded as the most common lymph node involved in NPC (King et al. 2000a). Retropharyngeal lymph nodes (RLNs) are divided into medial and lateral groups (Rouviere, 1938). The lateral nodes lie lateral to the pharyngeal constrictors and medial to the internal carotid artery. The medial group lies along or near the midline, directly posterior to the upper pharynx. RLNs are not amenable to evaluation using manual palpation. Consequently, the diagnosis of enlarged RLNs in patients with NPC is made on the basis of imaging examinations, such as x-ray computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI).

Background and objective The Chinese 2008 staging system for nasopharyngeal carcinoma (NPC) was a common set of recommendations by initial revision of the previous'92 staging system. This study was to verify the Chinese 2008 staging system and to provide evidence for its further revision. Methods Between January 2003 and December 2004, 924 consecutive patients with newly diagnosed, nondisseminated biopsy-proven NPC, presented at the Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, were entered into our study. All patients received magnetic resonance imaging examination of the neck and nasopharynx before treatment. According to the principle of the staging system, the indices of hazard consistency, hazard discrimination, prognostic value, and distribution were used to evaluate the Chinese 2008 staging system. Results According to the Chinese 2008 staging system, the distribution of stage group for the whole series was 4.9% for the stage I, 22.6% stage II, 38.0% stage III, and 34.5% stage IVA. As for hazard discrimination, the 4-year local relapse-free survival (LRFS) rates for T1-T4 patients were 95.4%, 93.7%, 90.5% and 79.1%, respectively. Although the separation of LRFS for all subclassifications of T-stage showed reasonable, the differences among the subgroups T1, T2, and T3 were still lack of significant statistically. The 4-year distant metastasis failure-free survival (DMFS) rates for N0-N3 patients were 89.4%, 84.3%, 73.6, and 59.2%, respectively. The 4-year overall survival (OS) rates for stage I-IV patients were 96.7%, 94.1%, 82.6% and 67.1%, respectively. As for hazard consistency, the distinctions between T3 with skull base involvement and T3 with medial pterygoid muscle in the hazard ratios of local failure (1.628 vs. 3.905) and disease failure (1.630 vs. 3.288) were large. Multivariate analyses showed that cervical nodal level, extranodal neoplastic spread, and laterality were independent prognostic factors for OS and DMFS, but maximal axial diameter was not. Conclusion Using the Chinese 2008 staging system for NPC produces an acceptable distribution of patient numbers. Stage group, T classification, and N classification represent independent prognosis factors for major endpoints. However, our study reveals several deficiencies in the current system yet.

Abnormal expression and activation of epidermal growth factor receptor (EGFR), which is closely related to the recurrence and poor prognosis of ovarian cancer, can promote chemotherapy resistance of tumor cells. Lung resistance protein (LRP), a multidrug resistance protein causing platinum-resistance, is an independent factor in predicting chemotherapy sensitivity to ovarian cancer. This study was to explore the correlations of EGFR and LRP to chemotherapy resistance and prognosis of ovarian cancer.Expressions of EGFR and LRP in 76 specimens of ovarian malignant tumor, nine borderline tumor, 17 benign tumor and 15 normal ovary were studied using immunohistochemistry. Patients with ovarian cancer were followed up. Correlations of EGFR and LRP to chemotherapy efficacy and survival time of patients with ovarian cancer after operation were analyzed.The positive rates of EGFR and LRP in malignant specimens (73.68% and 71.79%) were significantly higher than those in normal and benign ones (P0.01). EGFR was highly expressed in ovarian cancer patients at late stage (III-IV), with poor differentiation and ascites (P0.05). The short-term efficacy rates of ovarian cancer were lower in patients with positive expressions of EGFR and LRP (57.14% and 53.70%) than in those with negative expressions (P0.05). The positive rates of EGFR and LRP were significant higher in patients with chemotherapy resistance (92.86% and 85.71%) than in those sensitive to chemotherapy (P0.05). The three-year survival rate of ovarian cancer patients was 53.00%. Patients with positive EGFR and LRP and poor short-term efficacy after chemotherapy had short survival time (P0.01).The expression of EGFR and LRP could be used to predict chemotherapy resistance and prognosis of ovarian cancer.

Purpose: To evaluate the prognostic value of variables including nodal size, level, laterality, extranodal neoplastic spread (ENS), and necrosis in patients with nasopharyngeal carcinoma (NPC) and further explore the feasibility of an N-staging system using Radiation Therapy Oncology Group (RTOG) guidelines for lymph node levels based on magnetic resonance imaging (MRI). Experimental Design: The MRI scans of 924 patients with histologically diagnosed nondisseminated NPC were reviewed retrospectively. The distribution of the tumors was mapped using RTOG guidelines and laterality. The multiplicity of each tumor was calculated, as well as the size and status of ENS and the necrosis of individual nodes. Results: Nodal level, cervical lymph node laterality, and ENS were independent prognostic factors for disease failure and distant failure in multivariate analyses. There was no significant difference in the hazard ratios (HR) for distant failure between level II and retropharyngeal, level Ib, level V, or level III involvement, whereas patients with level IV and supraclavicular fossa involvement had a significant increase in HRs. The subsets that made up a given N stage group had similar HRs for distant failure. Both the HRs for disease failure and distant failure by the proposed N staging system between one stage and the next were statistically significant (P < 0.05). The survival curves of disease-free survival and distant metastasis-free survival for all subclassifications of N stage showed significant difference from the adjacent stage (P < 0.05). The overall distribution pattern of the proposed N staging was more equitable than that of the 6th American Joint Committee on Cancer N staging. Conclusions: Nodal variables including level, cervical lymph node laterality, and ENS are independent prognostic factors for NPC. The proposed N staging system of NPC using RTOG guidelines based on MRI is highly predictive and may provide a more objective method for staging NPCs.

To define by MRI the local extension patterns in patients presenting with nasopharyngeal carcinoma (NPC) and to improve clinical target volume delineation.Consecutive patients (N = 943) with newly diagnosed and untreated NPC were included in this study. All patients underwent MRI of the nasopharynx and neck, which was reviewed by two radiologists.According to the incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were initially classified into three risk grades: high risk (or = 35%), medium risk (or = 5-35%), and low risk (5%). Incidence rates of tumor invasion into anatomic sites at medium risk were increased, reaching 55.2%, when adjacent high-risk anatomic sites were involved. However, the rates were substantially lower, mostly10%, when adjacent high-risk sites were not involved. The incidence rates of concurrent tumor invasion into bilateral sites were10%, except in the case of prevertebral muscle involvement (13.1%). Among the 178 incidences of cavernous sinus invasion, there were often two or more simultaneous infiltration routes (60.6%); when only one route was involved, the foramen ovale was the most common (26.4%).In patients presenting with NPC, local disease spreads stepwise from proximal sites to more distal sites. Tumors extend quickly through privileged pathways such as neural foramina. The anatomic sites surrounding the nasopharynx are at low risk of concurrent bilateral tumor invasion. Selective radiotherapy of the local disease in NPC may be feasible.

It is difficult to discriminate progressive gastric cancer and gastric lymphoma by CT imaging, because incrassate gastric wall, lump in gastric cavity, confined gastric cavity, intumescent lymph node, and distant metastasis can be displayed in both of them. This study was to compare the CT findings between gastric cancer and gastric lymphoma to improve diagnosis of gastric tumors, especially for gastric lymphoma.CT images of 27 patients with pathologically proved progressive gastric cancer and 25 patients with pathologically proved gastric lymphoma were reviewed. Tumor location, appearance, scope of involvement, gastric wall thickness, mucous membrane, mucosal fold, serosa membrane, necrosis, enhancement degree and uniformity, involvement of other organs, and abdominal lymph nodes were observed.White line sign was observed in 23 cases (85.2%) of gastric cancer, but not in the 25 cases of gastric lymphoma. The extent of white line sign in gastric cancers was larger in portal vein phase than in arterial phase. Enhancement degree outside the white line was higher in portal vein phase than in arterial phase in 13 cases (48.1%) of gastric cancer. The extent of involved gastric wall was smaller than 50% of the whole gastric wall in all the 27 cases of gastric cancer, while it was larger than 75% in 23 cases (85.2%) of gastric lymphoma. Gastric mucous membrane ulcer was found in all of the 27 cases (100%) of gastric cancer, while it was found in only 1 case (4.0%) of gastric lymphoma. Intumescent lymph nodes in two or more areas were found in 11 cases (40.0%) of gastric lymphoma, but not in gastric cancer. Intumescent lymph nodes in the retroperitoneal space below renal hilum were found in 8 cases (32%) of gastric lymphoma, but not in gastric cancer.There are some different CT features between gastric cancer and gastric lymphoma, such as white line sign, gastric mucous membrane ulcer, extent of involved gastric wall, location of intumescent lymph nodes surrounding the stomach and in retroperitoneal space below renal hilum, and so on, which could be helpful in differential diagnosis of these two diseases.

The purpose of this study is to investigate the incidence, distribution and spread pattern of retropharyngeal lymph node (RLN) metastasis in the patient with nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI).MRI data of 294 patients with newly diagnosed NPC were reviewed retrospectively. Criteria for RLN metastasis were the minimal axial dimension ofor = 6 mm, or the presence of nodal necrosis.RLN involvement was detected in 165 (56.1%) patients. The incidence of metastatic lateral RLN decreased gradually from C1 to C3 level. A significantly higher incidence of metastatic RLN was observed in the patients with cancerous involvement of oropharynx, nasal cavity, pre-styloid parapharyngeal space, post-styloid parapharyngeal space or with cervical lymph node metastasis. Thirty-one patients (10.5%) had metastatic RLN only, and 54 (18.4%) showed metastatic cervical lymph nodes only, but 134 (45.6%) exhibited an involvement of both the RLN and cervical lymph node. A significantly lower incidence of metastatic RLN was found in T1, N0, and stage I disease.The incidence of metastatic lateral retropharyngeal lymph node decreases gradually from C1 to C3 level. Metastatic retropharyngeal lymph node is associated with cancerous involvement of surrounding tissue by primary tumor or with cervical lymph node metastasis. Retropharyngeal lymph node or cervical level II node can be considered equally as the first station of nodal metastasis in nasopharyngeal carcinoma.

Purpose To use magnetic resonance imaging to re-evaluate and improve the 6th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma. Methods and Materials We performed a retrospective review of the data from 924 biopsy-proven nonmetastatic nasopharyngeal carcinoma cases. All patients had undergone magnetic resonance imaging examinations and received radiotherapy as their primary treatment. Results The T classification, N classification, and stage group were independent predictors. No significant differences in the local failure hazards between adjacent T categories were observed between Stage T2b and T1, Stage T2b and T2a, and Stage T2b and T3. Although the disease failure hazards for Stage T1 were similar to those for Stage T2a, those for Stage T2b were similar to those for Stage T3. Survival curves of the different T/N subsets showed a better segregation when Stage T2a was downstaged to T1, T2b and T3 were incorporated into T2, and the nodal greatest dimension was rejected. The disease failure hazard for T3N0-N1 subsets were similar to those of the T1-T2N1 subsets belonging to Stage II; the same result was found for the T4N0-N2 subsets in the sixth American Joint Committee on Cancer staging system. However, the staging system we propose shows more consistent hazards within the same stage group and better survival discrimination among T categories, N categories, and overall stages. Conclusion Using the 6th American Joint Committee on Cancer staging system produces an acceptable distribution of patient numbers and segregation of survival curves among the different stage groups. The prognostic accuracy of the staging system could be improved by recategorizing the T, N, and group stage criteria.

Preoperative staging is important for optimal therapy planning and prognosis prediction of rectal carcinoma. The role of conventional computed tomography (CT) in preoperative staging of rectal carcinoma is controversial. This study was to evaluate the value of multislice spiral computed tomography (MSCT) in preoperative staging of rectal carcinoma.From Mar. 2006 to Feb. 2007, 87 patients with pathologically proved rectal cancer underwent preoperative plain and enhanced MSCT. Two radiologists evaluated independently tumor location, size, the depth of tumor invasion into the rectal wall (T), the involvement of regional lymph nodes (N) and the presence of distant metastases (M) on CT images. TNM staging was made according to CT findings and compared with the pathologic results. The accuracy, sensitivity, and specificity were assessed.All the 87 cases of rectal carcinoma were detected clearly by MSCT. The accuracy was 81.6% for TNM staging, 94.3% for T staging, 82.8% for N staging, and 98.9% for M staging. The sensitivity was 90.5% for T1-2 staging, 91.3% for T3 staging, and 97.7% for T4 staging. The specificity was 98.5% for T1-2 staging, 94.2% for T3 staging, and 97.7% for T4 staging. The sensitivity was 92.9% for N0 staging, 72.0% for N1 staging, and 82.4% for N2 staging. The specificity was 88.9% for N0 staging, 88.5% for N1 staging, and 91.7% for N2 staging. Only 1 case of distant metastasis was missed due to the liver lesion of less than 5 mm.MSCT is an accurate technique for preoperative staging of rectal carcinoma, which can assess the extension to adjacent tissues and the presence of lymph node and distant metastases exactly.

Adrenal cortical adenoma (ACA) is a common disease, and can be diagnosed easily with CT examination. However, some atypical adenomas are likely to be misdiagnosed. This study was to evaluate the common and uncommon CT features of ACA to improve the diagnostic accuracy.Common and uncommon CT features of 109 cases of histologically proved ACA were analyzed.Of the 109 cases of ACA, 104 showed unilateral single adenoma, 1 showed unilateral 2 adenomas, and 4 showed bilateral adenomas. The maximal diameter of the tumor was5 cm in 95 patients. The maximal diameter of non-functional adenomas was larger than that of Cushing's adenomas, and the latter was larger than that of Conn's adenomas. The maximal diameter of the tumor was5 cm in 14 patients. The probability of degeneration was higher in large adenomas than in small adenomas. The CT images of 85 cases before and after contrast administration were assessed: 74 presented homogenous, 11 presented heterogenous; 76 presented slight to moderate enhancement, and 9 presented remarkable enhancement. Two patients had recurrence after operation: 1 showed infiltration in the adjacent kidney and the psoas major on pathologic examination, 1 showed infiltration in the liver and thoracic vertebra on CT images.The common CT features of ACA include unilateral and single lesion, with the maximal diameter of5 cm, homogenous density before contrast administration, and slight to moderate enhancement after administration. The uncommon CT features of ACA include bilateral or unilateral and multiple lesions, with the maximal diameter of5 cm, heterogenous density before contrast administration, and remarkable enhancement after administration, recurrence, even canceration, metastasis after operation.

To analyze the degree and pattern of influence of magnetic resonance imaging (MRI) on staging according to the 6th edition of the American Joint Committee on Cancer staging system compared with computed tomography (CT).The MRI and CT scans and medical records of 420 consecutive patients with newly diagnosed nasopharyngeal carcinoma (NPC) were analyzed retrospectively. The tumors of all patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system.A significant difference (p0.05) was found between CT and MRI in demonstrating involvement in the oropharynx (CT, 25.0% vs. MRI, 14.5%), prevertebral muscle (CT, 18.4% vs. MRI, 36.0%), parapharyngeal space (CT, 82.6% vs. MRI, 68.8%), skull base (CT, 31.0% vs. MRI, 52.6%), sphenoid sinus (CT, 13.6% vs. MRI, 16.7%), ethmoid sinus (CT, 7.1% vs. MRI, 3.3%), intracranial area (CT, 4.8% vs. MRI, 16.0%), and retropharyngeal lymph nodes (CT, 52.1% vs. MRI, 69.0%). The incidence of cervical lymph node metastasis and lymph node metastasis at each level was similar according to CT and MRI. MRI resulted in changes in 49.8% of T stage cases, 10.7% of N stage cases, and 38.6% of clinical stage cases.MRI demonstrated early primary tumor involvement more precisely and deep primary tumor infiltration more easily. The use of MRI caused dramatic changes in the results of the T stage and clinical staging and should be preferred to CT in staging NPC. Patients would benefit from changes in treatment strategies resulting from the use of MRI.

To synthesize a novel gadolinium-loaded nanoparticle as a molecular imaging contrast agent for magnetic resonance imaging.Gadolinium ion was incorporated within a silica nanoparticle. The size of this nanosized particle was determined by using transmission electron microscope. The spin-echo (SE) images of nine nanoparticle dilutions in vitro were obtained from a 1.5 T clinical scanner, compared with gadolinium diethylene triaminepenta acetate (Gd-DTPA). In vivo distribution of nanoparticle in Balb/c nude mice and Balb/c nude mice with nasopharyngeal carcinoma (NPC) xenografted CNE-2 tumors was studied at MR imaging, 30 sec, 5 min, 30 min, 1 h, 2 h, 4 h, and 24 h after intravenous administration.The gadolinium-loaded nanoparticle was short rod-shaped, and approximately 30 to 40 nm in diameter. The value of longitudinal relaxativity (r(1)) of gadolinium nanoparticle was much higher than that of Gd-DTPA. Thirty minutes after injection the gadolinium nanoparticle, the signal intensities of liver, kidney and xenografted tumor increased from 226 +/- 10, 283 +/- 7 and 195 +/- 5 to 352 +/- 12, 328 +/- 10 and 245 +/- 7, respectively. The dynamic MRI scanning showed that gadolinium nanoparticles were mainly distributed in liver after intravenous administration. Strong enhancement was also detected in CNE-2 xenografted tumors.A new gadolinium-loaded nanoparticle with high relaxativity was synthesized successfully, and might serve as a carrier for magnetic resonance molecular imaging.

We investigated the prognostic value and gradation of the T category in N0 nasopharyngeal carcinoma (NPC) patients undergoing magnetic resonance imaging (MRI) and intensity-modulated radiotherapy (IMRT). A total of 749 patients were retrospectively reviewed, and a total of 181 N0 NPC patients were included in this retrospective study. All patients were restaged according to the 7th edition of the American Joint Committee on Cancer staging system. The following endpoints were estimated: overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS). The 5-year survival rates for T1 to T4 were: OS (97.3%, 100.0%, 86.1%, and 82.8%; P = 0.007), PFS (94.6%, 96.9%, 76.5%, and 76.7%; P = 0.002), LRFS (98.5%, 100.0%, 92.2%, and 86.7%; P

To compare the clinical significance of PET/CT and MRI in diagnosing lymph node metastasis and N staging of nasopharyngeal carcinoma (NPC).116 NPC patients had undergone PET/CT and MRI before therapy. The findings of PET/CT and MRI in diagnosing lymph node metastasis and N staging were compared according to the results of follow-up.A total of 614 lymph nodes in 116 patients were analyzed. 340 positive nodes and 274 negative nodes interpreted by image findings were verified during follow-up. The sensitivity, specificity and accuracy of PET/CT in diagnosing node metastasis was 93.2%, 98.2% and 95.4%, while that of MRI was 88.8%, 91.2% and 89.9%, respectively, with statistically significant difference in each between PET/CT and MRI (P0.05). Based on Fuzhou Staging System, 109 patients (94.0%) were correctly staged by PET/CT, and 103 patients (88.8%) by MRI, while according to UICC Staging System, 108 patients (93.1%) were correctly staged by PET/CT, and 100 patients (86.2%) by MRI.PET/CT is superior to MRI in diagnosing lymph node metastasis and N staging of nasopharyngeal carcinoma. The false-positive and false-negative assessment based on PET-CT scan findings may be caused by: (1) inflammatory hyperplastic node; (2) node with large areas of necrosis; (3) node in diameter less than spatial resolution limitation of PET.

To explore the reasonable radiologic criteria of retropharyngeal lymph nodal (RLN) metastasis of nasopharyngeal carcinoma (NPC).275 patients with newly diagnosed NPC were enrolled. All patients underwent Magnetic resonance imaging (MRI) before treatment to measure the sizes of maximal and minimal axial diameters of each node. Determination of malignancy was based on the results of MRI follow-up. Receiver operating characteristic (ROC) curve was used to determine the optimal axial diameter and cutoff size criterion of RLN metastasis.Among the 275 patients, a total number of 468 RLNs were assessed. 240 positive and 228 negative nodes were later confirmed by the MRI follow-up. The mean sizes of minimal and maximal axial diameters for positive nodes were significantly higher than those for negative nodes (9.9 mm +/- 4.8 mm vs 3.3 mm +/- 1.2 mm, 12.9 mm +/- 5.8 mm vs 5.7 mm +/- 2.0 mm, all P0.01). The reasonable criterion for diagnosing RLN metastasis was the minimal axial diameter ofor = 6 mm. The sensitivity, specificity and accuracy of this criterion were 84.1%, 94.3% and 89.1%, respectively. There were 3 nodes whose minimal axial diameter was6 mm in 50 RLNs with central necrosis. Central necrosis combined with the minimal axial diameter criteria slightly increased the sensitivity at a stable specificity.The reasonable radiologic criteria for assessing RLN metastasis of NPC are: (1) node with a minimal axial diameteror = 6 mm; and (2) any node with central necrosis.

Purpose: To investigate the incidence, distribution, and spread pattern of retropharyngeal lymph node (RLN) involvement in patients with nasopharyngeal carcinoma (NPC) by using magnetic resonance imaging (MRI). Methods and Materials: The MR images of 275 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were classified as metastatic based on size criteria, the presence of nodal necrosis, and extracapsular spread. Results: Retropharyngeal lymph node involvement was detected in 175 (63.6%) patients. Metastatic RLNs were seen at the following levels: occipital bone, 24 (9.6%) nodes; C1, 157 (62.5%) nodes; C1/2, 40 (15.9%) nodes; C2, 27 (10.8%) nodes; C2/3, 1 (0.4%) node; and C3, 2 (0.8%) nodes. The incidence of RLN involvement was equal to the incidence of cervical lymph node involvement (81.4% vs. 81.4%) in 215 patients with nodal metastases. A significantly higher incidence of metastatic RLNs was observed in the presence of oropharynx, prestyloid parapharyngeal space, post-styloid parapharyngeal space, longus colli muscle, medial pterygoid muscle, levator muscle of velum palatini, tensor muscle of velum palatini, Level II node, Level III node, and Level V node involvement. A significantly lower incidence of metastatic RLNs was found in T1, N0, and Stage I disease. Conversely, no significant difference in the incidence of metastatic RLNs was observed between T1, 2, and, 3; N2 and N3; or Stage II, III, and IV disease. Conclusions: There is an orderly decrease in the incidence of metastatic lateral RLNs from the C1 to C3 level. Metastatic RLNs associate well with involvement of certain structures in early stage primary tumors and lymph node metastases of the upper jugular chain (Level II, Level III nodes) and the posterior triangle (Level V nodes). Both RLNs and cervical Level II nodes appear to be the first-echelon nodes in NPC.

AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas. METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA, USA) needle driven by a spring-loaded Bard biopsy gun. RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group. The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin’s lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However, the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin’s disease (HD, 28.57%) in our group. CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas, and can be widely applied in the management of patients with suspected malignant lymphoma.

Nodal metastasis pattern of nasopharyngeal carcinoma (NPC) influences treatment planning. This study was to compare the diagnostic value of integrated positron emission tomography-computed tomography (PET-CT) with that of magnetic resonance imaging (MRI) in detecting nodal metastasis of NPC, and explore the regulation of nodal metastasis of NPC.Clinical data of 105 NPC patients, treated in Cancer Center of Sun Yat-sen University from Jun. 2003 to May 2004, were analyzed. All patients underwent PET-CT and MRI. Findings of PET-CT and MRI were evaluated with the results of follow-up. Distribution of metastatic nodes in different nodal groups was assessed.Among the 105 patients, nodal metastasis patterns shown on PET-CT and MRI were diverse in 35 patients. Thirty cervical nodes were positive on PET-CT, but negative on MRI; 25 of them were later confirmed positive by follow-up. Thirty-seven cervical nodes were negative on PET-CT, but positive on MRI; 21 of them were confirmed negative by follow-up. Based on the results of follow-up, 77 patients (73.3%) had nodal involvement. Level II nodes were the most frequently involved (87.0%). Along the jugular chain, the frequencies of nodal metastases in level III, level IV, supraclavicular fossa, and level VII were 42.9%, 14.3%, 7.8%, and 1.3%, respectively. The frequency of nodal metastases in retropharyngeal nodes was 70.1%. Cervical nodes involvement without retropharyngeal nodes involvement was seen in 23 patients (29.9%).The diagnostic accuracy of PET-CT in detecting nodal metastases of NPC is better than that of MRI. The nodal metastases of NPC reveal a decreasing frequency along the jugular chain. Both retropharyngeal and level II nodes are the first-echelon nodes of NPC.

AIM: To evaluate the value of multi-phasic CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in differential diagnosis of liver diseases, and to improve the specificity of CTAP and CTHA for liver cancer detection. METHODS: From January 1999 to December 2002, multi-phasic CTAP and CTHA were performed in 20 patients with suspected liver disease. CT scanning was begun 25 s, 60 s and 120 s for the early-, late- and delayed-phase CTAP examinations, and 6sec, 40 s and 120 s for the early-, late-and delayed-phase CTHA examinations respectively, after a transcatheter arterial injection of non-ionic contrast material. If a lesion was diagnosed as a liver cancer, transcatheter hepatic arterial chemoembolization (TACE) treatment was performed, and the follow-up CT was performed three or four weeks later. RESULTS: All eighteen HCCs in 12 cases were shown as nodular enhancement on early-phasic CTHA. The density of the whole tumor decreased rapidly on late and delayed phases, and the edge of 12 tumors (12/18) remained relatively hyperdense compared with the surrounding liver tissue, and demonstrated as rim enhancement. All HCCs were shown as perfusion defect nodules on multi-phasic CTAP. Five tumors (5/18) were shown as rim enhancement on delayed-phasic CTAP. Rim enhancement was shown as 1 to 2-mm-wide irregular, uneven and discontinuous circumferential enhancement at late-, and delayed-phase of CTHA or CTAP. Five pseudolesions and 4 hemoangiomas were found in multi-phasic CTAP and CTHA. No pseudolesions and hemoangiomas were shown as rim enhancement on late- or delayed-phasic CTHA and CTAP. CONCLUSION: Multi-phasic CTAP and CTHA could help to recognize the false-positive findings in CTAP and CTHA images, and improve the accuracy of CTAP and CTHA of liver cancer detection.

Background The development of intensity-modulated radiotherapy (IMRT) has revolutionized the management of nasopharyngeal carcinoma (NPC). The purpose of this study was to evaluate the prognostic value and classification of TNM stage system for retropharyngeal lymph node (RLN) metastasis in NPC in the IMRT era. Material and Methods We retrospectively reviewed data from 749 patients with biopsy-proven, non-metastatic NPC. All patients received IMRT as the primary treatment. Chemotherapy was administered to 86.2% (424/492) of the patients with stage III or IV disease. Results The incidence of RLN metastasis was 64.2% (481/749). Significant differences were observed in the 5-year disease-free survival (DFS; 70.6% vs. 85.4%, P

Background To translate and validate the Chinese version of the Quality Of Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N), a disease-specific scale to measure quality of life (QOL) for patients with head and neck cancer (HNC) who received radiotherapy. Methods The QOL-RTI/H&N was translated and validated according to the standard process: a translation and back-translation procedure, pilot testing and a validation study. HNC patients were enrolled from the Cancer Center of Sun Yat-sen University and assessed using the QOL-RTI/H&N, QLQ-C30 and QLQ-H&N35. Reliability (internal consistency reliability, split-half reliability and test-retest reliability), validity (content validity, construct validity, criterion validity and discriminant validity), and responsiveness analysis were performed to evaluate the psychometric characteristics of the QOL-RTI/H&N. Results A total of 238 patients (99.2%) completed the questionnaire. Item RTI23 had 16.0% missing data. Other items had low percentages of missing data (0.4% or 0.8%) or no missing data. The average time to finish the scale was 9.8 minutes. Cronbach's alpha of the domains ranged from 0.41 to 0.77. The split-half reliability coefficients ranged from 0.43 to 0.77. All of the intra-class correlation coefficients were equal to or greater than 0.8. All of the item-own domain correlation coefficients were greater than those of the item-other domain. Confirmatory factor analysis showed that Comparative Fit Index, Normed Fit Index and Non-Normed Fit Index were equal to 1.00. Root Mean Square Error of Approximation was 0.01, with 90% CI (0.00, 0.10). The domain scores of the QOL-RTI/H&N were significantly correlated with those of the QLQ-C30 or QLQ-H&N3. All domain scores of patients in different radiotherapy stages were statistically significant (P

Crystallization of polymers in confined microdomains could exhibit different features, including crystalline structure, morphology and novel dynamic processes. Two different such systems have been investigated. They are crystallizable mixtures of a block copolymer with a corresponding homopolymer and miscible semicrystalline/semicrystalline homopolymer blends. In a compatible blend of an AB diblock copolymer and its corresponding homopolymer A, spherical, cylindrical, lamellar, hexagonally-perforated (catenoid) lamellar, bicontinuous lad cubic (gyroid) and bicontinuous Pnm cubic (double diamond) microphases[l-4] can be formed. In AB/A compatible blends with one of the two blocks crystallizable, the crystallization behavior, the structure and the morphology could be very different from the extensively studied miscible polymer blends [5,6]. In this lecture, the AB/A blends with hard amorphous microdomains, meaning that the glass transition temperature, Tg, of the domains is higher than the melting point, Tm, of the crystallizable block, has been studied. Schematic diagrams of the systems are shown in Figure 1.

Background Intensity-modulated radiation therapy (IMRT) provides excellent locoregional control for nasopharyngeal carcinoma (NPC), and has gradually replaced two-dimensional conventional radiotherapy as the first-line radiotherapy technique. Furthermore, in the new seventh edition of the American Joint Committee on Cancer (AJCC) staging system, retropharyngeal lymph nodes were upgraded from N0 to N1 disease as a result of their negative impact on the distant metastasis-free survival (DMFS) rates of NPC. This retrospective study was conducted in order to review the treatment outcomes and patterns of failure in NPC patients with N0 disease after IMRT in order to effectively guide treatment in the future. Methods We retrospectively reviewed data from 506 biopsy-proven nonmetastatic NPC patients. There were 191 patients with negative cervical lymph node involvement. According to the seventh edition of the American Joint Committee on Cancer (AJCC) staging system, 110 patients (21.7%) were staged with N0 disease, and 81 patients (16.0%) were reclassified with N1 disease due to the presence of RLN metastasis. All patients received IMRT as the primary treatment. Results In patients with negative cervical lymph node involvement, distant metastasis-free survival (DMFS) was significantly higher in patients without retropharyngeal lymph node (RLN) metastasis than those with RLN metastasis (95.9% vs. 88.1% respectively, P = 0.04). For N0 disease, the 5-year overall survival (OS), local relapse-free survival (LRFS), nodal relapse-free survival (NRFS) and DMFS rates were 93.8%, 97.1%, 99.1% and 95.9%, respectively. For T1N0, T2N0, T3N0 and T4N0, OS was 97.8%, 100%, 93.8% and 76.9%, LRFS was 100%, 92.9%, 100% and 88.9% and DMFS was 96.6%, 90.9%, 100% and 93.3%, respectively. OS and LRFS were higher in T1-3 N0 patients than T4N0 patients (P < 0.01 and P = 0.01, respectively). Conclusions The seventh edition of the AJCC N-staging system improves prognostic accuracy by upgrading RLN metastasis to N1 disease. IMRT produces excellent survival rates in T1-3 N0 disease; however, T4N0 disease remains a challenge and additional improvements are required to achieve a favorable prognosis for these NPC patients.

Background To evaluate the prognostic significance of paranasal sinus invasion for patients with NPC and to provide empirical proofs for the T-staging category of paranasal sinus invasion according to the AJCC staging system for nasopharyngeal carcinoma. Methods The clinical records and imaging studies of 770 consecutive patients with newly diagnosed, untreated, and nondisseminated NPC were reviewed retrospectively. The overall survival, distant metastasis-free survival, and local relapse-free survival of these patients were analyzed using the Kaplan-Meier method, and the differences were compared using the log-rank test. Results The incidence of paranasal sinus invasion was 23.6%, with the rate of incidence of sphenoid sinus invasion being the highest. By multivariate analysis, paranasal sinus invasion was shown to be an independent prognostic factor for overall survival, distant metastasis-free survival, and local relapse-free survival (p

Background Hemostatic alterations occur during the development of cancer. Plasma D-dimer is a hypercoagulability and fibrinolytic system marker that is increased in patients with various solid tumours. The aim of this study was to evaluate the hemostatic status of nasopharyngeal carcinoma (NPC) patients by assessing plasma D-dimer levels to investigate its value as a prognostic marker. Methods We retrospectively analysed 717 patients with nasopharyngeal carcinoma, and we applied Cox regression and log-rank tests to assess the association of D-dimer levels with disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS). D-dimer levels were measured using a quantitative D-dimer latex agglutination assay. Results Using the 3rd quartile values (0.8 μg/L) as the optimal cut-offs, we found that patients with high D-dimer levels have a shorter 3-year DFS, (79%, 95%CI (73.1–84.9)) vs. (69%, 95%CI (59.2–78.8)), DMFS (87%, 95%CI (83.1–90.9)) vs. (77%, 95%CI (69.2–84.8)), and overall survival (82%, 95%CI (76.1–87.9)) vs. (76%, 95%CI (66.2–85.8)). Multivariate analysis revealed that pre-treatment D-dimer levels and EBV DNA were significant independent factors for DFS, DMFS, and OS in NPC patients. Subgroup analyses indicated that the plasma D-dimer levels could effectively stratify patient prognosis for early cancer, advanced stage cancer, and patients with EBV DNA ≥4000 copies/ml. Conclusions High D-dimer levels were associated with poor disease-free survival, distant metastasis-free survival, overall survival, and increased risk of mortality in NPC patients. Prospective trials are required to assess the prognostic value of D-dimer levels. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-583) contains supplementary material, which is available to authorized users.

Background Nasopharyngeal carcinoma (NPC) shows a high proportion of lymph node metastasis, and treatment guidelines have been developed for positive nodes. However, no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes (ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes. This study aimed to determine the prognostic value and radiation dose for ENLNs in N0-category NPC patients treated with intensity-modulated radiotherapy (IMRT). Methods We reviewed the medical data of 251 patients with non-metastatic, N0-category NPC treated with IMRT. Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure. The biological equivalent dose (BED) for ENLNs was calculated. Patient survival was compared between the small and large ENLN groups. Independent prognostic factors were identified using the Cox proportional hazards model. Results The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs 0.05 for all survival rates). In the subgroup analysis, patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED

Background To identify the radiation volume effect and significant dosimetric parameters for temporal lobe injury (TLI) and determine the radiation dose tolerance of the temporal lobe (TL) in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT). Methods Twenty NPC patients with magnetic resonance imaging (MRI)-diagnosed unilateral TLI were reviewed. Dose-volume data was retrospectively analyzed. Results Paired samples t-tests showed all dosimetric parameters significantly correlated with TLI, except the TL volume (TLV) and V75 (the TLV that received ≥75 Gy, P = 0.73 and 0.22, respectively). Receiver operating characteristic (ROC) curves showed V10 and V20 (P = 0.552 and 0.11, respectively) were the only non-significant predictors from V10 to V70 for TLI. D0.5cc (dose to 0.5 ml of the TLV) was an independent predictor for TLI (P 0.5cc was 0.843 (P Conclusions A D0.5cc of 69 Gy may be the dose tolerance of the TL. The risk of TLI was highly dependent on high dose ‘hot spots’ in the TL; physicians should be cautious of such ‘hot spots’ in the TL during IMRT treatment plan optimization, review and approval.