Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-13T02:49:47.214Z Has data issue: false hasContentIssue false
  • English
  • Français

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

Published online by Cambridge University Press:  27 March 2008

S M Ragab ,
F A Erfan ,
M A Khalifa ,
E M Korayem  and
H A Tawfik
S M Ragab*
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
F A Erfan
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
M A Khalifa
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
E M Korayem
Affiliation:
Department of Radiodiagnosis, Menoufya Liver Institute, Menoufya, Egypt
H A Tawfik
Affiliation:
Department of Radiotheraphy, Tanta University Hospitals, Tanta, Egypt
*
Address for correspondence: Mr Sameh M Ragab, PO Box 66482, Bayan 43755, Kuwait. Fax: 009655513945 E-mail: sragab@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.

Methods:

Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.

Results:

Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).

Conclusions:

Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

Keywords

Nasopharyngeal NeoplasmsCarcinomaRadiotherapyBiopsy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 11 , November 2008 , pp. 1230 - 1234
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Chew, CT. Nasopharynx (the postnasal space). In: Kerr, AG, Hibbert, J, eds. Scott-Brown's Otolaryngology. Oxford: Butterworth-Heinemann, 1997;1–30Google Scholar
2 Sham, JS, Wei, WI, Choy, D, Ho, CM, Tai, PT, Choi, PH. Treatment of persistent and recurrent nasopharyngeal carcinoma by brachytherapy. Br J Radiol 1989;62:355–61CrossRefGoogle ScholarPubMed
3 Teo, P, Leung, SF, Choi, P, Lee, WY, Johnson, PJ. Afterloading radiotherapy for local persistence of nasopharyngeal carcinoma. Br J Radiol 1994;67:181–5CrossRefGoogle ScholarPubMed
4 Wei, WI, Ho, CM, Yuen, PW, Fung, CF, Sham, JS, Lam, KH. Maxillary swing approach for resection of tumors in and around the nasopharynx. Arch Otolaryngol Head Neck Surg 1995;121:638–42CrossRefGoogle ScholarPubMed
5 Lee, AW, Law, SC, Foo, W, Poon, YF, Chan, DK, O, SK et al. Nasopharyngeal carcinoma: local control by megavoltage irradiation. Br J Radiol 1993;66:528–36CrossRefGoogle ScholarPubMed
6 Teo, P, Yu, P, Lee, WY, Leung, SF, Kwan, WH, Yu, KH et al. Significant prognosticators after primary radiotherapy in 903 nondisseminated nasopharyngeal carcinoma evaluated by computer tomography. Int J Radiat Oncol Biol Phys 1996;36:291–304CrossRefGoogle ScholarPubMed
7 Gong, QY, Zheng, GL, Zhu, HY. MRI differentiation of recurrent nasopharyngeal carcinoma from postradiation fibrosis. Comput Med Imaging Graph 1991;15:423–9CrossRefGoogle ScholarPubMed
8 Olmi, P, Fallai, C, Colagrande, S, Giannardi, G. Staging and follow-up of nasopharyngeal carcinoma: magnetic resonance imaging versus computerized tomography. Int J Radiat Oncol Biol Phys 1995;32:795–800CrossRefGoogle ScholarPubMed
9 Kao, CH, ChangLai, SP, Chieng, PU, Yen, RF, Yen, TC. Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography. J Clin Oncol 1998;16:3550–5CrossRefGoogle ScholarPubMed
10 Peng, N, Yen, S, Liu, W, Tsay, D, Liu, R. Evaluation of the effect of radiation therapy to nasopharyngeal carcinoma by positron emission tomography with 2-[F18] fluro-2deoxy-D-glucose (PET-FDG). Clin Positron Imaging 2000;3:51–6CrossRefGoogle Scholar
11 Tai, CJ, Shiau, YC, Wang, JJ, Ho, YJ, Ho, ST, Kao, CH. Detection of recurrent or residual nasopharyngeal carcinomas after radiotherapy with technetium-99m tetrofosmin single photon emission computed tomography and comparison with computed tomography – a preliminary study. Cancer Invest 2003;21:536–41CrossRefGoogle ScholarPubMed
12 Pharynx (including base of tongue, soft palate and uvula). In: Fleming, ID, Cooper, JS, Henson, DE, Hutter, RVP, eds. AJCC Cancer Staging Manual. Philadelphia: Lippincott, 1997;31–9Google Scholar
13 Chua, DT, Sham, JS, Kwong, DL, Wei, WI, Au, GK, Choy, D. Locally recurrent nasopharyngeal carcinoma: treatment results for patients with computed tomography assessment. Int J Radiat Oncol Biol Phys 1998;41:379–86CrossRefGoogle ScholarPubMed
14 Hwang, JM, Fu, KK, Phillips, TL. Results and prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1998;41:1099–111CrossRefGoogle ScholarPubMed
15 Kwong, DL, Wei, WI, Cheng, AC, Choy, DT, Lo, AT, Wu, PM et al. Long term results of radioactive gold grain implantation for the treatment of persistent and recurrent nasopharyngeal carcinoma. Cancer 2001;91:1105–133.0.CO;2-Z>CrossRefGoogle ScholarPubMed
16 Leung, TW, Tung, SY, Sze, WK, Sze, WM, Wong, VY, Wong, CS et al. Salvage radiation therapy for locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000;48:1331–8CrossRefGoogle ScholarPubMed
17 Leung, TW, Tung, SY, Sze, WK, Sze, WM, Wong, VY, O, SK. Salvage brachytherapy for patients with locally persistent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000;47:405–12CrossRefGoogle ScholarPubMed
18 Choy, D, Sham, JS, Wei, WI, Ho, CM, Wu, PM. Transpalatal insertion of radioactive gold grain for the treatment of persistent and recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1993;25:505–12CrossRefGoogle ScholarPubMed
19 Chua, DT, Wei, WI, Sham, JS, Cheng, AC, Au, G. Treatment outcome for synchronous locoregional failures of nasopharyngeal carcinoma. Head Neck 2003;25:585–94CrossRefGoogle ScholarPubMed
20 Fee, WE Jr, Moir, MS, Choi, EC, Goffinet, D. Nasopharyngectomy for recurrent nasopharyngeal cancer: a 2- to 17-year follow-up. Arch Otolaryngol Head Neck Surg 2002;128:280–4Google ScholarPubMed
21 King, WW, Ku, PK, Mok, CO, Teo, PM. Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma: a twelve-year experience. Head Neck 2000;22:215–223.0.CO;2-B>CrossRefGoogle ScholarPubMed
22 Morton, RP, Liavaag, PG, McLean, M, Freeman, JL. Transcervico-mandibulo-palatal approach for surgical salvage of recurrent nasopharyngeal cancer. Head Neck 1996;18:352–83.0.CO;2-X>CrossRefGoogle ScholarPubMed
23 Wei, WI. Salvage surgery for recurrent primary nasopharyngeal carcinoma. Crit Rev Oncol Hematol 2000;33:91–8CrossRefGoogle ScholarPubMed
24 Kwong, DL, Nicholls, J, Wei, WI, Chua, DT, Sham, JS, Yuen, PW et al. Correlation of endoscopic and histologic findings before and after treatment for nasopharyngeal carcinoma. Head Neck 2001;23:34–413.0.CO;2-#>CrossRefGoogle ScholarPubMed
25 Ahmad, A, Stefani, S. Distant metastases of nasopharyngeal carcinoma: a study of 256 male patients. J Surg Oncol 1986;33:194–7CrossRefGoogle ScholarPubMed
26 Khor, TH, Tan, BC, Chua, EJ, Chia, KB. Distant metastases in nasopharyngeal carcinoma. Clin Radiol 1978;29:27–30CrossRefGoogle ScholarPubMed
27 Miura, T, Hirabuki, N, Nishiyama, K, Hashimoto, T, Kawai, R, Yoshida, J et al. Computed tomographic findings of nasopharyngeal carcinoma with skull base and intracranial involvement. Cancer 1990;65:29–373.0.CO;2-2>CrossRefGoogle ScholarPubMed
28 Sham, JS, Cheung, YK, Choy, D, Chan, FL, Leong, L. Nasopharyngeal carcinoma: CT evaluation of patterns of tumor spread. AJNR Am J Neuroradiol 1991;12:265–70Google ScholarPubMed
29 Chong, VF, Fan, YF. Detection of recurrent nasopharyngeal carcinoma: MR imaging versus CT. Radiology 1997;202:463–70CrossRefGoogle ScholarPubMed