title: Evaluation of cervical nodal necrosis in nasopharyngeal carcinoma by computed tomography: incidence and prognostic significance.
abstract: OBJECTIVE
  The purpose was to study the prognostic value of contrast-enhanced computed tomography (CT) nodal necrosis in nasopharyngeal carcinoma.
  
  
  METHODS
  One hundred sixty-one patients with newly diagnosed nasopharyngeal carcinoma and nodal metastases were reviewed. Forty patients also received cisplatin-based neoadjuvant chemotherapy in addition to radiotherapy. Nodal necrosis was defined as presence of hypodense areas in more than 33% of the node. Nodal response rate to chemotherapy, overall nodal control rate, local control rate, distant failure rate, overall relapse-free survival rate, and overall and cause-specific survival rates were compared between patients with and without nodal necrosis. Multivariate analysis was also performed.
  
  
  RESULTS
  The incidence of nodal necrosis was 22.9%. Overall nodal response rates to chemotherapy were 88.9% (8/9) in patients with nodal necrosis and 74.2% (23/31) in those without. No significant differences in nodal control rate, local control rate, distant failure rate, and overall and cause-specific survival rates were found. Five-year overall relapse-free survival rate was lower in patients with cervical nodal necrosis (36%) as compared with those without (53%, p = .04). Multivariate analysis, however, did not confirm cervical nodal necrosis to be an independent prognostic factor.
  
  
  CONCLUSIONS
  Presence of nodal necrosis in nasopharyngeal carcinoma does not affect nodal response to chemotherapy and nodal control by radiotherapy with or without chemotherapy. Cervical nodal necrosis does not appear to be an independent factor in predicting treatment outcome. Further studies to correlate nodal density with oxygenation status as well as tumor cell kinetics are warranted.
authors.affiliation: Department of Radiotherapy and Oncology, University of Hong Kong, Hong Kong.
authors.forename: D T
authors.initials: DT
authors.lastname: Chua
authors.forename: J S
authors.initials: JS
authors.lastname: Sham
authors.forename: D L
authors.initials: DL
authors.lastname: Kwong
authors.forename: D T
authors.initials: DT
authors.lastname: Choy
authors.forename: L
authors.initials: L
authors.lastname: Leong
authors.forename: F L
authors.initials: FL
authors.lastname: Chan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D009336:Necrosis; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed