title: Parapharyngeal extension of nasopharyngeal carcinoma: still a significant factor in era of modern radiotherapy?
abstract: OBJECTIVE
  To retrospectively analyze the prognostic value of parapharyngeal space (PPS) extension after conformal radiotherapy for nasopharyngeal carcinoma.
  
  
  METHODS
  Between 1998 and 2005, 700 patients were treated with conformal radiotherapy at 2 Gy/fraction daily to a total of 70 Gy. All patients underwent staging with magnetic resonance imaging. The incidence of PPS was determined, and the extent of involvement was further subclassified regarding the presence or absence of carotid space (CS) involvement. The prognostic parameters, including age, gender, stage, chemotherapy, additional boosting, and extent of PPS involvement, were analyzed by univariate and multivariate analyses.
  
  
  RESULTS
  The median duration of follow-up was 51 months, and the 5-year overall survival rate for the whole group was 73%. The overall incidence of PPS extension was high (74%), and 29% had additional extension to the CS. Multivariate analysis showed age, gender, chemotherapy, T stage, and N stage to be significant prognostic factors, but not PPS involvement with or without CS extension. In the subgroup of patients with Stage T2 disease (n = 242), the presence of PPS involvement alone or PPS plus CS extension had no statistically significant effect in terms of local control (p = 0.68), distant metastases (p = 0.34), or overall survival (p = 0.24) compared with those without PPS involvement (Stage T2a).
  
  
  CONCLUSIONS
  With better tumor delineation by magnetic resonance imaging and improved coverage using modern radiotherapy techniques, PPS extension per se no longer predicts for disease outcome. Hence, subcategorizing Stage T2 disease is no longer important in future International Union Against Cancer/American Joint Committee on Cancer classifications.
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, People's Republic of China. ngwt1@ha.org.hk
authors.forename: Wai T
authors.initials: WT
authors.lastname: Ng
authors.forename: Siu H
authors.initials: SH
authors.lastname: Chan
authors.forename: Anne W M
authors.initials: AW
authors.lastname: Lee
authors.forename: Kam Y
authors.initials: KY
authors.lastname: Lau
authors.forename: Tze K
authors.initials: TK
authors.lastname: Yau
authors.forename: Wai M
authors.initials: WM
authors.lastname: Hung
authors.forename: Michael C H
authors.initials: MC
authors.lastname: Lee
authors.forename: Cheuk W
authors.initials: CW
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000532:radiotherapy*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors