Unidimensional measurement may be superior to assess primary tumor response after neoadjuvant chemotherapy for nasopharyngeal carcinoma
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Chuanben Chen1,2,3, Xiurong Lin1,2,3, Yuanji Xu1,2,3, Penggang Bai1,2,3, Youping Xiao4, Yuhui Pan1,2,3, Chao Li1,2,3, Zhizhong Lin1,2,3, Mingwei Zhang5 and Yunbin Chen4
1Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
2Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
3Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
4Department of Radiology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
5Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
Chuanben Chen, email: firstname.lastname@example.org
Keywords: nasopharyngeal carcinoma, neoadjuvant chemotherapy, tumor measurement, magnetic resonance imaging
Received: November 22, 2016 Accepted: December 28, 2016 Published: February 01, 2017
Application of current response evaluation criteria in solid tumors (RECIST 1.1) for assessment of irregularly shaped nasopharyngeal carcinoma (NPC) is a gray area with much ambiguity. Our aim was to compare unidimensional measurements (UDM) and bidimensional measurements (BDM) on magnetic resonance images in alternative planes for measurement of tumor response after neoadjuvant chemotherapy (NACT) in patients with locally advanced NPC. 59 patients with untreated non-metastatic NPC were prospectively enrolled. The size or change in size of the primary tumor and retropharyngeal nodes was assessed by UDM and BDM on axial and coronal planes before and after 2 cycles of NACT. Tumor volume was considered as the reference standard. Correlation between volume and diameter was analyzed using a general linear model. The degree of agreement and discordance of response classification based on different measures were evaluated with κ statistic and McNemar's test, respectively. Both axial UDM (RECIST 1.1) and axial BDM (WHO) showed a significant association with volumetric standard. However, the agreement of axial UDM with VM was better than that of axial BDM (κ value: 0.514 to 0.372). In addition, when increasing coronal planes to evaluate tumor response with UDM and BDM, an inferior agreement between coronal BDM and VM was still observed. Notably, coronal UDM showed the best consistency with volume (κ = 0.585). Hence, axial UDM showed better correlation with volumetric measurements than axial BDM. Since coronal UDM showed high correlation to VM, we suggest further research to assess its use for response assessment of NPC after NACT.
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