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Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>We sought to define the locoregional extension patterns of nasopharyngeal carcinomas (NPCs) by positron emission tomography (PET)\/magnetic resonance imaging (MRI) and to improve clinical target volume (CTV) delineation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between May 2017 and March 2021, 331 consecutive patients with nonmetastatic NPCs who underwent pretreatment, simultaneous whole-body PET\/MRI for staging were included in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The high-risk regions included the base of the sphenoid bone, the prestyloid compartment, prevertebral muscle, foramen lacerum, medial pterygoid plate, sphenoidal sinus, clivus, petrous apex, and foramen ovale. When the high-risk regions were invaded, the incidence rates of tumor invasion into the medium-risk regions increased. In contrast, when the high-risk regions were not involved, the incidence rates of tumor invasion into the medium-risk regions were mostly less than 10%, excluding the post-styloid compartment and oropharynx. According to the updated consensus guidelines of the neck node levels for head and neck tumors from 2013, level IIa (77.3%, 256\/331), level IIb (75.8%, 251\/331), and level VIIa (71.3%, 236\/331) were the most frequently involved levels, followed by levels III (42.6%), Va (13.9%), IVa (8.8%), IVb (3.6%), Ib (3.6%), Vb (2.4%), VIIb (2.4%), VIII (1.8%), Vc (0.9%), and Xa (0.3%). Skip lymph node metastasis occurred in only 1.9% of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For NPCs, primary disease and regional lymph node spread follow an orderly pattern, and a skip pattern of lymph node metastasis was unusual. Involved level radiotherapy might be feasible for cervical lymph node levels below the caudal border of cricoid cartilage and level VIIb.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2021.763114","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T04:38:27Z","timestamp":1639370307000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Locoregional Extension Patterns of Nasopharyngeal Carcinoma Detected by FDG PET\/MR"],"prefix":"10.3389","volume":"11","author":[{"given":"Caineng","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanfan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qifeng","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoying","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaozhong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0140-6736(19)30956-0","article-title":"Nasopharyngeal Carcinoma","volume":"394","author":"Chen","year":"2019","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.12.035","article-title":"Modified Reduced-Volume Intensity-Modulated Radiation Therapy in non-Metastatic Nasopharyngeal Carcinoma: A Prospective Observation Series","volume":"156","author":"Guo","year":"2021","journal-title":"Radiother Oncol"},{"key":"B3","unstructured":"NCCN Guidelines Version 12021"},{"key":"B4","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.radonc.2017.10.032","article-title":"International Guideline for the Delineation of the Clinical Target Volumes (CTV) for Nasopharyngeal Carcinoma","volume":"126","author":"Lee","year":"2018","journal-title":"Radiother Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-018-3986-3","article-title":"Clinical Utility of Simultaneous Whole-Body 18 F-FDG PET\/MRI as a Single-Step Imaging Modality in the Staging of Primary Nasopharyngeal Carcinoma","volume":"45","author":"Chan","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.04.021","article-title":"Feasibility of Multiparametric Imaging With PET\/MR in Nasopharyngeal Carcinoma: A Pilot Study","volume":"93","author":"Cao","year":"2019","journal-title":"Oral Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-06779-5","article-title":"Detection and Staging of Recurrent or Metastatic Nasopharyngeal Carcinoma in the Era of FDG PET\/Mr","author":"Piao","year":"2021","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B8","volume-title":"UICC TNM Classification of Malignant Tumours","author":"Brierley","year":"2017"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-40618-3","volume-title":"AJCC Cancer Staging Manual","author":"Amin","year":"2017"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2017.607","article-title":"Paranasal Sinus Invasion in Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy","volume":"51","author":"Cao","year":"2019","journal-title":"Cancer Res Treat"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.11.053","article-title":"Extension of Local Disease in Nasopharyngeal Carcinoma Detected by Magnetic Resonance Imaging: Improvement of Clinical Target Volume Delineation","volume":"75","author":"Liang","year":"2009","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2016.299","article-title":"Magnetic Resonance Imaging-Detected Intracranial Extension in the T4 Classification Nasopharyngeal Carcinoma With Intensity-Modulated Radiotherapy","volume":"49","author":"Cao","year":"2017","journal-title":"Cancer Res Treat"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.10.010","article-title":"Delineation of the Neck Node Levels for Head and Neck Tumors: A 2013 Update. 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