Li et al reported a model for predicting nasopharyngeal necrosis (NPN) following radiation therapy of a nasopharyngeal carcinoma. This can help to identify a patient who may require more aggressive management. The authors are from State Key Laboratory of Oncology in South China and Sun-Yat-sen University Cancer Center in Guangzhou.
Patient selection: nasopharyngeal carcinoma treated with radiation
Clinical features of post-radiation necrosis: foul nasal smell, refractory headache, necrotic secretions
Parameters:
(1) age in years
(2) pathological type (WHO) - type I (keratinizing), type II (non-keratinizing), type III (undifferentiated)
(3) diabetes
(4) T stage
(5) RT technique (2-dimensional radiotherapy vs intensity-modulated radiotherapy)
(6) re-radiotherapy
(7) CRP in mg/L
(8) hemoglobin in g/L
(9) serum albumin in g/L
NOTE: The nomogram lacked clear designations. The following is based on best guess.
Parameter
Finding
Points
age in years
<= 46 years
0
> 46 years
8.5
pathological type
WHO I or II
27.5
WHO III
0
diabetes
no
0
yes
27.1
T stage
1 or 2
0
3 or 4
18.6
RT technique
2DRT
0
IMRT
27.5
re-radiotherapy
no
0
yes
100
CRP
< 1 mg/L
0
1 to 3 mg/L
22.5
>= 3 mg/L
28
hemoglobin
< 110
76.7
110 to 150
29.1
> 150
0
serum albumin
>= 35 g/L
0
< 35 g/L
58.1
total score =
= SUM(point for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 372
• The higher the score the greater the risk for necrosis.
