Post-Treatment MRI Results for Nasopharyngeal Cancer

Two months after treatment for nasopharyngeal carcinoma, the MRI still shows bright spots?

I am a stage II nasopharyngeal carcinoma patient with bilateral cervical lymphadenopathy.
I completed 33 sessions of radiation therapy and 6 cycles of chemotherapy at National Taiwan University Hospital on August 24, 2016.
Two months after treatment, I had an MRI on October 20 and went to see the results on October 21 (the official report was not yet available, but the radiation oncologist reviewed it for me).
The result showed that the mass in my right neck, which was originally 2x2 cm, has reduced to about 1x1 cm.

1.
Is this normal? (Could it be that the MRI was done too soon after treatment, only two months later, and the radiation effects have not fully eliminated the tumor yet?)
2.
Is it possible that the original tumor has not been completely eradicated after radiation therapy?
3.
Should I have another MRI in three months, or would a PET/CT be more appropriate?
Thank you, Dr.
Chen, for your guidance.

Mr. Li, 40~49 year old female. Ask Date: 2016/10/23

Dr. Chen Sirong reply Oncology

Mr.
Li / 41 years old / Male
Hello,
1.
Is this normal? (Is it because the MRI was done too soon after treatment (2 months), causing the radiation effects to not completely eliminate the tumor?)
A: The timing seems reasonable.
You can confirm this through one of the following two methods:
1.1 You can perform a PET scan to see if the lymph nodes still have activity.
An MRI can only tell you that there are remaining lymph nodes, but it cannot differentiate whether the lymph nodes contain dead cells that have not yet been absorbed, fibrotic remnants, or if there are still living cells present.
1.2 You can opt for direct surgery to remove the remaining lymph nodes and send them for pathological examination to check for any malignant cells.
2.
Is it possible that the original tumor was not completely eradicated after radiation therapy?
A: Yes, it is possible.
However, surgery can effectively resolve issues in the neck, whereas nasopharyngeal tumors cannot be surgically cured.
So, congratulations on the improvement in your nasopharynx.
The issue in your neck is relatively minor and can be addressed surgically.
You should:
1.
First use a PET scan to determine whether the lymph node is composed of dead cells post-treatment or if there may still be cancer cells present.
2.
Consider direct surgery.
3.
Should you have another MRI in three months, or a PET/CT scan? If you decide to undergo testing, I personally recommend a PET scan either now or in three months.
You can discuss this with your attending physician.
Conclusion: Although the lymph node is present, it may be:
A.
Dead cells that have not yet been absorbed or fibrotic remnants.
B.
Living cancer cells.
I recommend using a PET scan to differentiate.
The current options are:
A.
Immediate surgery to eliminate the issue once and for all.
B.
Monitor with follow-up examinations now or in three months.
If the MRI shows lymph nodes enlarging or if the PET scan shows strong uptake in the lymph nodes, then immediate surgery should be considered.
Thank you for your inquiry.
Taoyuan Hospital
Dr.
Chen Sih-Rong

Reply Date: 2016/10/23

More Info

Understanding the post-treatment MRI results for nasopharyngeal cancer, especially after undergoing radiation therapy and chemotherapy, is crucial for both patients and healthcare providers. Your situation, having completed treatment for stage II nasopharyngeal cancer with bilateral neck lymph node involvement, raises several important considerations regarding the interpretation of MRI results and subsequent management.

1. Is the reduction in tumor size normal?
The decrease in size of the lymph node from 2x2 cm to 1x1 cm within two months post-treatment can be considered a positive sign. It indicates a response to the radiation and chemotherapy, suggesting that the treatment may be effectively reducing the tumor burden. However, it is essential to understand that imaging results can be influenced by various factors, including the timing of the MRI. Two months post-treatment may be relatively early to see the full effects of radiation therapy, as it can take time for the body to absorb and eliminate necrotic tissue. Therefore, while the reduction in size is encouraging, it is not uncommon for residual masses to remain visible on imaging for some time after treatment.

2. Is it possible that the original tumor has not been eradicated?
Yes, there is a possibility that some cancer cells may remain viable after radiation therapy. Radiation is designed to kill cancer cells, but it does not always eliminate every cell, especially if the tumor was particularly aggressive or if the radiation dose was not sufficient to cover all tumor areas. The presence of a residual mass does not automatically indicate active disease; it could also represent necrotic tissue or fibrosis. To clarify this, further imaging studies, such as a PET scan, can be beneficial as they assess metabolic activity and can help differentiate between active cancer and non-viable tissue.

3. Should another MRI or a PET/CT be performed in three months?
Follow-up imaging is essential in monitoring for recurrence or progression of the disease. A repeat MRI in three months can provide valuable information about the status of the lymph node and any changes in size or characteristics. Additionally, a PET/CT scan may be recommended if there is concern about residual disease or if the MRI findings are ambiguous. PET scans are particularly useful in assessing metabolic activity and can help determine whether any remaining tissue is active cancer or simply post-treatment changes.

In summary, the reduction in size of the lymph node is a positive indicator, but ongoing monitoring through follow-up imaging is crucial. It is advisable to discuss with your healthcare provider the best approach for follow-up imaging, considering both MRI and PET/CT options, to ensure comprehensive assessment and management of your condition. Regular follow-ups and communication with your oncology team will help in making informed decisions regarding your health and treatment plan.

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