ABSTRACT
Objectives@#. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). @*Methods@#. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. @*Results@#. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/ PP– status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population, while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP+ patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP– counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P<0.001). @*Conclusion@#. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.
ABSTRACT
@#BACKGROUND:Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, findings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8％) males and 168 (41.2％) females with a median age of 57.9 years (range 19–87). Regarding cancer staging, 266 patients (65.3％) had metastatic disease and 142 (34.7％) had local and loco-regional disease. The hospitalization rate was 59.6％. The most common symptoms were shortness of breath (23.2％), pain (17.8％), fever (14.2％), and nausea/vomiting (14.4％). The most common cancer sites were the lung (32.5％), gastrointestinal system (25.4％), and breast (9.3％). The initial evaluation determined progressive disease (42.4％), chemotherapy effects (20.7％), infections (17.2％), radiotherapy effects (4.7％), extravasation (1.8％), anemia (1.4％), and unknown (11.3％). During follow up, 191 (46.8％) patients died after admission to the ED. The 1-year overallsurvival of allpatients was 7.3 months. CONCLUSIONS:Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.