ABSTRACT
<p><b>OBJECTIVE</b>To study the clinical characteristics, diagnosis, treatment and prognostic factors of patients with postradiation nasopharyngeal necrosis (PRNN) in nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Sixty patients with PRNN were studied retrospectively, 50 males and 10 females, age ranging from 30 - 70 years of (median 51.5 years). All patients were treated with endoscopic debridement and systemic or local anti-inflammatory treatment. Kruskal-Wallis H test was used to assess the interval time between irradiation completion and necrosis onset and related factors of treatment outcome. Multivariate Cox proportional hazards regression survival analysis was performed to analyze risk factors.</p><p><b>RESULTS</b>The latent period between the last irradiation and the onset of the symptom ranged from 1 to 156 months, with a median of 5 months. The median interval time was 7.0 months in 1 course group and 4.5 months in ≥2 courses group (χ2=5.527, P=0.031), and 7.5 months in T2 group and 5.0 months in ≥T3 group (χ2=4.330, P=0.037), respectively. Forty-one patients of them had nasopharyngeal infection, and the difference in curative effect between infection group and non-infection group was significantly (χ2=14.775, P<0.001). Symptoms were alleviated in all patients after endoscopic debridement and systemic or local anti-inflammatory treatment. Follow-up for all patients ranged from 2 to 46 months (median 12.5 months). Seven patients with internal carotid artery exposure died of sudden nasopharyngeal massive bleeding and fifteen patients died of tumor or systemic exhaustion; five cases were lost, and the rest were all in survival. Inter carotid artery erosion was an independent prognostic risk factor according to multivariate Cox proportional hazards regression survival analysis (P<0.05).</p><p><b>CONCLUSIONS</b>Endoscopic debridement is effective in treating irradiation-related nasopharyngeal necrosis. The occurrence of nasopharyngeal necrosis is related to infection, irradiation dose and course, and T stage. Internal carotid artery erosion is a severe situation and also an independent prognostic factor for the patients. The most common causes of death were nasopharyngeal bleeding and systemic exhaustion.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma , Debridement , Endoscopy , Nasopharyngeal Neoplasms , Pathology , Radiotherapy , Nasopharynx , Pathology , Necrosis , Prognosis , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the effect of post-mastectomy radiotherapy with different fractionated dose schemes for early breast cancer.</p><p><b>METHODS</b>From January 1987 to January 1993, 367 patients with early breast cancer were given post-mastectomy radiotherapy with three different fractionated dose schemes. 149 patients received conventional radiotherapy with 50 Gy/25 fractions/5 weeks (Group A). 177 patients received 45 Gy/15 fractions/5 weeks (Group B). Forty-one patients were treated with 23 Gy/4 fractions/17 days (Group C). 257 patients received systemic therapy (chemotherapy and/or endocrine therapy).</p><p><b>RESULTS</b>The overall 5-year survival and 5-year disease-free survival rates were 87.4% and 89.6%. The 5-year disease-free survival rate were 90.8%, 86.5% and 84.6% for A, B and C groups (P = 0.16). The corresponding loco-regional failure rates were 2.7%, 2.8% and 2.4%, respectively. There was no statistically significant difference in the local control and efficacy of the three groups.</p><p><b>CONCLUSION</b>With similar 5-year tumor-free survival rates by the conventional fractionation and hypofractionation, the scheme with 45 Gy/15 fractions/5 weeks has the advantage of giving less factions, which is suitable for a unit with limited radiation resources. The course of hypofractionation with 23 Gy/4 fractions/17 days is much shorter than conventional radiotherapy, which may benefit patients with higher risk of metastasis who need to undergo chemotherapy earlier. This study warrants further investigations.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Breast Neoplasms , Mortality , Radiotherapy , General Surgery , Combined Modality Therapy , Dose Fractionation, Radiation , Mastectomy , Neoplasm Recurrence, Local , Survival RateABSTRACT
Objective To investigate the treatment method and prognostic factors of patients with non-Hodgkin lymphoma(NHL)of palatine tonsil.Methods 70 patients with NHL of palatine tonsil were re- viewed.According to Ann Arbor staging classification,12 patients had stageⅠ,39 stageⅡ,15 stageⅢand 4 stageⅣ.Working formulation was used in pathologic classification which was low grade 8 cases,intermedi- ate grade 28 cases and high grade 34 cases.30 cases were treated by chemotherapy alone,3 cases by radio- therapy alone,37 cases by chemotherapy and radiotherapy.Results The overall survival rate was 56.3%. They were 82.5% in 1 year,67.3% in 2 years and 58.5% in 5 years,respectively.The overall survival rates in high grade cases of pathologic classification were 20.0% in chemotherapy alone,0 in radiotherapy alone, 52.6% in chemotherapy and radiotherapy(P