ABSTRACT
Objective:To explore the efficacy of elective nodal irradiation (ENI) and involved field irradiation (IFI) combined with chemotherapy in treatment of esophageal cancer.Methods:A total of 104 patients with esophageal cancer in Affiliated Hospital of Jiangnan University from May 2018 to May 2020 were selected as subjects for prospective study. All patients were randomly divided into observation group and control group by lottery method with 52 cases in each group. The target volume of observation group was delineated with IFI, and the control group was delineated with ENI. The curative effects, the levels of serum tumor markers [carbohydrate antigen 50 (CA50), squamous cell carcinoma (SCC) and carcinoembryonic antigen (CEA)] before and after treatment, the 1-year overall survival (OS) rate, the incidence of adverse reactions and the scores of various dimensions of health survey summary (SF-36) after treatment were compared between the two groups.Results:The total effective rate in the observation group was 90.38% (47/52), the total effective rate in the control group was 84.62% (44/52), and the difference was not statistically significant ( χ2 = 0.79, P =0.374). There was no statistical difference in CA50, CEA, SCC levels between the two groups before and after treatment (all P > 0.05). After treatment, the CA50, CEA and SCC levels in the two groups were lower than those before treatment, and the differences were statistically significant (all P < 0.05). The 1-year OS rate of the observation group was 94.23%, the control group was 90.38%, and the difference in OS between the two groups was not statistically significant ( χ2 = 0.54, P = 0.462). The incidence of acute radiation esophagitis in the observation group was lower than that in the control group, and the difference was statistically significant ( P < 0.001). There was no statistical difference between the two groups in SF-36 scale scores of physical functioning, role-physical, bodily pain, mental health, vitality, social functioning, role-emotional, and general health after treatment (all P > 0.05). Conclusions:Both ENI and IFI are effective treatments for patients with esophageal cancer. There is no significant difference in the quality of life of patients between the two delineation methods, but the incidence of acute radiation esophagitis is lower in patients with IFI regimen.
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Objective:To explore the value of nomogram based on arterial spin labeling (ASL) MRI perfusion parameters and clinicopathological features in predicting the response to chemoradiotherapy (CRT) in advanced nasopharyngeal carcinoma (ANPC, stage Ⅲ and Ⅳ).Methods:From June 2018 to January 2021, 70 patients with ANPC confirmed by pathology were prospectively enrolled in Affiliated Hospital of Jiangnan University. Nasopharyngeal MRI plain scan, ASL and contrast-enhanced scan were performed before CRT, and routine MRI re-examination was performed within 1 week after the end of CRT. The pre-CRT perfusion parameter tumor blood flow (TBF) from ASL and clinicopathological features were recorded, and the maximum diameter (MD) of the tumor on T 1WI images was measured. The patients were divided into CRT effective group (48 cases) and ineffective group (22 cases) according to the response evaluation criteria in solid tumors. The independent sample t test was used to compare the differences of TBF, age and MD between effective group and ineffective group. The χ 2 test was used to compare the differences of gender, clinical stage and pathological type between the 2 groups. Using binary logistic regression analysis, clinicopathological model and TBF combined clinicopathological model were constructed, and the nomogram of combined model was constructed. The diagnostic efficacy of the models was obtained by receiver operating characteristic (ROC) curve analysis, and the area under the ROC curves (AUC) of the 3 models were compared by DeLong method. The calibration curve for the nomogram was generated, and the concordance index (C index) was acquired. Results:The TBF of the effective group and the ineffective group were (113±9) and (97±14) ml·100 g -1·min -1, with a statistical difference ( t=5.17, P<0.001). The MD value of the effective group was smaller than that of the ineffective group, with a statistical difference ( t=-2.24, P=0.028). There were statistical differences in clinical stage and pathological type between the 2 groups (χ 2 values were 12.21 and 12.95, respectively, both P<0.001). Three independent predictors, including TBF (OR=7.749), clinical stage (OR=0.129) and pathological type (OR=5.228), were included in logistic regression analysis. The AUC, sensitivity and specificity of TBF model in predicting the response to CRT were 0.843, 87.5% and 72.7%, of clinicopathological model were 0.822, 80.2% and 59.1%, of the nomogram model were 0.893, 81.2% and 90.9%. There was no statistical difference of AUC between the nomogram model and TBF model ( Z=1.23, P=0.215). However, the AUC of the nomogram model was greater than that of the clinicopathological model ( Z=2.47, P=0.031). The calibration curve showed that there was a good concordance index (C index=0.892) between the predicted value of nomogram and the actual clinical observation value. Conclusion:TBF, clinical stage and pathological type are independent predictors of the response to CRT in ANPC patients, and the nomogram based on these three factors has a good ability in predicting the response to CRT.
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Objective To observe the effect of residual tumor after radiotherapy on survival rate of patients with nasopharyngeal carcinoma (NPC). Methods From Jan. 1989 to Dec. 1998, 108 of 304 NPC patients pathologically confirmed, had residual tumor after radical radiotherapy, of whom, 26, 68, 14 had residual lesion in the nasopharyngeal cavity alone, cervical lymph node alone, and nasopharyngeal cavity plus cervical lymph node. Results The overall 1 , 3 , 5 , and 10 year survival rates (OS) significantly decreased in the residual group. The highest OS was in the group with nasopharynx residual alone, and the lowest in nasopharynx plus residual lymph node group. The bigger the residual lesion, the lower the OS. Conclusions The overall survival rate decreases in patients with residual lesion after radiotherapy, especially in patients with both nasophrynx and regional lymph node residual. Tumor residual after radiotherapy can be a prognostic indicator for patients with NPC.