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Objective:To evaluate the survival prognosis for T 1 stage nasopharyngeal carcinoma patients complicated with different stages of cervical lymph node metastasis, aiming to provide reference for optimizing the treatment plan. Methods:Clinical data of 413 patients in non-keratinizing carcinoma and undifferentiated locally early nasopharyngeal carcinoma (T 1N 0-3M 0-1) undergoing radiotherapy alone or radiochemotherapy in Department of Radiation Oncology of our hospital from January 2014 to December 2019 were retrospectively analyzed. The survival analyses were performed with Kaplan-Meier method and statistically compared using the log-rank test. Results:Of all patients, 291 were male, and 122 were female (aged from 9 to 78 years old) with a median age of 51 years old. All patients were diagnosed with T 1N 0-3M 0-1 nasopharyngeal carcinoma. In the TNM stage grouping system, 48(11.6%) patients were classified as stage Ⅰ (T 1N 0M 0), 158(38.2%) cases of stage Ⅱ(T 1N 1M 0), 162(39.2%) cases of stage Ⅲ(T 1N 2M 0), and 45(10.9%) cases of stage Ⅳ A to Ⅳ B(T 1N 3M 0/T 1N xM 1). Eight patients (1.9%) with stage Ⅳ B had metastasis at presentation. The lymph node positivity rate of all patients reached up to 88.1%. Seven patients received three-dimensional conformal radiotherapy, 371 cases of intensity-modulated radiotherapy and 35 cases of volumetric-modulated arc therapy. The 5-year overall survival rate was (95.9±1.2)% and with 100% for T 1N 0M 0 patients, (99.2±0.8)% for T 1N 1M 0 patients, (95.1±2.2)% for T 1N 2M 0 patients and (87.9±6.6)% for T 1N 3M 0 patients, respectively. Primary distant metastasis and N 3 stage were significantly correlated with poor prognosis (both P<0.05). The most common long-term side effect of radiotherapy was xerostomia with an incidence rate of 18.6%(17.9% for grade 1 toxicity), followed by hearing damage and tooth discomfort. Only 2 patients developed Grade Ⅲ toxic reactions, manifested as complete hearing loss. Conclusions:Although T 1 nasopharyngeal carcinoma patients have a high propensity of cervical node metastasis, favorable clinical prognosis can be obtained after radiotherapy alone. Moreover, the long-term side effects under precision radiation exert no severe effect upon the quality of life of patients.
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Objective To investigate the relationship between the timing and the curative effect of radiotherapy in the treatment of refractory choroidal hemangioma.Methods Clinical data of 23 patients (23 eyes) who were diagnosed with refractory choroidal hemangioma from August 2005 to August 2016 and treated in our hospital were retrospectively analyzed.Routine fractional radiotherapy was performed.The total dose of routine radiotherapy was 24 Gy (3 Gy/8F) for 14 eyes,34 Gy (2 Gy/17F) for five eyes and 46 Gy (2 Gy/23F) for four eyes,respectively.Patients were divided into the low-and high-dose groups,early-and late-radiotherapy groups,and active-and expectant-treatment groups according to the total dose of radiotherapy,whether they received active-or expectant-treatment before radiotherapy,and whether the time interval between the incidence of initial symptoms and the time of receiving radiotherapy exceeded one year.The curative effect between two groups was statistically compared by Fisher's exact test.Results A total of 70％(16/23) of the affected eyes were cured at 6 months after radiotherapy.The effective rate in the diseased eyes receiving radiotherapy within 1 year after the onset of initial symptoms was significantly higher than that in those receiving radiotherapy over 1 year (P＜0.05),whereas no statistical significance was observed in the effective rate between the low-and high-dose groups,and between the active-and expectant-treatment groups (both P＞0.05).Conclusions Radiatherapy is a safe and effective treatment of refratory choroidal hemangioma.Early radiotherapy contributes to the recovery of visual acuity of the affected eyes.
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Background and purpose:Adenoid cystic carcinoma is a rare tumor from salivary gland tissues; the incidence is about 1% to 2% of all head and neck malignant tumors. The incidence of adenoid cystic carcinoma of nasal sinuses is lower. Its characteristics include slow growth, less lymph node metastasis, easy to tissue invasion and growing along the nerves. It has high rate of recurrence and distant metastasis. Patients with the disease always have poor prognosis. This study aimed to investigate the prognosis and its impacting factors in Chinese patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses.Methods:This was a single center, prospective, observational study in Chinese patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses. Total 104 patients who received radiotherapy during the period between Sep. 2000 and Nov. 2012 were included and followed up for median 5.1 years. Kaplan-Meier, log-rank test, and COX proportional hazards model were used for survival-related analysis. Results:Mean age of patients was (54.5±11.5) years with equal numbers of males and females. The most common primary site was nasal cavity (63.5%) followed by maxillary sinus (29.8%). 76.0% of patients were at clinical stagesⅢ-Ⅳ, 56.7% of patients with positive surgical margin and 34.6% of patients with positive nerve invasion. In terms of treatment regimens, 67.3% of patients received postoperative radiotherapy, 27.9% received preoperative radiotherapy, only 4.8% received pure radiotherapy, and 29.8% received chemotherapy combined with surgery and radiotherapy.Conformal radiation therapy (CRT) was the most common radiotherapy which was used in 81.7% of patients, followed by intensity-modulated radiation therapy (IMRT) which was used in 18.3% of patients. Finally, 18 patients had recur-rence and 28 patients had distant metastasis. The most common metastatic site was lung, and nerve invasion was the independent risk factor for recurrence or metastasis (P=0.000 2). The overall survival rates of 5 and 10 years were 77% (95%CI: 68.7%-85.3%) and 67.8% (95%CI: 57.8%-77.9%), respectively. The disease-free survival rates of 5 years and 10 years were 57.8% (95%CI: 48.0%-67.7%) and 56.4% (95%CI: 46.3%-66.4%), respectively. Recurrence or distant metastasis was critical risk factor for overall survival (HR=60.1, 95%CI: 8.15-443.1,P<0.0001). Positive nerve invasion was a signiifcant factor for disease-free survival (HR=2.99, 95%CI: 1.642-5.445,P=0.0002). The primary sites, clinical stage, status of surgical margin, or radiotherapy methods had no impact on the prognosis of patients with adenoid cystic carcinoma of nasal cavity and paranasal sinuses.Conclusion:Positive nerve invasion, recurrence or distant metastasis may be important factors affecting the prognosis of Chinese patients with adenoid cystic carcinoma of nasal cavity and nasal sinuses.
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Objective To investigate the clinical features and survival status of mucosal melanoma of the nasal cavity and paranasal sinuses and to analyze the prognostic factors.Methods A retrospective analysis was performed on the clinical data of 94 patients with mucosal melanoma of the nasal cavity and paranasal sinuses treated from January 2000 to December 2012.Of the 94 patients,50 were male,and 44 were female.The median age of onset was 60 years (range,26-85 years).The primary sites were nasal cavity (86 patients),maxillary sinus (7 patients),and nasopharynx (1 patient).Cervical lymph node metastasis was observed in 10 patients (7 patients before treatment,2 patients during treatment,and 1 patient after treatment).No patient had distant metastasis.Patients were treated with surgery ± radiotherapy.The Kaplan-Meier method was used to calculate survival rates,and the logrank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 80,54,and 50,respectively.The 1-,3-,and 5-year disease-related survival rates were 71％,33％,and 22％,respectively.Univariate analysis showed that the prognostic factors were age over 55 years (P =0.034),involvement of the posterior naris (P =0.011),involvement of the maxillary sinus (P =0.009),involvement of the hard palate (P =0.003),cervical lymph node metastasis (P =0.001),and therapeutic method (P =0.038).Multivariate analysis showed that the prognostic factors were involvement of the posterior naris (P =0.027),involvement of the orbit (P =0.005),and involvement of the hard palate (P =0.003).Conclusions The distant metastasis and local recurrence rates are high among patients with mucosal melanoma of the nasal cavity and paranasal sinuses,so combination therapy is imperative.Cervical lymph node metastasis rate is low.Rational clinical staging needs to be further explored.
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Objective To investigate the protective effects of reducing average radiation dose and increasing protective weight on the auditory system (tympanic cavity,the bony portion of eustachian tube,vestibule,and cochlea) during intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods The planning system (ADAC Pinnacle3 8.0m) with direct machine parameter optimization was used to optimize the IMRT planning for 40 patients with NPC (stage Ⅰ + Ⅱ:20 patients ;stage Ⅲ + Ⅳ:20 patients).Without reducing the radiation dose for target volume,the IMRT planning was optimized by limiting the average dose administered to the auditory system or increasing the protective weight for the protected organs in auditory system.The protective effects were assessed by analyzing the average dose received by the auditory system.Results After limiting the average dose administered to the auditory system without reducing the radiation dose for target volume,the average dose received by the auditory system was significantly reduced (3855.5-5391.3 Gy vs 2960.3-4559.6 Gy,P =0.000 for all) ; when the protective weight for the auditory system was increased,the average dose received by the auditory system was even more reduced (3855.5-5391.3 Gy vs 2725.4-4271.4 Gy,P =0.000 for all).For all three regimens,the average dose was significantly higher in stage Ⅲ + Ⅳ patients than in stage Ⅰ + Ⅱ patients (P =0.000 for all).Conclusions For the IMRT planning for NPC,limiting the average dose administered to the auditory system can greatly reduce the average dose received by the auditory system,and increasing the protective weight for the auditory system can further reduce the average dose received by the auditory system.However,the protective effect on the auditory system may be reduced as the stage of NPC increases.
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OBJECTIVE@#To evaluate the therapeutic effect of malignant tumor of nasal cavity and sinus that based on modern radiotherapy.@*METHOD@#Two hundred cases of malignant tumor of nasal cavity and sinus were retrospectively analyzed from 2004 to 2007. All the cases were location by CT simulator system and were treated with three dimensional conformal radiotherapy.@*RESULT@#Among malignant tumor of nasal cavity and sinus, the incidence for locations was nasal cavity > maxillary sinus > ethmoid sinus > sphenoid sinus; the incidence for the type of pathology was squamous cell carcinoma > adenocarcinoma > olfactory neuroblastoma and olfactory esthesioneuroepithelioma > malignant melanoma > rhabdomyosarcoma; the incidence for general metastasis was rhabdomyosarcoma > malignant melanoma > adenocarcinoma, inverted papilloma and malignant changes > squamous cell carcinoma, olfactory neuroblastoma and olfactory esthesioneuroepithelioma. No severe radiation-related complication were found.@*CONCLUSION@#Clinical stage, pathological type were the important factors effecting the prognosis of patients with malignant tumor of nasal cavity and sinus. Three dimensional conformal radiotherapy based on CT simulator system could improve therapeutic effect and protect the normal tissue very well.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Adenocarcinoma , Pathology , Radiotherapy , Carcinoma, Squamous Cell , Pathology , Radiotherapy , Esthesioneuroblastoma, Olfactory , Pathology , Radiotherapy , Nasal Cavity , Nose Neoplasms , Pathology , Radiotherapy , Paranasal Sinus Neoplasms , Pathology , Radiotherapy , Prognosis , Radiotherapy, Conformal , Methods , Retrospective Studies , Survival RateABSTRACT
OBJECTIVE@#To investigate the distribution patterns of microvascular density(MVD) and lymph vessel density (LVD) in nasopharyngeal carcinoma, and to discuss their relationships with tumor recurrence-metastasis and prognosis.@*METHOD@#One hundred and six patients with pathologically proved nasopharyngeal carcinoma were included in this study. Immunostainings for the vascular endothelial marker CD34 and the lymph vessel marker D2-40 were performed. The microvascular and lymph vessels within the tumor and the peritumoral area were respectively quantified with computer assisted morphometric analysis.@*RESULT@#Both microvascular and lymph vessels were positive in the specimen of 106 nasopharyngeal carcinoma patients, with MVD and LVD higher in the peritumoral area than in the tumor. Univariate analysis showed that intra-tumor MVD,intra-tumor and peritumor LVD were correlated with nasopharyngeal carcinoma recurrence-metastasis (P 0.05). Multivariate analysis demonstrated that intra-tumor MVD and peri-tumor LVD were two independent risk factors of nasopharyngeal carcinoma recurrence-metastasis. Higher intra-tumor MVD was associated with adverse prognosis of nasopharyngeal carcinoma (P < 0.05).@*CONCLUSION@#High MVD and LVD may be of significance in predicting poor prognosis in patients with nasopharyngeal carcinoma. Intra-tumor and peri-tumor microvessels may play different roles in the tumor recurrence and metastasis. Intra-tumor MVD and peri-tumor LVD should be the therapeutic targets in the nasopharyngeal carcinoma.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Squamous Cell , Pathology , Lymphangiogenesis , Lymphatic Metastasis , Lymphatic Vessels , Pathology , Microvessels , Pathology , Nasopharyngeal Neoplasms , Pathology , Neoplasm Staging , Neovascularization, Pathologic , PrognosisABSTRACT
Background and purpose: Langerhans cell histiocytosis (LCH) is a rare complex reticulocndotheliai disease that often invades the head and neck. There in no consensus of treatment. Radiation is one of the treatment options for the localized lesions. Our aim in the study was to analyze the radiotherapeutic efficacy for LCH in the head and neck region. Methods: 8 patients with eosinophilic granuloma (EG) and 1 case with Hand-Schuller-Christian disease (HSC) were treated with radiotherapy in our hospital from July 2000 to May 2007. Their clinical data were retrospectively analyzed. Results: 5 cases of EG were treated with tumor partial excision and radiation, while the other 3 cases of EG were given radiation alone after biopsy. The HSC was administered with radiation and endocrine therapy. All the patients were followed up for 1.5-8 years. The response rate was 89%. Conclusion: Radiotherapy of LCH is an effective modality, but the optimal dose needs to be further studied.
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The incidence of middle ear effusion due to radiotherapy of head and neck carcinoma is as high as 16—26 percent.Irradiation causes tissue reactions such as congestion,edema, mucositis and fibrosis, which is responsible for the postirradiation tubal dysfunction. The tubal function is worst 6 months after radiotherapy . The cancer disappears after radiotherapy, but the tubal dysfunction still would happen if inflammation and local radiotherapy-induced oedema exist. The tubal function improved at 5 years after radiotherapy if the irradiation dosage is below 70 Gy in patients with nasopharyngeal carcinoma. The mean radiation dosage in the ears with patulous tubes compared for tubals with normal opening has no significant difference. The incidence of otorrhea is very high 2 years after radiotherapy in patients treated by myringotomy and ventilation tube insertion. The tubal function may become normal without treatment and patulous tubes may develope 5 to 10 years after radiotherapy.
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Objective To evaluate treatment effects and to determine the prognostic factors of primary orbital lymphoma. Methods From March 1984 to October 2000, 44 primary orbital lymphoma patients were admitted into our hospital, with 27 males and 17 females. Twenty-seven patients had eyelid or conjunctiva primary, and 17 patients orbit primary. Patient's age ranged from 14 to 86 years (median, 50.5years). According to the Ann Arbor Staging System, there were 40 ⅠEA, 4 ⅡEA lesions. Cobolt-60 ?ray was given first to the whole orbit to 30-35?Gy followed by 180 kv X-rays or 9 Mev ?-beam to the focus to a total dose of 41.0-51.5?Gy (median, 46.5?Gy). Kaplan-Meier method was used to analyze the survival. Log-rank test was used to detect the difference between groups.Results Only 1 patient failed from primary site and 5 patients from distant metastasis after radiotherapy. The 5-year and 10-year cause-specific survival rate were 90.9% and 84.5%, respectively. On univariate and multivariate analyses, eyelid or conjunctiva localization and Ann Arbor stage ⅠEA were independent favorable prognostic factors for survival. The 5-year survival was much higher in eyelid or conjunctiva patients than in orbital ones (96.3% vs 70.6%, P=0.013). The survival time was longer in stage Ⅰ than in stage Ⅱ (P=0.000). Neither the RT dose nor the age or sex influenced the outcome.Conclusions Localized orbital lymphoma can be well controlled with low-dose RT alone. Patients with eyelid or conjunctival localization and stage Ⅰ have better cause-specific survival.