ABSTRACT
Objective To analyze the 10-year survival outcome and failure patterns for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT),aiming to provide reference for optimized treatment for NPC.Methods Clinical data of 866 patients with NPC receiving IMRT from January 2001 to December 2008 were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier estimator.Univariate analysis was carried out by log-rank test and multivariate analysis was performed using Cox proportional hazards model.Results The median follow-up time was 132 months.The 10-year local recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),progression-free survival (PFS) and disease specific survival (DSS) were 92.0％,83.4％,75.7％ and 78.6％,respectively.A total of 210 patients died including 124 patients (59.0％) from distant metastasis,which was the primary cause of death,and 47 (22.3％) from local regional recurrence.Independent negative factors of DSS included age＞50 years (P=0.00),LDH ≥ 245 IU/L (P=0.00),Hb＜ 120 g/L (P=0.01),T2-T4 staging (P=0.00),N1-N3 staging (P=0.00) and GTV-nx＞20 cm3(P=0.00).The 10-year LRFS,DMFS and DSS of stage Ⅱ NPC patients did not significantly differ after IMRT alone and chemoradiotherapy (P=0.83,0.22,0.23).For patients with stage Ⅲ NPC,the 10-year LRFS and DSS in the chemoradiotherapy arm were significantly higher than those in the IMRT alone (P=0.01,0.01),whereas no statistical significance was observed in the DMFS between two groups (P=0.14).The overall survival of stage Ⅳa+Ⅳb NPC patients is relatively poor.Conclusions IMRT can improve the long-term survival of NPC patients.Distant metastasis is the primary failure pattern.Patients with stage Ⅰ-Ⅱ NPC can obtain satisfactory survival outcomes after IMRT alone.The addition of chemotherapy can further enhance the LRFS and DSS of stage Ⅲ NPC patients.However,the optimal therapeutic strategy remains to be urgently investigated for stage a+ Ⅳb NPC patients.
ABSTRACT
Objective To approach the brain protective effect and mechanism of Sini decoction on rats with cardiopulmonary resuscitation (CPR) syndrome.Methods Fifty Sprague-Dawley (SD) rats were divided into sham operation group (n = 10), CPR model group (n = 20) and Sini decoction treatment group (n = 20) by random number table. The rat models were established by trachea clipping to induce cardiac arrest, and after heart beat stopped for 5 minutes, CPR was carried out. In the Sini decoction group, Sini decoction 5 g/kg was given through a stomach tube, once per 24 hours, while in the sham and CPR model groups, the same amount of normal saline was given by the same method at the same time. Venous blood was collected before CPR and 6, 12, 24, 48 and 72 hours after CPR, and the levels of serum interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent test (ELISA); after CPR for 72 hours, the rat brain tissue was obtained from all the groups, the content of caspase-3 in brain tissue was detected by immunohistochemistry method, and its protein expression caspase-3 was detected by Western Blot; the apoptosis situation of brain tissue was detected by terminal deoxynucleotidyl transferase-mediated duTP nick end labeling (TUNEL).Results With the prolongation of time, the levels of IL-6 and TNF-α in CPR model and Sini decoction groups showed a tendency firstly increased and then decreased, IL-6 reached its peak value after resuscitation for 24 hours, while TNF-α reached its peak value after resuscitation for 48 hours, and both IL-6 and TNF-α were decreased after resuscitation for 72 hours ; beginning from 6 hours after resuscitation, the levels of serum IL-6 (ng/L: 61.79±1.31, 62.49±1.42 vs. 21.48±0.79) and TNF-α (ng/L: 48.32±1.98, 25.32±1.96 vs. 18.34±2.45) in CPR model and Sini decoction treatment groups were all significantly higher than those in sham group, since 12 hours after resuscitation, the level of IL-6 was significantly lower in Sini decoction than that in CPR model group (ng/L: 70.41±2.21 vs. 88.32±1.59), and since 6 hours after resuscitation, TNF-α was obviously lower in Sini decoction group than that in CPR model group (ng/L: 25.32±1.96 vs. 48.32±1.98, allP < 0.05), both IL-6, TNF-α persisting to 72 hours after resuscitation, and their levels did not return to normal at the end of experiment in the two groups. After the end of resuscitation, the content and protein expression of caspase-3 and rate of cell apoptosis in the brain tissue in CPR model group were significantly higher than those in the sham group [caspase-3 content (A value,×103): 2.59±0.26 vs. 1.57±0.06, caspase-3 protein (gray value): 0.80±0.08 vs. 0.43±0.04, apoptosis rate: (2.01±0.08)% vs. (0.26±0.02)%, allP < 0.05], above indexes in the Sini decoction treatment group were significantly lower than those in the CPR model group [caspase-3 content (A value,×103): 1.89±0.08 vs. 2.59±0.26, caspase-3 protein (gray value): 0.57±0.02 vs. 0.80±0.08, apoptosis rate: (1.03±0.05)% vs. (2.01±0.08)%, allP < 0.05).Conclusion The Sini decoction has a protective effect on rats with post-resuscitation syndrome, and its mechanism is possibly realized by the inhibition of inflammatory factors and reduction of cell apoptosis.
ABSTRACT
Objective To evaluate the clinical value of selective arterial chemotherapy after radiotherapy for advanced nasopharyngeal carcinoma (stageⅢ,Ⅳa). Methods Sixty patients with advanced nasopharyngeal carcinoma were randomized to receive either combined elective arterial chemotherapy and radiotherapy (IACT group, 30 patients) or combined general intravenous chemotherapy and radiotherapy(IVCTgroup, 30 patients). Four weeks after radiotherapy, the effect of two methods was compared. Results The efficiency rate and the 1-year local disease control rate were 93.33 %, 92.86 % in IACT and 70.00 %, 71.43 % in IVCT, respectively. There were outstanding differences between the two groups(P
ABSTRACT
<p><b>OBJECTIVE</b>To summarize retrospectively the 5-year survival rates and long-term complication of stage Ib-IIIa cervical carcinoma treated by combination of subradical external radiation and brachytherapy plus radical operation.</p><p><b>METHODS</b>106 patients with cervical carcinoma were all treated by radical hysterectomy and pelvic lymphadenectomy, of whom 78 had had preoperative radiotherapy (external radiation and brachytherapy), 16 combination of brachytherapy and radical operation, 12 adjuvant postoperative radiotherapy (external radiation and brachytherapy). (60)Co was used for external radiation, in which the point B dose was 25 - 30 Gy in preoperative radiation and 40 - 50 Gy in postoperative radiation. (192)Ir high-dose-rate afterloading unit was used in brachytherapy, with a dose of 6 - 18 Gy at point A.</p><p><b>RESULTS</b>The follow up rate was 95.3%. The overall 5-year survival rates were 78.2% (61/78) in the preoperative radiotherapy group, 68.8% (11/16) in brachytherapy plus radical operation, 33.3% (4/12) in the postoperative radiotherapy group, showing a higher 5-year survival rate in the preoperative radiotherapy group than the postoperative radiotherapy group (P < 0.05). In stage II patients, the preoperative radiotherapy group -77.6% (45/58) also gave a higher survival than the postoperative radiotherapy group -25.0% (1/4) (P < 0.05). But all the other groups gave differences of insignificance. The chief long-term complications were radio-proctitis and cystitis, with incidences of 34.6% (27/78), 31.3% (5/16), 33.3% (4/12) in the preoperative radiotherapy group, brachytherapy plus radical operation group and the postoperative radiotherapy group (P > 0.05).</p><p><b>CONCLUSION</b>The overall 5-year survival rate of combined subradical external radiation and brachytherapy plus radical operation was obviously higher than that of postoperative radiotherapy for stage Ib-IIIa and II patients, with statistically significant differences. However, the incidence of long-term complications give no statistical significance in the preoperative radiotherapy group or brachytherapy plus the operation group as compared with the postoperative radiotherapy group.</p>