ABSTRACT
Objective:To retrospectively analyze the failure patterns and outcomes of patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) after undergoing induction chemotherapy (IC) followed by definitive radiotherapy.Methods:For patients with locally advanced HPSCC who were treated with IC and definitive radiotherapy from August 2008 to December 2019, their data were collected from the medical records system, and their clinical characteristics, failure patterns, and survival were retrospectively analyzed.Results:A total of 116 eligible patient with squamous cell carcinoma were included in this study. with a median age of 59 (39-79), and 3, 3, 60, and 50 of them had stage Ⅱ, Ⅲ, Ⅳ A, and Ⅳ B HPSCC, respectively. Among these patients, 81 received 1~2 cycles of IC, and 35 received 3-4 cycles of IC. After treatment with IC, 54, 13, and 49 patients received concurrent chemoradiotherapy, radiotherapy combined with targeted therapy, and radiotherapy alone, respectively. The median follow-up was 34.6 months (95% CI: 28.7-40.5 months). The 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS) of all the patients were 63.5%, 82.8%, 75.2%, 47.3%, and 43.1%, respectively. Median PFS and OS were 26.1 and 28.0 months, respectively. Treatment failure was reported in 59 patients, of whom 22, 5, 12, 10, 3, 6 and 1 experienced local, regional, distant only, local-regional, regional-distant, local-distant, and local-regional-distant failure, respectively. The objective response rate (CR+ PR) of patients after IC was 55.2% (64/116). The LRFS, RRFS, PFS, and OS of IC responders (CR+ PR) were better than those of IC non-responders (SD+ PD) ( χ2 = 12.52, 5.16, 13.19, 11.72, all P< 0.05). Conclusions:IC combined with radical radiotherapy has efficacy to a certain extent in the treatment of locally advanced HPSCC, and locoregional recurrence predominates the failure patterns. The prognosis of IC responders is significantly better than that of IC non-responders.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the accuracy of CT in preoperative discrimination of cT3 from cT4 in patients with Siewert II esophagogastric junction (EGJ) adenocarcinoma according to UICC/AJCC 8th edition and IGCA 4th edition.</p><p><b>METHODS</b>CT imaging data of 43 consecutive patients with Siewert II EGJ adenocarcinoma who underwent preoperative CT and were diagnosed as pT3 or pT4 by postoperative pathology were retrospectively analyzed. Inclusion criteria were as follows:(1)no previous history of gastric operation, radiochemotherapy, targeted treatment; no contraindications of CT enhanced scanning; (2) good filling of gastric cavity by CT, clear image without artifacts, all axial-coronal-sagittal 3-plane reconstruction images obtained by abdominal stage 3 enhanced scan; (3) operation within 1 week after CT examination; (4) Siewert II EGJ adenocarcinoma confirmed by operation, pT3 and pT4 by postoperative pathology. Transverse and multiplanar reconstruction images were reviewed by two radiologists in double-blind method. Distance between cancer epicenter and esophagogastric junction line, and the contour of the serosa were retrospectively measured on CT scans. The cT staging judgment was performed according to the UICC/AJCC 8th edition (Siewert II EGJ adenocarcinoma should be staged as esophageal cancer) and IGCA 4th edition (Siewert II EGJ adenocarcinoma should be staged as gastric cancer) respectively. Consistency of cT staging and pathological pT staging was compared between UICC/AJCC and IGCA.</p><p><b>RESULTS</b>Preoperative CT revealed that the mean length between tumor epicenter and esophagogastric junction line was(1.5±0.4) cm (0.7-2.5 cm), and such length was ≤2 cm in 41 cases, whose concordance with surgical judgment was 95.3%(41/43). IGCA staging: 18 cases were preoperatively assessed as cT3 and 25 cases as cT4a. UICC/AJCC staging: 41 cases with cancer epicenter locating within 2 cm below esophagogastric junction line were staged as cT3 according to esophageal cancer staging; 2 cases with cancer epicenter locating > 2 cm below esophagogastric junction line were staged according to gastric cancer staging, of whom one was staged as cT3 due to regular serosa and the other was staged as cT4a due to irregular serosa. Postoperative pathology: 33 cases were pT3 and 10 cases were pT4a. The accuracy of preoperative CT in discrimination of T3 from T4a was 74.4%(32/43) with UICC/AJCC criteria and 65.1%(28/43) with IGCA criteria, whose difference was significant(P<0.01).</p><p><b>CONCLUSIONS</b>Preoperative CT can accurately localize the 2 cm threshold line of Siewert II esophagogastric junction adenocarcinoma, which is beneficial to the discrimination of cT3 from cT4a EGJ adenocarcinoma. Application of the UICC/AJCC 8th edition criteria to above discrimination has higher accuracy as compared to IGCA 4th edition in cT-staging by CT.</p>
Subject(s)
Humans , Adenocarcinoma , Double-Blind Method , Esophageal Neoplasms , Diagnostic Imaging , Esophagogastric Junction , Neoplasm Staging , Retrospective Studies , Stomach Neoplasms , Diagnostic Imaging , Tomography, X-Ray ComputedABSTRACT
Purpose To compare the CT features of hepatic metastases of gastro-entero-pancreatic adenocarcinomas with and without neuroendocrine differentiation [NED(+) and NED(-)] and to explore the value of CT features in differentiation of the two groups.Material and Methods From January 2009 to December 2015,abdominal CT scans of 17 pathologically proved cases of NED(+) gastro-entero-pancreatic adenocarcinomas with hepatic metastases and 34 pathologically proved cases of NED(-) hepatic metastases with sex,age and primary site matched were retrospectively reviewed.CT features including hepatic metastases number,size,distribution,shape and enhancement were assessed,as well as presence of lymphadenopathy or ascites.Differences of CT features between the two groups were analyzed.Results Compared with NED(-) group,hepatic metastases of NED(+) group more frequently demonstrated a peripheral enhancement on artery phase (94.1％ vs.44.1％,P＜0.05),and more washout on portal venous phase (41.2％ vs.5.9％,P＜0.05),while hepatic metastases of NED(--) group showed more plateau type (91.2％ vs.58.8％).There was no significant difference of other findings between the two groups (P＞0.05).Logistic regression revealed that enhancement area in hepatic artery phase and enhancement changes in portal venous phase were independent factors for differential diagnosis (P＜0.05).The area under the ROC curve of combining the two features was 0.811 (P＜0.05).Conclusion There are some different CT enhancement features between NED(+) and NED(-) hepatic metastases of gastro-entero-pancreatic adenocarcinomas,which are helpful in differential diagnosis.
ABSTRACT
Objective To explore the risk factors for early interhepatic recurrence and metastasis of hepatocellular carcinoma (HCC)on CT imaging before treatment.Methods 1 1 5 patients suffered from HCC from July 2003 to January 2009 were retrospec-tively enrolled for reviewing their clinical characteristics and CT signs.The status of metastasis and/or recurrence was followed reg-ularly.Signs on pre-treatment enhanced CT images were measured and analyzed.Analysis of variance and independent sampler t test were applied for Univariate survival analysis.Then multivariate analysis was carried out by the Logistic regression,Lon rank meth-od,and p-value < 0.05 was defined to be statistically significant.Results The early interhepatic recurrence and metastasis rate of the study group was 58.26%.With univariate analysis,tumor size,location,extent,capsule,satellite nodule,vascular invasion, AVM and necrosis were the risk factors for early recurrence and metastasis of HCC on pre-treatment enhanced CT imaging (P<0.05).Multi-variable Logistic regression analysis showed that tumor size,satellite nodule,vascular invasion capsule and were independently sig-nificant CT signs for early interhepatic recurrence and metastasis of HCC (P =0.031,0.005、0.037、0.048).Conclusion Pre-treat-ment enhanced CT imaging with HCC was closely related to early interhepatic recurrence and metastasis of the tumor.A tumor of larger size,with satellite nodules,without complete capsule and vascular invasion on CT may predict a tendency to early interhepatic recurrence and metastasis of HCC.
ABSTRACT
OBJECTIVE To analyze whether the vidian canal can be served as a landmark to endoscopic nasal skull base surgery and provide clinical reference by imaging and anatomical methods. METHODS Twenty three cadaveric heads were scanned through axial and coronal high resolution CT to observe the vidian canal and its relationship with around structures.Three cadaveric heads, in which arteries were injected with latex,were dissected by endoscopic transnasal or transmaxillary to pterygopalatine fossa and cavernous sinus approaches.RESULTS 1.The course and shape of vidian canal and its relationship with around structures can be clearly detected through high resolution CT.All the vidian canals were on the same level or below the internal carotid canal.2.Anatomic study corresponded to the results of imaging.Vidian content pointed to the anterior genu of internal carotid artery constantly.The vidian canal and foramen rotundum can serve as a surgical corridor.CONCLUSION As the landmark, vidian canal plays an important role in the endoscopic nasal skull base surgery.Being a bony canal,it can be detected through high resolution CT easily and clearly.
ABSTRACT
OBJECTIVE To analyze the incidence of the bifurcation of the facial nerve in mastoid segment and to give the anatomic information for mastoid surgery. METHODS From March 2005 to April 2006, there were 112 patients undergoing the decompress operations which the range included the mastoid segment. The bifurcation of the mastoid segment was recorded and compared with the preoperational High-resolution Computed tomography (HRCT) scans. RESULTS There were 5 cases with the nerve bifurcation. The incidence was 4.5 %. Four of those 5 cases were diagnosed preoperatively by HRCT scans (the accurate rate was 80 %). CONCLUSION Bifurcation of the mastoid segment was not rare. Otologic surgeon should pay attention to this anatomic variation to avoid injuring the branch of the facial nerve. HRCT scans were useful to find this abnormality.
ABSTRACT
Objective To evaluate the role of CT imaging in staging of hypopharyngeal and laryngeal carcinoma.Methods 85 patients with hypopharyngeal or laryngeal carcinoma proved by operation were examined contrast-enhanced CT scan.The CT images were analysed by two experienced radiologists who were unknown pathologic results,in combination with the clinical data,the TNM staging of tumors were evaluated,then the results were compared with that of pathology,and Wilcoxon rank sum test was used for statistical analysis.P value less than 0.05 was considered statistically significant.Results The accuracy of the staging of lesions was 70.1% based on clinical data alone,while the clinical informations in combination with CT,the accuracy reached 87.1%,that was of significant statistically(P=0.001).Conclusion CT imaging is useful in staging of hypopharyngeal and laryngeal carcinoma,especially when it is combined with clinical data.
ABSTRACT
Objective To investigate CT value in diagnosing hypopharyngeal and laryngeal disease.Methods The clinical data and CT images of 76 patients with hypopharyngeal and laryngeal tumors and tumor-like lesions were retrospectively reviewed.There were malignant lesions in 66 cases and benign lesions in 10 cases.CT findings in these patients were evaluated and correlated with surgical and pathologic findings.First,we used a CT features were qualitatively analysed using logistic regression model for predicting the lesion to be malignant or benign.Then,two experienced radiologists who were unknown the results of final diagnosis of these patients,retrospectively analyzed all CT images and made their diagnosis.Finally,CT images of 10 benign and 10 randomly selected malignant patients were reviewed by the other two experienced radiologists,who known the component ratio of the cases and unknown the final results.Interobserver agreement of the two reviewers was assessed by calculation of Kappa value for their diagnosis.Results The logistic regression model revealed that the location of lesion and the surrounding structure infiltrated by the tumor were the only significant factors for predicting the malignancy.Of the two factors,the surrounding structure infiltrated by the tumor had the accuracy of 55% with sensitivity 53% and specificity 80%.When most of the cases were malignant(66/76),there was a moderate interobserver agreement for the two radiologists in diagnosis of the diseases.When the malignant and benign cases were equal,there was a poor interobserver agreement(Kappa=0.20) for the two reviewers,and the diagnostic accuracy was slightly higher than the rate by random selection.Conclusion It is difficult to use the CT features in qualifying the hypopharyngeal and laryngeal diseases.
ABSTRACT
Objective To explore if only single-phase enhanced CT can be used for pre-treatment staging of hypopharyngeal and laryngeal carcinoma.Methods The double phase enhanced CT images in 47 cases with hypopharyngeal or alryngeal carcinoma were retrospectively studied.CT number of tumor,vocal cord and sternocleidomastoideus muscle was measured on plain,early-phase,and late-phase enhanced CT scan,and the definition of tumor margins, small-vessel artifacts and mucous artifacts was recorded. The effective radiation dose of patients was calculated for 16DCT and HCT according to dose-length product (DLP).Results There was no significant difference between the density of tumor and the vocal cord on plain CT scan. There were more mucous artifacts and/or small-vessel artifacts in early-phase enhanced CT images. The definition of tumor margin in late-phase enhanced CT image was better than or almost same as that in early-phase enhanced CT image. The effective radiation dose with 16DCT was 1.5 times to that with HCT at the same scanning range. Conclusion Only late-phase enhanced CT imaging is recommended to be performed for the staging of hypopharyngeal or laryngeal carcinoma, and it will reduce the effective radiation dose received by patients.