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Objective:To compare the efficacy and adverse events of induction chemotherapy combined with radiotherapy alone (IC+ RT) and induction chemotherapy combined with concurrent chemoradiotherapy (IC+ CCRT) for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy in this Meta-analysis.Methods:Retrospective or randomized controlled clinical studies published between 2010 and 2020 were searched from the Cochrane Library, PubMed, and Web of Science databases. The selected studies included nasopharyngeal carcinoma patients treated with IC+ CCRT or IC+ RT. STATA 12 software was used to combine the hazard ratio (HR), risk ratio (RR) and 95% confidence interval (CI), and random or fixed effect models were used for statistical analysis.Results:A total of 2483 patients from eight retrospective studies were included. The overall survival in the IC+ CCRT group was similar to that in the IC+ RT group ( HR=0.78, 95% CI: 0.58-1.04, P=0.091). However, the distant metastasis-free survival ( HR=0.56, 95% CI: 0.42-0.74, P<0.001) and progression-free survival ( HR=0.65, 95% CI: 0.54-0.77, P<0.001) were improved in the IC+ CCRT group compared with those in the IC+ RT group. In terms of adverse reactions, the acute adverse reactions in the IC+ CCRT group were increased significantly compared with those in the IC+ RT group. Conclusions:In the treatment of nasopharyngeal carcinoma, the overall survival of two treatment modes is similar, but the distant metastasis-free survival and progression-free survival in the IC+ CCRT group are better than those in the IC+ RT group, whereas the incidence of adverse reactions is also increased. IC+ CCRT may be a recommended treatment for nasopharyngeal carcinoma patients, but more research is needed.
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Objective:To systematically compare the efficacy and safety of chrono-chemotherapy combined with radiotherapy in patients with locally advanced nasopharyngeal carcinoma.Methods:Seven databases were searched, including the Cochrane Library (Issue 5, 2021), PubMed, Embase, CBM, CNKI, VIP and Wanfang Database. The method ological quality of the eligible studies was evaluated. The Meta-analysis was performed by the Revman 5.3 software.Results:Sixteen studies consisting of 1275 patients were finally included. Among them, 642 patients were treated with chrono-chemotherapy combined with radiotherapy and 633 patients received conventional chemotherapy combined with radiotherapy. Results showed that compared with conventional chemotherapy group, the effective rate was significantly elevated ( OR=1.66, 95% CI: 1.17-2.34, P=0.004), the incidence of leucopenia, thrombocytopenia, gastrointestinal reaction, grade 3-4 oral mucosal reaction and grade 3-4 radiothermitis was significantly reduced (all P<0.001), and the quantity of CD3, CD4 and CD4/CD8 was significantly increased in the chrono-chemotherapy group. Conclusion:Current evidence shows that compared with conventional chemotherapy, chrono-chemotherapy combined with radiotherapy could improve the effective rate, reduce adverse reactions and mitigate the destruction of immune function simultaneously.
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Objective:According to 2013 updated consensus guidelines of neck node levels, the distribution characteristics of cervical lymph nodes of nasopharyngeal carcinoma (NPC) were analyzed, aiming to provide preliminary reference for the clinical target volume (CTV) delineation of level Ⅴ in NPC.Methods:A total of 1110 patients pathologically diagnosed with NPC from 2012 to 2020 were retrospectively recruited for further analysis. All patients’ MRI and contrast-enhanced CT simulation scan imageswere retrospectively reviewed, metastatic lymph nodes were mapped using the 2013 International Consensus Guidelines. Then, the correlation between Ⅴa, Ⅴb and Ⅴc metastatic lymph nodes and other lymph nodes was analyzed. An NPC case diagnosed with T 1N 0M 0 was selected as the baseline standard for the normal anatomical structure and proportion of Ⅴc area. The metastatic lymph nodes in Vc were delineated on the CT simulation scan image of sample case, and the distribution characteristics of the metastatic lymph nodes inⅤc were analyzed. Results:Among the 1110 patients, 1004(90.5%) patients had lymph node metastases. The most common area of metastatic lymph node levels were level Ⅶa (74.7%) and level Ⅱb(70.7%), and the skip metastasis of lymph nodes was rare (1.0%). The multivariate analysis showed lymph node metastasis in level Va was correlated with levels Ⅱb, Ⅲ, Ⅳa, Ⅴb, and Ⅷ region ( P=0.010, 0.001, 0.001, 0.001, 0.037). Lymph node metastasis in level Ⅴb was correlated with levels Ⅲ, Ⅳa, Ⅴa and Ⅴc region ( P=0.006, 0.001, 0.001, 0.001). Lymph node metastasis in level Ⅴc was correlated with levels Ⅳb and Ⅴb region ( P=0.008, 0.001). There were 28 cases of lymph node metastasis in levelⅤc. A total of 38 metastatic lymph nodes were counted in level Vc. Among them, 33(86.8%) lymph nodes were located in the medial of the omohyoid muscle (Ⅴc-1 region), and 5(13.2%) were located in the lateral of the omohyoid muscle (Ⅴc-2 region). Conclusions:This study reflects the principle of individualized CTV delineation, which is based on the levels of nodal spread in NPC patients. When correlation is observed among different level V, V should be delineated as the moderate risk lymphatic drainage (CTV n2). It is recommended to individualized delineate level Vc when the CTV n2 covers Vc. The Ⅴc-2 region should be delineated as CTV n2 only when there is nodal spread in the ipsilateral Ⅴc-1 region.
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Objective:To explore the value of 18F-FDG PET/CT in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Methods:A retrospective analysis including 100 patients (77 males, 23 females, age (51.0±12.4) years) with nasopharyngeal carcinoma and 107 patients(61 males, 46 females, age (52.3±18.2) years) with nasopharyngeal lymphoma after 18F-FDG PET/CT at Tianjin Medical University Cancer Institute and Hospital from October 2011 to December 2019 was performed. All patients were confirmed by pathology. Differences of clinical data, PET metabolic parameters and CT morphology between nasopharyngeal carcinoma group and nasopharyngeal lymphoma group were compared (independent-sample t test or Mann-Whitney U test). Multiple regression analysis and ROC curve analysis were used to evaluate the efficacy of the combined features in the differential diagnosis of nasopharyngeal carcinoma and nasopharyngeal lymphoma. Results:As for nasopharyngeal carcinoma group and nasopharyngeal lymphoma group, there were statistically significant differences in SUV max (10.86±3.99 vs 14.81±7.24; t=-4.90, P=0.001), peak of SUV (SUV peak; 7.84±3.13 vs 10.86±5.66; t=-4.79, P=0.001), and total lesion glycolysis (TLG; 39.00(19.98, 62.56) vs 56.75(33.02, 102.06) g; z=-3.24, P=0.001). However, the diagnostic efficiencies were low (AUCs: 0.657, 0.646, 0.636, respectively). Multiple regression model showed that SUV max combined with multiple morphological and clinical features (gender, lesion location, with or without involvement of surrounding structures, cervical lymph node metastasis, parapharyngeal involvement and spleen involvement) could improve the differential diagnosis efficiency significantly (AUC=0.900). Conclusion:18F-FDG PET/CT metabolic parameter SUV max combined with CT morphological and clinical features have high diagnostic efficiency in the differential diagnosis of nasopharyngeal malignant tumors.
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Objective:To assess the role of Glasgow prognostic score (GPS) in the prognostic evaluation of nasopharyngeal carcinoma patients.Methods:Clinical data of 129 nasopharyngeal carcinoma patients who received radical radiotherapy in Affiliated Hospital of Jiangnan University from January 2012 to December 2013 were retrospectively analyzed. Clinicopathological characteristics of the patients were collected, including gender, age, TNM staging, pathological type and treatment regimen, etc. The GPS before and at 3 months after radiotherapy were calculated. The survival curve was drawn by the Kaplan- Meier method. Cox regression model was used for analysis of prognostic factors. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to evaluate the predictive capability of clinical parameters on prognosis. Results:With a median follow-up of 89.0 months (range: 5.1-104.6 months), the 5-year progression-free survival (PFS) of 129 patients was 79.8% and 84.5% for the 5-year overall survival (OS). At 3 months after radiotherapy, the 5-year PFS were 85.6%, 61.1% and 33.3% in the GPS 0, 1 and 2 groups, and 90.4%, 66.7% and 33.3% for the 5-year OS, respectively (all P<0.01). At 3 months after radiotherapy, the GPS, clinical staging (Ⅰ-Ⅲ vs. Ⅳ A) and concurrent chemotherapy were significantly correlated with PFS and OS (all P<0.01). ROC curve showed that at 3 months after radiotherapy, the AUC values of GPS, clinical staging and two combined in predicting OS were 0.694, 0.815 and 0.860, respectively. Conclusions:At 3 months after radiotherapy, higher GPS is an independent poor prognostic factor for nasopharyngeal carcinoma patients. The combination of GPS and clinical staging yields high accuracy in the prognostic evaluation of nasopharyngeal carcinoma patients.
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Objective:To evaluate the efficacy of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for treating patients with T 1-2N 1M 0 nasopharyngeal carcinoma (NPC). Methods:343 patients diagnosed with T 1-2N 1M 0 NPC in Zhejiang Cancer Hospital and Sun Yat-sen University Cancer Center from January 2008 to December 2016 were recruited in this study. All patients received IMRT and divided into the radiotherapy (RT) and chemoradiotherapy (CRT) groups. Patients in the CRT group were further assigned into the concurrent chemoradiotherapy (CCRT), induction chemotherapy+ CCRT (IC+ CCRT) and CCRT+ adjuvant chemotherapy (AC) groups. Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) were estimated by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox models. Results:The median follow-up time for surviving patients (303/343) was 91(range: 49-138) months. The 5-year OS, CSS, PFS, LRFFS, and DMFS rates in the CRT group were not superior to those of the RT group (93.7%: 93.9%, 93.7%: 93.9%, 89.0%: 87.7%, 93.8%: 92.8%, 93.8%: 91.2%, all P>0.05). No significant difference was found in treatment outcomes of patients with T 1N 1 or T 2N 1 NPC between two groups (all P>0.05). In multivariable analyses, only age was an independent prognostic factor for OS, PFS, CSS and DMFS, and negative correlation was found between them. No survival benefits were achieved in the CCRT, IC+ CCRT, CCRT+ AC and RT groups, and no significant differences were found in clinical efficacy among the three combined (all P>0.05). Conclusions:IMRT alone yields comparable clinical efficacy to CRT in treating patients with T 1-2N 1M 0 NPC. However, whether CT can be eliminated in the T 1-2N 1M 0 population still needs further confirmation by prospective, randomized and controlled clinical trials.
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Nasopharyngeal carcinoma (NPC) is one of the common head and neck malignant tumors. Radiotherapy is the main treatment for NPC. The comprehensive application of chemotherapy strategies (induction, concurrent and adjuvant) in radiotherapy has improved the efficacy in the treatment of locally advanced NPC. Based on current evidence, concurrent chemoradiotherapy combined with adjuvant or induction chemotherapy has been recommended as the standard treatment for locally advanced NPC. However, there are still many deficiencies in the standard treatment, and the application of induction and adjuvant chemotherapy remains controversial. Establishing a more ideal and individualized chemoradiotherapy for locally advanced NPC is still the research direction in the future.
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From synchronous metastasis to metachronous metastasis and from oligometastasis to disseminated metastasis, distant metastatic nasopharyngeal carcinoma (stage IV B) has great heterogeneity. The prognosis of stage IV B nasopharyngeal carcinoma patients with distant metastases is closely related to the anatomical characteristics of metastases. Therefore, it is necessary to subdivide M 1 stage to lay the foundation for individualized treatment of patients with metastatic nasopharyngeal carcinoma. In addition to systemic chemotherapy, the primary tumors and metastatic lesions should be considered during the treatment of newly-diagnosed metastatic nasopharyngeal carcinoma. Currently, there is a lack of recognized treatment modes for newly-diagnosed stageⅣ B nasopharyngeal carcinoma, and more studies are needed to evaluate the clinical benefits of different treatment methods.
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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 correlation between the changes of oral bacterial flora during head and neck radiotherapy and radiation-induced oral mucositis (ROM).Methods:The oral bacterial samples of patients with nasopharyngeal carcinoma and accompanying family members were obtained before and at the end of radiotherapy and subjected to high-throughput sequencing. C57BL/6 mice were used to establish the ROM models. On the 9 th day after radiotherapy, oral bacterial samples were collected in the radiotherapy group and the negative control group. On the 3 rd, 5 th, 7 th, and 9 th days post-radiotherapy, the tongue tissues were obtained from another batch of mice in the negative control and radiotherapy groups. Inflammatory factors were detected with PCR and HE staining was performed. Results:The oral bacterial diversity of patients after radiotherapy significantly differed from that of patients before radiotherapy and their accompanying family members before and after radiotherapy in Observed species, Chao1, Simpson index (all P<0.05). There was a significant difference in Shannon index between the severe and mild ROM patients ( P=0.036). LEfSe analysis showed that patients with severe ROM had higher levels of g_ Streptococcus and f_ Streptococcus, and lower levels of f_ Familyxl, g_ Gemini and o_ Bacillus. The Simpson index and PCoA results in the oral bacterial samples significantly differed between the negative control and radiotherapy groups (all P<0.05). Conclusions:Radiotherapy can disrupt the balance of bacterial flora. The dysregulated oral bacterial flora is closely associated with the aggravation of ROM.
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Objective:To retrospectively analyze the long-term survival (10-15 years) and late toxicity of nasopharyngeal carcinoma (NPC) patients after intensity-modulated radiotherapy (IMRT), aiming to provide reference for the optimal treatment of NPC.Methods:132 patients with NPC who were treated with IMRT in Sichuan Cancer Hospital from 2003 to 2009 were recruited. Among them, 3 patients were classified as stage Ⅰ, 22 cases of grade Ⅱ, 61 cases of grade Ⅲ, 43 cases of Ⅳ A and 3 cases of Ⅳ B, respectively. The median dose was 73.37Gy (66 to 85Gy), divided into 33 times. Twenty patients received radiotherapy alone, 112 cases of concurrent radiochemotherapy. The survival rate was calculated by Kaplan-Meier method and log- rank test. Univariate prognostic analysis was performed. Cox model was used to conduct multivariate prognostic analysis. The late radiation toxicity was evaluated by RTOG/EORTC criteria. Results:The median follow-up duration was 128 months (range, 3 to 191 months). The 10-and 15-year local control rates of NPC patients were 86.0% and 79.9%. The disease-free survival rates were 72.5% and 63.2%, and the overall survival (OS) rates were 65.2% and 57.1%. The local recurrence rate was 12.1%, and the distant metastasis rate was 16.7%. A total of 53 patients died, of whom 15 patients died of local recurrence, 20 patients died of distant metastasis and 18 patients died of other diseases (pneumonia, intracranial hemorrhage and accident, etc.). The 10-and 15-year non-tumor-related mortality rates were 11.3% and 13.6%. Univariate analysis showed that age, smoking habit, lactate dehydrogenase (LDH), T stage and clinical stage were the independent prognostic factors of OS in NPC patients. Multivariate analysis demonstrated that LDH, T stage and synchronous chemotherapy were the prognostic factors of OS in NPC patients. The incidence of gradeⅠ-Ⅱ late radiation injury (hearing impairment, dysphagia, dental caries and xerostomia) was 90.4%, and 8.5% for grade Ⅲ-Ⅳ late radiation injury (skin fibrosis, hearing impairment and radiation brain injury).Conclusions:The 10-and 15-year OS of NPC patients treated with IMRT is relatively high. With the prolongation of survival, the non-tumor-related mortality rate is increased. Distant metastasis is the main cause of treatment failure. The main late injuries include grade Ⅰ/Ⅱ hearing impairment, dysphagia, dental caries and xerostomia.
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Objective@#To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade.@*Methods@#Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model.@*Results@#In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%, 70.1%, 91.2%, 97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05).@*Conclusions@#Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.
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The complexity of intensity-modulated radiotherapy (IMRT) equipment and the accuracy of clinical radiotherapy require extremely high standards for the, quality control of IMRT for nasopharyngeal carcinoma. Reasonable, reliable and targeted quality control is an essential part of precise radiotherapy. At present, domestic radiotherapy equipment is developing rapidly. Nevertheless, radiotherapy equipment, personnel composition and quality control significantly differ among hospitals. Therefore, it is difficult to achieve homogeneity in the quality control of radiotherapy. Establishing an expert consensus on the quality control of domestic radiotherapy equipment can clarify the content of quality control, testing procedures, testing conditions and personnel qualification and requirement. It can effectively ensure the standardization and homogeneity of the quality control and establish the responsibility, procedures, processes and quality management of the quality control, aiming to offer the optimal radiotherapy to each patient.
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Objective To explore the feasibility of 3D printed individualized applicator for the intracavitary HDR-brachytherapy for nasopharyngeal carcinoma.Methods CT scan was performed in 1 case of recurrent rT1 nasopharyngeal carcinoma and 1 case of T2 residual nasopharyngeal carcinoma and the obtained images were transmitted to 3D image processing software.The geometric contour parameters of the nasopharyngeal cavity were obtained and a pipeline was designed to make it close to the recurrent gross tumor volume (rGTV).Individualized cavity applicators were created by using 3D printer.The applicator was inserted into the patient's nasopharyngeal cavity through oral cavity.The source tube and false source were inserted into the preset pipe of the applicator.CT scan was performed again and the images were transmitted to the 3D brachytherapy planning system.Mter delineating the target volume and organ at risk,treatment plan was optimized.After completing the first treatment,the applicator was removed.Before second treatment in a few days,CT scan was reviewed to confirm whether the position was correct.Results When the applicator was inserted into the nasopharyngeal cavity,it could be fully aligned with the nasopharyngeal wall and self-fixed without additional fixation measures.Comparing the location of false source in multiple reviews of CT scan,the error was ≤ 1 mm.No significant discomfort was reported throughout the treatment.In optimized three-dimensional treatment,100％ prescription dose curve included the full rGTV,maximum dose of the brain stem and spinal cord was＜30％ prescription dose.Recurrent patients were given with a prescription dose of DT 40Gy/8 fractions/4 weeks and patients with residual tumors were given with 12Gy/2 fractions/1 week.No tumor recurrence was observed at postoperative 3 months in two cases.Conclusions The 3D printed individualized nasopharyngeal intracavitary applicator has the advantages of self-fixation,accurate location,good repeatability and good patient tolerance.The short-term outcome is effective,whereas its long-term clinical effect and adverse reactions need to be further observed.
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Objective To define the maximum-tolerated dose (MTD) of lobaplatin (LBP) in a weekly regimen combined with concurrent radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma (NPC).Methods A total of 18 cases with stage Ⅲ/Ⅳ A NPC were enrolled.Concurrent chemoradiotherapy was given to all the patients with a dose escalation of LBP.The initial dose of LBP was 15 mg/m2 with an escalating dose of 5 mg/m2.At least 3 patients were assigned into each group.Patients were proceeded into the next dose group if no dose-limiting toxicity (DLT) occurred until the MTD was achieved.Efficacy and toxicity were evaluated regularly.Results Three patients were assigned into the 10 mg/m2,3 into the 15 mg/m2,and 6 into the 20 mg/m2 and 25 mg/m2 groups,respectively.Two patients experienced DLT in the 25 mg/m2 group.Hence,the MTD was determined as 20 mg/m2.At 3 months after corresponding treatment,the remission rate of nasopharyngeal tumors and neck-positive lymph nodes of the patients was 100％.The most common toxicity was reversible bone marrow suppression.Conclusions The MTD of weekly lobaplatin plus concurrent IMRT is 20 mg/m2 for locally advanced NPC.This regimen is reliable and safe,which is worthy of further clinical study.
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Objective To evaluate the short-term efficacy and toxicities of intensity-modulated carbon ion radiotherapy (IMCT) for patients with locoregionally recurrent nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT).Methods A total of 112 patients with locoregionally recurrent nasopharyngeal carcinoma undergoing salvaging IMCT between May 2015 and February 2018were enrolled in the study.All patients previously received one course of definitive X-ray IMRT.Among them,10 patients (9％) were diagnosed with stage Ⅰ,26 patients (23％) with stage Ⅱ,41 patients (37％) with stage Ⅲ and 35 patients (31％) with stage Ⅳnasopharyngeal carcinoma,respectively.The median age of the cohort was 48 years (range,17-70 years) old.The median dose to the gross tumor volume (GTV) was 60 GyE (range,50-69 GyE).Results With a median follow-up time of 20 months (range,5-45 months),20 patients died and 42 patients developed local recurrence.The 2-year overall survival (OS) and local progression-free survival (LPFS) rates were 85％ and 52％.Both univariate and multivariate analyses demonstrated that stage Ⅳ disease was associated with significantly worse OS.No predictors were found for LPFS.No acute toxicity of grade 3 or higher was observed during reirradiation.Severe (grade 3 or above) late toxicities included xerostomia (n =1),hearing impairment (n =2),temporal lobe injury (n =1) and mucosal necrosis (n =19).Conclusions IMCT is an efficacious and safe treatment for patients with locoregionally recurrent nasopharyngeal carcinoma with acceptable toxicity profile.Long-term follow-up is necessary to further evaluate the long-term efficacy and late toxicities.
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Objective To retrospectively analyze the characteristics of nasopharyngeal carcinoma,long-term efficacy,adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade.Methods Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed.All patients were treated with IMRT.The survival analysis was performed by Kaplan-Meier method.The multivariate analysis was conducted with Cox's regression model.Results In non-endemic northwest China,a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma,and a majority of them were pathologically characterized as differentiated subtypes.The 5-year overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7％,70.1％,91.2％,97.0％ and 81.0％,respectively.Multivariate analysis showed that age,pathological type,nasopharyngeal tumor volume＞23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P＜0.05).Age,pathological type,neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P＜0.05).N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P＜0.05).Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area.Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.
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Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma.Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time,5 times a week,a total dose of 51-60 Gy,17-20 times/4 weeks) were retrospectively analyzed.The short-and long-term radiation-induced injury,Karnofsky performance score (KPS),short-and long-term clinical efficacy were evaluated.Results For the short-term radiation-induced injury,the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P＜0.05).Regarding the long-term radiation-induced injury,the incidence of dry mouth (95.4％) and deafness (51.0％),difficulty in opening mouth (79.1％),maxillofacial fibrosis (33.3％) and radiation-induced encephalopathy (15.0％) significantly differed before and following treatment (all P＜ 0.05).The actual long-term radiation-induced injury included dry mouth (91.5％),deafness (50.9％),difficulty in opening mouth (76.5％),maxillofacial fibrosis (32.0％) and radiation-induced encephalopathy (14.4％).The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P＜0.05).The local control rates were 29.4％,68.6％,79.1％,83.7％ and 86.9％ at 1-,3-,6-,9-and 12-month after corresponding treatment,respectively.The local control rate significantly differed between 1 and 3 months,and between 3 and 6 months after treatment (both P＜0.05).The 1-,2-,3-,4-and 5-year survival rates were calculated as 96.1％,80.4％,68.5％,57.9％ and 51.1％,respectively.Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma,which yields relatively high short-and long-term clinical efficacy,high local control rate and well tolerance by the patients.
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Objective@#To explore the correlation between microdamage in white matter and radiotherapy dose at early stage after radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC).@*Methods@#Thirty-three patients who were initially diagnosed with NPC were recruited and received diffusion tensor imaging (DTI) scan and neuro-cognitive scale test within 1 week before RT and the first day after RT. DTI-related characteristic parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ‖), and radial diffusivity (λ⊥) were calculated based on whole-brain voxel analysis method. Paired t-test was conducted to evaluate statistical significance between pre-RT and post-RT groups. In the subgroup analysis, all the subjects were divided into 3 groups according to the average dose of temporal lobe, and each group was set with an equal dose interval range. The DTI-related parameters of whole brain pre-RT and post-RT in each group were statistically compared. All the statistical results were corrected by FDR with a threshold of P<0.05 and clusters>100.@*Results@#FA, MD, λ‖ and λ⊥in the post-RT group significantly differed compared with those in the pre-RT group (P<0.05). The values of FA, MD, λ‖ and λ⊥were 0.455±0.016, (9.893±0.403)×10-4, (13.441±0.412)×10-4 and (8.231±0.429)×10-4, respectively. Subgroup analysis showed that the extent and degree of λ‖ and λ⊥ changes were exacerbated with the increase of the average dose of temporal lobe after RT. Particularly in high-dose group, the average dose range was 25-35 Gy and the extent of regions with significant changes was significantly larger than those in the medium-dose (15-25 Gy) and low-dose groups (5-15 Gy)(P<0.05).@*Conclusions@#DTI can be utilized to detect" normal" brain tissue microdamage in NPC patients at early stage after RT. The average radiation dose of temporal lobe may be one of the reasons for the severity of cerebral microdamage. In the future, DTI technique may be useful for guiding exposure dose of organs at risk during RT planning and to evaluate the cohort with a high risk of cerebral microdamage at early stage after RT, thereby protecting normal cerebral tissues to the maximum extent.
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Objective@#To investigate the radiotherapy (RT)-induced changes in the brain structural network in patients with nasopharyngeal carcinoma (NPC).@*Methods@#Three-dimensional structural magnetic resonance data (3D-T1W) was adopted to investigate the structural network in 103 patients with NPC before and after receiving RT. The structural networks were then reconstructed using 3D-T1W. The radiation-induced changes in topology properties of small world network were analyzed by using graph theoretical analysis.@*Results@#Patients showed small world properties before and after RT. Compared with the pre-RT group, the global and local efficiency were lower, the shortest path length was longer and the clustering coefficient was less in the post-RT group. In addition, the hub regions in the post-RT group were significantly different from those in the pre-RT group, mainly located in the left rolandic operculum, right inferior frontal gyrus, right parahippocampal gyrus, right lingual gyrus, bilateral supramarginal gyrus, left superior temporal gyrus and temporal pole of the right middle temporal gyrus.@*Conclusion@#It is speculated that RT leads to high efficiency of network topology and information transmission, which provides a novel perspective for exploring the RT-induced brain changes, diagnosis of RT-induced injury and evaluation of RT efficacy.