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Objective:To explore the relationship between semi-quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and long-term prognosis of locally advanced nasopharyngeal carcinoma, and to find prognostic indicators from non-invasive images of locally advanced nasopharyngeal carcinoma.Methods:Data were collected from January 2011 to January 2012 via a prospective clinical trial with locally advanced nasopharyngeal carcinoma. Clinical information was from 71 patients who completed the treatment plan with long-term follow-ups and UICC 2010 stage Ⅲ, Ⅳ A, Ⅳ B. The patients received three cycles of Taxotere-Platinol-Fluorouracil (TPF) regimen chrono-chemotherapy, followed by two cycles of concurrent paclitaxel chemotherapy with intensity-modulated radiotherapy (IMRT). DCE-MRI examination was performed before induction chemotherapy to obtain DCE-MRI related semi-quantitative parameters. Correlation analysis was conducted between DCE-MRI related semi-quantitative parameters and short-term efficacy of nasopharyngeal lesions after concurrent radiotherapy and chemotherapy. Results:Of all 77 patients, 71 completed treatment and were followed up from 9 to 86 months, with a median follow-up of 77 months, with 80.2% and 67.6% in 3- and 5-year OS, 73.2% and 60.5% in 3- and 5-year PFS, respectively. Evaluation of short-term efficacy of nasopharyngeal lesions after concurrent chemoradiotherapy: the difference in tissue arrival time of contrast agent between complete response (CR) group and partial response (PR) group was statistically significant ( t=0.537, P<0.05). Univariate survival analysis found that OS ( χ2=3.982, P<0.05) and PFS ( χ2=4.019, P<0.05) in the group with short contrast arrival time were significantly higher than those in the group with long contrast arrival time. OS ( χ2=7.593, P<0.05) and PFS ( χ2=5.624, P<0.05) of patients aged over 45 years were significantly lower than those aged less than 45 years. Cox multivariate regression model showed that advanced clinical stage (stage Ⅳ A, Ⅳ B) ( P=0.048) and age≥45 years ( P=0.031) were independent prognostic factors of OS in patients with nasopharyngeal carcinoma. Long arrival time of contrast agent ( P=0.018), age≥45 years ( P=0.004), advanced N(2-3) stage ( P=0.032) and enhancement peak<3 000 ( P=0.005) were independent prognostic factors of PFS in patients with nasopharyngeal carcinoma. Conclusions:The arrival time of the contrast agent in DCE-MRI may be a reliable prognostic factor for locally advanced nasopharyngeal carcinoma.
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OBJECTIVE:To compare the clinical efficacy of erlotinib between late non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) exon 19 mutation and those with exon 21 mutation.METHODS:Late NSCLC patients with EGFR mutation positive enrolled in our hospital during Oct.2013-Nov.2014 were selected.Patients with EGFR exon 19 Del mutant were regarded as group A,and patients with exon 21 L858R mutant were regarded as group B,45 cases in each group.All patients were orally administered with Edotinib hydrochloride tablets till progression.The disease control rate (DCR),median survival time (MST),median time to progress (mTTP),one-year survival rate and incidence of adverse reactions in 2 groups were compared.RESULTS:The DCR (93.02％) and one-year survival rate (81.40％) in group A were obviously higher than that of group B (72.09％,60.47％) (P＜0.05),MST [(15.47 ± 2.87) month] and mTTP [(182.00 ± 8.24) d] were obviously longer than that of group B [(12.55 ± 2.92) month,(162.00 ± 7.22) d] (P＜0.01).There was no statistical significance in the incidence of adverse reactions in 2 groups (P＞0.05),and there were no severe adverse reactions.CONCLUSIONS:For patients with late NSCLC,erlotinib shows superior efficacy in patients with EGFR exon 19 mutation to patients with EGFR exon 21 mutation.