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Objective:To evaluate the 8 th edition of AJCC/UICC staging system for stage Ⅲ nasopharyngeal carcinoma (NPC) by the survival analysis. All patients were treated with intensity-modulated radiotherapy (IMRT). Methods:Among 1351 treatment-na?ve NPC patients who received radiotherapy/chemoradiotherapy in our hospital from December 2008 to October 2014, 742 and 784 cases were classified as clinical stage Ⅲ based on the criteria of the 7 th and 8 th edition of AJCC/UICC staging systems, respectively. These patients were classified into three subgroups according to the 7 th and 8 th edition of AJCC/UICC staging systems: T 3N 0-1 as G 1( n=226, n=245), T 1-2N 2 as G 2( n=180, n=187) and T 3N 2 as G 3( n=336, n=352). The 5-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and local-regional recurrence-free survival (LRRFS) were analyzed with Kaplan- Meier method. The differences among different groups were evaluated by log-rank test. Results:There were 93.6% patients evaluated by the 8 th AJCC/UICC staging system remained the same cohort with those by the 7 th AJCC/UICC staging system. The 5-year OS, PFS, DMFS and LRRFS of the 8 th and 7 th staging systems were 84.8% and 85.4%, 76.2% and 77.0%, 80.4% and 81.3%, 89.8% and 90.6%, respectively (all P>0.05). The OS, PFS or DMFS significantly differed among three subgroups classified by the 8 th staging system (all P<0.001). In addition, statistical significance was observed between G 1 and G 2, and between G 1 and G 3(both P<0.05), whereas no statistical significance was noted between G 2 and G 3( P=0.183, 0.310, 0.248). Conclusions:The distribution features and clinical endpoints of clinical stage Ⅲ defined by the 8 th AJCC/UICC staging system are similar to those defined by the 7 th AJCC/UICC staging system. The distribution of survival risk significantly differs among different subgroups. N 2 plays a major role in assessing the survival risk of patients with stage Ⅲ NPC. In the era of IMRT plus chemotherapy, the effect of local tumors on clinical prognosis has been diminished. The 8 th AJCC/UICC staging system remains to be further improved.
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Objective To investigate the relationship of radiation dose with the volume and late toxicity of the sternocleidomastoid muscle ( SM) in patients with nasopharyngeal carcinoma. Methods SM was divided into upper part and lower part based on the lower edge of cricoid cartilage. Patients were divided into three groups according to the prescribed dose for clinical target volume at the lower neck ( CTV2 ) ( 0, 54,60 Gy) . The dosimetric parameters included Dmean , V66 , and V60 for the upper, lower, and whole SM. SM was delineated and the volume was calculated on computed tomography images in the treatment planning system before and at 6, 12, and 18 months after treatment. The anteroposterior and transversal diameters of SM at C3?C4 , C4?C5 , C5?C6 , and C6?C7 levels were measured and recorded. Late toxicity of neck skin and SM was evaluated according to the Common Terminology Criteria for Adverse Events V4 .0 criteria. Between?group comparison was made by t?test or Kruskal?Wallis non?parametric test. Between?group comparison of the sample rate was made by one?way analysis of variance. The correlation analysis was made by Spearman correlation. Results There were significant difference in SM volume between the three time points after treatment ( P=0. 000) . At 12 or 18 months after treatment, the volume of SM wasignificantly reduced ( P=0. 000,0. 000);the reduction in SM volume was significantly correlated with V66 of the SM and the upper SM ( P=0. 015,0. 020) . At 18 months after treatment, SM fibrosis was significantly correlated with V60 of the upper SM ( P=0. 030);the fibrosis of neck skin was significantly correlated with the Dmean and V60 of the upper SM ( P=0. 029,0. 005) . Conclusions In order to prevent the incidence of the fibrosis of neck skin and SM, the dose homogeneity should be as high as possible, while the number of hot spots should be as small as possible.
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Objective To explore a desirable therapeutic regimen,which is effective,reasonable and practicable for locally advanced nasopharyngeal cancer (LA-NPC) patients in the era of IMRT,with a potential of translating into survival improvement of these patients.Methods Patients presented with stage Ⅲ-Ⅳ B,WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy (CCRT group) (45 cases) or induction chemotherapy plus radiotherapy alone (IC + RT group) (43 cases),with random number table.IMRT and rapid arc planning were generated in the same treatment planning system for all patients.These two arms received docetaxel plus cisplatin for first cycle of chemotherapy,and cisplatin only for the second cycle.Results Forty-five patients received CCRT and 43 received IC + RT.All the patients completed two cycles chemotherapy.Compared to the CCRT group,the incidence rate of grade 2-4 leukopenia was lower in IC + RT group[67.4 ％ (29/43) vs.86.7 ％ (39/45),x2 =4.628,P =0.031],while the incidence rate of dermatitis,mucositis,neutropenia and fungal infection of oral cavity had no significant differences (all P ＞ 0.05).The tumor response rate (95.3 ％ vs.100.0 ％,P =0.236),2-year overall survival rate (95.5 ％ vs.94.2 ％,P =0.627),2-year progression free survival rate (94.6 ％ vs.88.6 ％,P =0.303),2-year local recurrent free survival rate (97.3 ％ vs.95.5 ％,P =0.951),2-year regional recurrent free survival rate (94.7 ％ vs.96.2 ％,P =0.949),and 2-years distant metastasis free survival rate (93.7 ％ vs.91.5 ％,P =0.454) of the two groups were similar while comparing CCRT to IC + RT group.Conclusion Combined IMRT with TP/DDP regimen,the efficacy of IC + RT is similar to CCRT for LA-NPC.The IC + RT group has less severe leukopenia than CCRT group,which is worth further study.
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Objective To analyze the prognostic factors in patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma (NPC). Methods We collected the data of 68 patients with initially diagnosed bone-only metastatic NPC admitted to The Affiliated Tumor Hospital of Shantou University Medical College from 1997 to 2015. Forty-nine patients received chemoradiotherapy. The Kaplan-Meier method was used to calculate the overall survival rate;the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The median follow-up was 953 months. The 1-, 2-, 3-, and 5-year overall survival ( OS) rates were 53%, 38%, 21%, and 15%, respectively. The median OS time was 134 months. The univariate prognostic analysis showed that spinal metastases, the number of bone metastases, lactic dehydrogenase level before treatment, the radiotherapy technology and dose for primary tumor, and the short-term outcome of primary tumor were associated with OS ( P=002, 001, 000, 002, 002, 001 ) . The multivariate prognostic analysis showed that ≤3 bone metastases, dose to primary tumor>65 Gy, and intensity-modulated radiotherapy ( IMRT) were favorable prognostic factors for OS ( P=003,002,004) . Conclusions For patients with initially diagnosed bone-only metastatic NPC, active treatment ( IMRT, dose to primary tumor>65 Gy) should be considered for those with ≤3 bone metastases to achieve a complete response of primary tumor.
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Objective To analyze the prognostic factors in patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma (NPC). Methods We collected the data of 68 patients with initially diagnosed bone-only metastatic NPC admitted to The Affiliated Tumor Hospital of Shantou University Medical College from 1997 to 2015. Forty-nine patients received chemoradiotherapy. The Kaplan-Meier method was used to calculate the overall survival rate;the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The median follow-up was 953 months. The 1-, 2-, 3-, and 5-year overall survival ( OS) rates were 53%, 38%, 21%, and 15%, respectively. The median OS time was 134 months. The univariate prognostic analysis showed that spinal metastases, the number of bone metastases, lactic dehydrogenase level before treatment, the radiotherapy technology and dose for primary tumor, and the short-term outcome of primary tumor were associated with OS ( P=002, 001, 000, 002, 002, 001 ) . The multivariate prognostic analysis showed that ≤3 bone metastases, dose to primary tumor>65 Gy, and intensity-modulated radiotherapy ( IMRT) were favorable prognostic factors for OS ( P=003,002,004) . Conclusions For patients with initially diagnosed bone-only metastatic NPC, active treatment ( IMRT, dose to primary tumor>65 Gy) should be considered for those with ≤3 bone metastases to achieve a complete response of primary tumor.
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Objective To investigate the level Ⅰb contouring,dose analysis and regional recurrence in level Ⅰb lymph node-negative (Ⅰb-negative) nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT).Methods One hundred ninety newly-diagnosed,Ⅰb-negative NPC patients treated by IMRT were enrolled.Level Ⅰb contouring and dose prescribing in this cohort were classified into planned prophylactic irradiation (PPI) group (56 cases) and non-planned prophylactic irradiation (non-PPI) group (134 cases).The mean dose (Dmean) of the level Ⅰb bilaterally and submandibular glands (SMGs) was recorded for comparison.Results After a median follow-up of 47 months,there was no level Ⅰb regional recurrences noted in the entire group.The mean doses of level Ⅰb and the submandibular glands were significantly lower in the non-PPI group than those in the PPI group as follows:(50.81±5.37) Gy vs (59.68±3.32) Gy for the left level Ⅰb,(51.55±5.02) Gy vs (59.66±3.85) Gy for the left submandibular gland,(51.55±5.02) Gy vs (59.66±3.85) Gy for the right level Ⅰb and (57.25±4.69) Gy vs (63.41±2.88) Gy for the right submandibular gland (all P =0.000).Conclusion In this retrospective analysis of non-randomized single institute data,it seems unlikely that PPI to level Ⅰb is necessary in Ⅰb-negative NPC patients treated by IMRT.