RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
Objective To analyze the clinical treatment modalities and clinical prognosis of patients diagnosed with primary nasopharyngeal adenoid cystic carcinoma (NACC).Methods The medical records of 46 patients with NACC between March 1971 and November 2015 were retrospectively analyzed.Among them,22 patients were male and 24 female.The median age of all patients was 47 years (range:23-74 years).Among them,34 patients received radiotherapy alone including 25 patients treated with conventional radiotherapy and 9 receiving intensity-modulated radiation therapy (IMRT).Five patients underwent salvage surgery for the residual tumors after radiotherapy.Twelve patients were treated with a comprehensive treatment modality (surgery combined with radiotherapy).Results The median follow-up time was 66.0 months (range:11.0-270.6 months).The 5-and 10-year overall survival,locoregional failure-free survival,and distant metastasis failure-free survival rates were 70％ and 40％,64％ and 47％,70％ and 62％,respectively.In the radiotherapy alone group,12(35％) cases obtained complete response,13 had partial response and 9 remained stable after radiotherapy.The 5-year overall survival and locoregional failure-free survival rates in the radiotherapy alone and combined therapy groups were 69％ and 74％,63％ and 66％,respectively (all P＞ 0.05).Conclusion The course of NACC is relatively slow.Radiotherapy is recommended for patients with high sensitivity towards radiotherapy.Salvage surgery is feasible for those who are insensitive to radiotherapy or with residual tumor after radiotherapy.
RESUMEN
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.
RESUMEN
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.
RESUMEN
Objective To analyze survival benefits of radiotherapy in patients with nasopharyngeal carcinoma (NPC) with distant metastases and analyze relevant prognostic factors.Methods Medical records of 329 patients newly diagnosed with metastatic NPC screened from the Surveillance,Epidemiology and End Results (SEER) database (199 of 329 patients received radiotherapy) between 2010 and 2015 were retrospectively analyzed.Overall survival (OS) and disease-specific survival (DSS) were calculated by Kaplan-Meier curve.The effect of different clinicopathological factors on the clinical prognosis of metastatic NPC patients was evaluated by logrank test and Cox regression analysis.Results The median follow-up time was 12 months.The 3-and 5-year OS rates were 27.4％ and 19.7％.The median OS was 17.9 months.Univariate analysis demonstrated that patients aged＜ 50 years,male,undifferentiated type,stage T3 or T4,positive regional lymph node,brain and liver metastases and 1-2 metastatic sites obtained OS and DSS benefits at 3 years after radiotherapy.Univariate and multivariate Cox analyses after propensity score matching showed that radiotherapy was an independent prognostic factor for metastatic NPC (OS,P=0.004;DSS,P=0.014).Besides,patients aged 60-69 years (OS,P=0.033;DSS,P=0.045),keratinizing squamous cell carcinoma (OS,P＜ 0.05;DSS,P＜ 0.05),stage T4 (OS,P =0.002;DSS,P =0.024),1-2 metastatic sites (OS,P =0.039;DSS,P =0.058),3-4 metastatic sites (OS,P =0.003;DSS,P =0.005) and no chemotherapy (OS,P=0.000;DSS,P=0.000) had poor OS and DSS,whereas sex,race and degree of differentiation exerted no effect on OS and DSS.Conclusions Radiotherapy can significantly improve the OS and DSS of patients with metastatic NPC.Prospective and randomized controlled studies are required to further explore the role of radiotherapy in the management of metastatic NPC.
RESUMEN
Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging ( DWI) and diffusion kurtosis imaging ( DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered).All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1. 1( response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n＝36) and non-response group (NRG;n＝5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient ( ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy, all parameters significantly differed between two groups ( P＝0. 000-0. 013) except for the Dmeanand ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmeanwas calculated as 87. 5% and the specificity was 91. 3% for predicting local control (optimal threshold＝0. 30, AUC: 0. 924; 95%CI: 0. 83-1. 00 ). Conclusion Kmeanvalue after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.
RESUMEN
Objective To evaluate the clinical efficacy of oral ulcer protective agent in the prevention and treatment of oral mucositis in nasopharyngeal carcinoma (NPC) radiotherapy and its effect upon serum inflammatory factors.Methods A total of 90 patients diagnosed with nasopharyngeal carcinoma presenting with grade I oral mucositis caused by radiotherapy in our hospital were selected and randomly divided into two groups.In the experimental group,oral ulcer protective agent was given,and Kangfuxin gargle was administered in the control group.The incidence time and degree of radioactive oral mucositis,visual analogue scale (VAS) pain score,serum levels of CRP,TGF-β1,IL-6 and T lymphocyte subsets were statistically compared between two groups by independent-sample t-test.Results At 4 and 6 weeks after corresponding treatment,the incidence of grade Ⅱ and Ⅲ oral mucositis in the experimental group was significantly lower than that in the control group (P=0.018,0.021,0.027,0.014)).In the experimental group,the incidence of moderate and severe pain assessed by VAS was significantly lower compared with that in the control group (P=0.019,0.025);After corresponding treatment,the CRP levels in both groups were down-regulated and the CRP level in the experimental group was considerably lower than that in the control group (P=0.013).The levels of TGF-β1 and IL-6 in the control group were significantly increased (P=0.015、0.021),whereas dramatically declined in the experimental group (P=0.012,0.019).CD3(+),CD4 (+),CD8(+) and CD4(+)/CD8(+) were remarkably elevated in two groups,and more significant increase was observed in the experimental group (P=0.024,0.036,0.029,0.017).Conclusions Oral ulcer protective agent can effectively inhibit the progression of oral mucosal injury,shorten the healing time and relieve the pain of oral mucosal injury in patients with NPC.,which is worthy of clinical application.
RESUMEN
Objective To investigate the relationship between the incidence of radiation-induced brain stem injury after intensity-modulated radiotherapy (IMRT) and the radiation dose volume in patients with nasopharyngeal carcinoma.Methods A retrospective analysis was performed on the data of 258 patients newly diagnosed with nasopharyngeal carcinoma who received IMRT in our group from 2005 to 2013.The radiation dose per unit volume of brain stem was analyzed.The relationship between the incidence of brain stem injury induced by IMRT and the radiation dose volume was studied.The survival rate was calculated using the Kaplan-Meier method.The factors influencing the radiation-induced brain stem injury were analyzed using the Cox regression model.Results Two patients with stage T3 disease and three patients with T4 disease had radiation-induced brain stem injury.The 3-and 5-year injury incidence rates were 1.6％ and 2.4％,respectively.The latency ranged between 9 and 58 months,with a median latency of 19 months.The median D1％ and Dmax for the brain stem were 54.24 and 59.22 Gy in all patients,54.31 and 59.45 Gy in patients with stage T3 disease,and 61.29 and 66.37 Gy in patients with stage T4 disease,respectively.In the five patients with brain stem injury,the D1％ and Dmax were larger than 60 and 63 Gy,respectively.The univariate analysis showed that the incidence of radiation-induced brain stem injury was correlated with D1％,Dmax,D0.1 cm3,D0.5 cm3,and D1.0 cm3 (all P=0.01).The incidence of radiation-induced brain stem injury was significantly lower in patients with D1％,Dmax,D0.1 cm3,D0.5 cm3,and D1.0 cm3 no larger than 60,63,60,58,and 56 Gy,respectively (all P =0.00).Conclusions The incidence of radiation-induced brain stem injury after IMRT is relatively low in patients with nasopharyngeal carcinoma.Strict control of the dose to the brain stem may help to reduce the incidence of brain stem injury and improve the long-term quality of life.
RESUMEN
Objective To compare the agreement among Chinese 1992, 2008 and UICC 2010 staging systems of nasopharyngeal carcinoma (NPC) and evaluate their predictive value of radiotherapeutic prognosis.Methods 347 NPC patients without distant metastasis treated in our hospital from 2000 to 2005 were retrospectively analyzed.Every patient was categorized into T, N, and clinical stage by Chinese 1992, 2008 and UICC 2010 staging systems, respectively.Kappa value was used to evaluate the agreement among three systems.Kaplan-Meier method was used to analyze the 5-year overall survival (OS), local-free survival (LFS) and distant metastasis-free survival (DMFS), the difference between subgroup was tested by Logrank.Results The agreement of clinical stage, T and N stage between Chinese 2008 and UICC 2010 staging system was better than that of them compared to 1992 staging system, Kappa value were 0.700、0.881 and 0.722.The agreement of T stage was better than N and clinical stage among these three staging system.The difference of OS between stageⅢ and stage Ⅳ was significant in Chinese 2008 and UICC 2010 staging system (χ2=4.48,P=0.034;χ2=8.88,P=0.003), and with no different in 1992 staging system (χ2=0.40,P=0.526).There was no significant difference of LFS between T1 and T2,T2 and T3,T3 and T4 in all staging systems (χ2=1.85,0.53,0.50,P=0.174,0.467,0.479;χ2=1.25,2.10,1.99,P=0.264,0.148,0.159;χ2=0.77,0.60,0.87, P=0.381,0.441,0.350).There were no significant differencesin 1992 staging system, while there was significant differences of DMFS between N1 and N2, N2 and N3 in 2008 stage system, N1 and N2 in UICC 2010 stage system.Conclusions The predictive value of Chinese 2008 and UICC 2010 staging system for prognosis were similar, and were better than that of 1992 staging system in NPC.
RESUMEN
Objective To analyse the preliminary clinical results of intensity modulated radiation therapy (IMRT) for 122 untreated nasopharyngeal carcinoma (NPC)pafients.Methods 122 NPC pa- tients received IMRT alone from Feb.2001 to Jun.2004,with 31 females and 91 males,and a median age of 45 years(range 25-66).According to the Fuzhou Stage Classification,there were StageⅠ11 patients, StageⅡ34,StageⅢ62,and StageⅣa 15.IMRT was carried out using an inverse planning system (COR- VUS 5.0,Peacock plan) developed by the NOMOS Corp.The treatment was given with the Multi-leaf Inten- sity Modulating Collimator (MIMIC) using a slice-by-slice arc rotation approach.The prescription dose was 68 Gy/30f to the nasopharynx gross tumor volume (GTV_(nx)),60-66 Gy/30f to positive neck lymph nodes (GTV_(nd)),60 Gy/30f to the first clinical target volume (CTV_1) and 54 Gy/30f to the second clinical target volume (CTV_2).Kaplan-Meier method was used to calculate the overall survival rate (OS),distant metas- tasis-free survival rates (DMFS),and local-regional control rates from the last date of therapy.Log-rank test was used to detect the difference between groups.Results The median follow-up time was 20 months ( range 6 to46 months).The 1-,2-,and 3-year OS was 95.2%,91.4%,85.1%,DMFS was 91.9%, 88.6%,85.6%,and the local-regional control rates was 96.5%,93.2%,93.2%,respectively.Statistics of the local control rate was insignificant either for advanced T(T3+T4) stage or early T(T1+T2) stage diseases(P=0.148).The 2-year regional control rate was insignificant either for patients with N(+) or N (-),but the 2-year DMFS was significant both for patients with N(+) and N(-)lesions(P=0.004).For 17 patients who failed,there were two with residual disease and one with recurrence at the primary site (17.6%),three patients in the neck (17.6%),twelve patients (70.6%) in distant metastases.Conclu- sions Intensity modulated radiation therapy does provide excellent local-regional control for untreated NPC, especially in patients with advanced T stage or N(+) lesion.Distant metastasis is the main cause of failure. N (+) is significantly correlated with distant metastasis.
RESUMEN
Objective To investigate the clinical value of FDG PET imaging in the follow up of nasopharyngeal carcinoma after radiotherapy. Methods Twelve patients with nasopharyngeal carcinoma underwent FDG PET, CT and/or MRI during the follow up of 12 18 months after radiotherapy. The results of FDG PET were double blind evaluated and compared with these of CT and MRI. The recurrent lesions in six of these patients were pathologically confirmed and six by CT scan. Results Nine of 12 patients did not show any recurrence by CT and MRI scans. However, FDG PET scans showed significantly increased FDG metabolism, indicating recurrence in 3 of these patients. In 2 patients, both CT/MRI and FDG PET indicated recurrence. The remaining one patient had radiotherapy induced cerebral necrosis. He was misdiagnozed as an intracranial recurrence by MRI, but FDG imaging was negative. Conclusions FDG PET imaging has an advantage in distinguishing the relapse or necrosis in the follow up of post radiotherapy nasopharyngeal carcinoma patients. PET, CT and MRI is able to give a detail both in morphological and functional changes of disease. They are especially useful in the follow up or the set up of treatment planning for recurrent nasopharyngeal carcinoma.