Effect of Shengmai Yin on Epithelial-Mesenchymal Transition of Nasopharyngeal Carcinoma Radioresistant Cells / 中国结合医学杂志

OBJECTIVE@#To investigate the mechanism by which Chinese medicine Shengmai Yin (SMY) reverses epithelial-mesenchymal transition (EMT) through lipocalin-2 (LCN2) in nasopharyngeal carcinoma (NPC) cells CNE-2R.@*METHODS@#Morphological changes in EMT in CNE-2R cells were observed under a microscope, and the expressions of EMT markers were detected using quantitative real-time PCR (RT-qPCR) and Western blot assays. Through the Gene Expression Omnibus dataset and text mining, LCN2 was found to be highly related to radiation resistance and EMT in NPC. The expressions of LCN2 and EMT markers following SMY treatment (50 and 100 µ g/mL) were detected by RT-qPCR and Western blot assays in vitro. Cell proliferation, migration, and invasion abilities were measured using colony formation, wound healing, and transwell invasion assays, respectively. The inhibitory effect of SMY in vivo was determined by observing a zebrafish xenograft model with a fluorescent label.@*RESULTS@#The CNE-2R cells showed EMT transition and high expression of LCN2, and the use of SMY (5, 10 and 20 µ g/mL) reduced the expression of LCN2 and reversed the EMT in the CNE-2R cells. Compared to that of the CNE-2R group, the proliferation, migration, and invasion abilities of SMY high-concentration group were weakened (P<0.05). Moreover, SMY mediated tumor growth and metastasis in a dose-dependent manner in a zebrafish xenograft model, which was consistent with the in vitro results.@*CONCLUSIONS@#SMY can reverse the EMT process of CNE-2R cells, which may be related to its inhibition of LCN2 expression. Therefore, LCN2 may be a potential diagnostic marker and therapeutic target in patients with NPC.

Study on the sensitivity of a volumetric modulated arc therapy plan verification equipment on multi-leaf collimator opening and closing errors and its gamma pass rate limit / 生物医学工程学杂志

To investigate the γ pass rate limit of plan verification equipment for volumetric modulated arc therapy (VMAT) plan verification and its sensitivity on the opening and closing errors of multi-leaf collimator (MLC), 50 cases of nasopharyngeal carcinoma VMAT plan with clockwise and counterclockwise full arcs were randomly selected. Eight kinds of MLC opening and closing errors were introduced in 10 cases of them, and 80 plans with errors were generated. Firstly, the plan verification was conducted in the form of field-by-field measurement and true composite measurement. The γ analysis with the criteria of 3% dose difference, distance to agreement of 2 mm, 10% dose threshold, and absolute dose global normalized conditions were performed for these fields. Then gradient analysis was used to investigate the sensitivity of field-by-field measurement and true composite measurement on MLC opening and closing errors, and the receiver operating characteristic curve (ROC) was used to investigate the optimal threshold of γ pass rate for identifying errors. Tolerance limits and action limits for γ pass rates were calculated using statistical process control (SPC) method for another 40 cases. The error identification ability using the tolerance limit calculated by SPC method and the universal tolerance limit (95%) were compared with using the optimal threshold of ROC. The results show that for the true composite measurement, the clockwise arc and the counterclockwise arc, the descent gradients of the γ passing rate with per millimeter MLC opening error are 10.61%, 7.62% and 6.66%, respectively, and the descent gradients with per millimeter MLC closing error are 9.75%, 7.36% and 6.37%, respectively. The optimal thresholds obtained by the ROC method are 99.35%, 97.95% and 98.25%, respectively, and the tolerance limits obtained by the SPC method are 98.98%, 97.74% and 98.62%, respectively. The tolerance limit calculated by SPC method is close to the optimal threshold of ROC, both of which could identify all errors of ±2 mm, while the universal tolerance limit can only partially identify them, indicating that the universal tolerance limit is not sensitive on some large errors. Therefore, considering the factors such as ease of use and accuracy, it is suggested to use the true composite measurement in clinical practice, and to formulate tolerance limits and action limits suitable for the actual process of the institution based on the SPC method. In conclusion, it is expected that the results of this study can provide some references for institutions to optimize the radiotherapy plan verification process, set appropriate pass rate limit, and promote the standardization of plan verification.

Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer / Correlação dos achados de PET-CT, RM e histopatologia no seguimento de pacientes com carcinoma nasofaríngeo

Abstract Introduction: Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the postradiotherapy period is improved. Objective: The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. Methods: A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients' age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. Results: Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). Conclusions: Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Resumo Introdução: As opções de tratamento cirúrgico são limitadas para o carcinoma nasofaríngeo por várias razões, inclusive aspectos epidemiológicos e histológicos, proximidade de estruturas importantes, drenagem linfática carregada e dificuldade de garantir uma margem cirúrgica segura; portanto, o tratamento primário é geralmente radioterapia e quimioterapia. Com a tecnologia atual de radioterapia, o sucesso oncológico aumentou e a qualidade de vida dos pacientes durante o período pós-radioterapia é garantida. Objetivo: O papel da ressonância magnética e da tomografia computadorizada por emissão de pósitrons no seguimento de pacientes com carcinoma nasofaríngeo recorrente, inicialmente tratados com radioterapia, foi avaliado em relação aos achados histopatológicos. Método: Foram incluídos no estudo 110 pacientes com carcinoma nasofaríngeo que receberam radioterapia. Pacientes com suspeita de recorrência de acordo com o exame endoscópico nasofaríngeo e com achados de ressonância magnética foram solicitados a fazer tomografia computadorizada por emissão de pósitrons. Foram feitas biópsias de 40 pacientes com lesões suspeitas nas imagens de tomografia computadorizada por emissão de pósitrons. Os pacientes foram avaliados segundo idade, sexo, presença/ausência de realce por contraste na ressonância magnética, valores SUVmax de lesões nasofaríngeas e cervicais, estágios T/N no diagnóstico inicial, recorrência histopatológica e histórico de esvaziamento cervical. Resultados: A recorrência foi observada em 8 pacientes (20,0%). Entre esses, 4 (10,0%) apresentaram recorrência na nasofaringe e 4 (10,0%) no pescoço. Pacientes com recorrência eram do sexo masculino, apresentavam idade mais avançada, estágio avançado T/N, realce por contraste na ressonância magnética e maiores valores de SuvMax nasofaríngeo e cervical na tomografia computadorizada por emissão de pósitrons. Entretanto, essas diferenças não foram estatisticamente significantes. Apenas o histórico de esvaziamento cervical foi significantemente mais comum entre aqueles com recorrência (p < 0,001). No entanto, na análise multivariada, aqueles com um valor de SUVmax nasofaríngeo superior a 4,58 apresentaram um risco 7,667 vezes maior de recorrência (p = 0,036). Conclusão A ressonância magnética e a tomografia computadorizada por emissão de pósitrons devem ser avaliadas em conjunto no seguimento da doença. Pacientes com valor de SUVmax mínimo de 4,58 na tomografia computadorizada por emissão de pósitrons após realce com contraste na sequência T2 na ressonância magnética podem ser considerados mais adequados para biópsia. Biópsias em pacientes com um valor de SUVmax menor do que 4,58 podem ser evitadas. Dessa forma, podemos evitar o estresse cirúrgico para o paciente e custos desnecessários.

Plasmocitoma extramedular de laringe: a propósito de un caso / Extramedullary plasmacytoma of the larynx: a case report

Resumen Los plasmocitomas solitarios son una rara forma de presentación de neoplasias de células plasmáticas. Deben ser diferenciados del mieloma múltiple en el momento del diagnóstico y realizar un seguimiento estricto por el riesgo de transformación a mieloma. La localización de los mismos en la laringe es muy inusual, dado que sólo se han publicado 56 casos. Se presenta el caso de una paciente con un plasmocitoma extramedular de laringe que se trató mediante cirugía y radioterapia. Se revisan los criterios diagnósticos y los problemas terapéuticos.

Abstract Solitary plasmacytomas are a rare form of plasma cell neoplasms. They should be differentiated from multiple myeloma at the time of diagnosis and strictly monitored for the risk of transformation to myeloma. Their location in the larynx is very unusual, since only 56 cases have been published. We present the case of a patient with extramedullary plasmacytoma of the larynx that has been treated with surgery and radiotherapy. We reviewed the literature for diagnostic criteria and therapeutic problems.

Segmentation of organs at risk in nasopharyngeal cancer for radiotherapy using a self-adaptive Unet network / 南方医科大学学报

OBJECTIVE@#To investigate the accuracy of automatic segmentation of organs at risk (OARs) in radiotherapy for nasopharyngeal carcinoma (NPC).@*METHODS@#The CT image data of 147 NPC patients with manual segmentation of the OARs were randomized into the training set (115 cases), validation set (12 cases), and the test set (20 cases). An improved network based on three-dimensional (3D) Unet was established (named as AUnet) and its efficiency was improved through end-to-end training. Organ size was introduced as a priori knowledge to improve the performance of the model in convolution kernel size design, which enabled the network to better extract the features of different organs of different sizes. The adaptive histogram equalization algorithm was used to preprocess the input CT images to facilitate contour recognition. The similarity evaluation indexes, including Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD), were calculated to verify the validity of segmentation.@*RESULTS@#DSC and HD of the test dataset were 0.86±0.02 and 4.0±2.0 mm, respectively. No significant difference was found between the results of AUnet and manual segmentation of the OARs (@*CONCLUSIONS@#AUnet, an improved deep learning neural network, is capable of automatic segmentation of the OARs in radiotherapy for NPC based on CT images, and for most organs, the results are comparable to those of manual segmentation.

Angiofibroma de fosa temporal: reporte de un caso / Temporal fossa angiofibroma: a case report

RESUMEN El angiofibroma nasofaríngeo es el tumor benigno más frecuente de la nasofaringe, representando el 0,05% del total de las neoplasias de cabeza y cuello. Los angiofibromas en localizaciones distintas a la nasofaringe son entidades raras. Ellos son descritos esporádicamente en la literatura, ubicándose principalmente en el seno maxilar. En este artículo presentamos un caso de fibroangioma extranasofaríngeo localizado en fosa temporal derecha seguido de una revisión de literatura.

ABSTRACT Nasopharyngeal angiofibroma is the most common benign tumor of the nasopharynx, representing 0.05% of total neoplasms of the head and neck. Extranasopharyngeal angiofibromas are rare entities described sporadically in the literature, being located mainly in the maxillary sinus. We present a case of an extra-nasopharyngeal fibroangioma located in the right temporal fossa followed by a literature review.

Spinal Cord Glioblastoma Induced by Radiation Therapy of Nasopharyngeal Rhabdomyosarcoma with MRI Findings: Case Report

Radiation-induced spinal cord gliomas are extremely rare. Since the first case was reported in 1980, only six additional cases have been reported.; The radiation-induced gliomas were related to the treatment of Hodgkin's lymphoma, thyroid cancer, and medullomyoblastoma, and to multiple chest fluoroscopic examinations in pulmonary tuberculosis patient. We report a case of radiation-induced spinal cord glioblastoma developed in a 17-year-old girl after a 13-year latency period following radiotherapy for nasopharyngeal rhabdomyosarcoma. MRI findings of our case are described.

Aesthetic management of tooth discolouration: conservative treatment for a patient with undifferentiated nasopharyngeal carcinoma / Abordagem estética da descoloração dentária: tratamento conservador de um paciente com carcinoma nasofaríngeo indiferenciado

PURPOSE: Dental aesthetics has considerable impact in our beauty-conscious society. The darkening of the anterior teeth causes concern for adolescents due to the compromised physical appearance. This article presents a clinical case of tooth staining in an individual who had undergone radiotherapy/chemotherapy for an undifferentiated nasopharyngeal carcinoma. CASE DESCRIPTION: A 14-year-old boy presented to the dental clinic complaining of pain and staining of the maxillary and mandibular incisors, canines and premolars after having undergone radiotherapy/chemotherapy and stated his desire to remove the dark stains from the surface of the teeth due to his compromised oral aesthetics. Tooth whitening was performed with hydrogen peroxide, followed by micro-abrasion. At a two-year follow-up visit, clinical success was observed and the child was very satisfied. CONCLUSION: The adoption of such methods provided efficient alternatives for the re-establishment of a healthy smile, thereby returning pleasing facial aesthetics to the patient. The minimization of distress is nearly always the focus of clinical efforts at promoting psychological health in cancer survivors.

OBJETIVO: Atualmente, a estética dentária tem um impacto considerável na sociedade. O escurecimento dos dentes anteriores causa preocupação para os adolescentes, devido à aparência física comprometida. Este artigo apresenta um caso clínico de descoloração dentária em um indivíduo submetido a radioterapia/quimioterapia para tratamento de um carcinoma indiferenciado de nasofaringe. DESCRIÇÃO DO CASO: Um adolescente do gênero masculino, de 14 anos de idade, apresentou-se à clínica odontológica com queixa de dor e pigmentação dos incisivos superiores e inferiores, caninos e pré-molares após ter sido submetido a radioterapia/quimioterapia, declarando seu desejo de remover as manchas escuras na superfície do dentes comprometidos, devido à sua estética bucal. Foi realizado um clareamento dentário com peróxido de hidrogênio, seguido por micro-abrasão. Em um período de dois anos de seguimento, foi observado o sucesso clínico e a satisfação da criança. CONCLUSÃO: A adoção de tais métodos proporciona alternativas eficientes para o restabelecimento de um sorriso saudável, resgatando assim uma imagem facial agradável para o paciente. A minimização do sofrimento é geralmente o foco dos esforços clínicos visando a promoção da saúde psicológica em pacientes que sobreviveram ao câncer.

Multi-institutional Comparison of Intensity Modulated Radiation Therapy (IMRT) Planning Strategies and Planning Results for Nasopharyngeal Cancer

The intensity-modulated radiation therapy (IMRT) planning strategies for nasopharyngeal cancer among Korean radiation oncology facilities were investigated. Five institutions with IMRT planning capacity using the same planning system were invited to participate in this study. The institutions were requested to produce the best plan possible for 2 cases that would deliver 70 Gy to the planning target volume of gross tumor (PTV1), 59.4 Gy to the PTV2, and 51.5 Gy to the PTV3 in which elective irradiation was required. The advised fractionation number was 33. The planning parameters, resultant dose distributions, and biological indices were compared. We found 2-3-fold variations in the volume of treatment targets. Similar degree of variation was found in the delineation of normal tissue. The physician-related factors in IMRT planning had more influence on the plan quality. The inhomogeneity index of PTV dose ranged from 4 to 49% in Case 1, and from 5 to 46% in Case 2. Variation in tumor control probabilities for the primary lesion and involved LNs was less marked. Normal tissue complication probabilities for parotid glands and skin showed marked variation. Results from this study suggest that greater efforts in providing training and continuing education in terms of IMRT planning parameters usually set by physician are necessary for the successful implementation of IMRT.

Avaliação dos fatores clínicos e do tratamento em pacientes com carcinoma indiferenciado da nasofaringe / Assessment of clinical and therapeutic factors in patients with nasopharyngeal undifferentiated carcinoma

O carcinoma de nasofaringe é neoplasia rara, com incidência maior em países do Sudeste Asiático. OBJETIVO: Avaliar dados demográficos, clínicos, terapêuticos e prognósticos do carcinoma indiferenciado de nasofaringe em um serviço de referência. CASUÍSTICA E MÉTODO: Estudo retrospectivo de 46 pacientes, de janeiro de 1978 a agosto de 2000. Nenhum paciente foi previamente tratado e não apresentava tumor sincrônico e metástase à distância. RESULTADOS: A idade variou de 14 a 78 anos (média, 46), sendo 35 (76 por cento) pacientes masculinos. Todos eram de etnia caucasiana ou afro-brasileira. O tempo de história variou de 1 a 48 meses (média, 7), sendo 47 por cento tabagistas e 33 por cento etilistas. O sintoma mais relatado foi a presença de nódulo no pescoço (34 pacientes). Quanto ao estadiamento clínico, 22 foram estadiados como T1/T2 e 24 como T3/T4, enquanto 24 foram classificados como N2 e 16, N3. O tratamento instituído com finalidade curativa foi a radioterapia, associada à quimioterapia concomitante nos estádios III e IV. Dos 27 pacientes com seguimento após o tratamento inicial, 52 por cento apresentavam-se vivos e livres de doença há três anos. CONCLUSÃO: Os pacientes eram de estádio clínico avançado, com sobrevida livre de doença em três anos de 52 por cento.

The nasopharyngeal carcinoma (NPC) is a rare cancer with a high incidence in Southern Asia. AIM: to study the demographic, clinical, therapeutic, and prognostic factors of nasopharyngeal undifferentiated carcinoma in a reference service. MATERIALS AND METHODS: A retrospective study was made of 46 patients from January 1998 to August 2000. The patients had no previous treatment and did not present any evidence of synchronous tumors or distance metastases. RESULTS: The age ranged from 14 to 78 years (mean = 46 years); 35 (76 percent) patients were male. All patients were Caucasian or African-Brazilian. The onset of initial symptoms ranged from 1 to 48 months (mean = 7 months); 47 percent of the subjects smoked tobacco and 33 percent consumed alcoholic beverages. A lump in the neck was the most frequent symptom (34 patients). Twenty-two patients were clinically staged as T1/T2 and 24 patients as T3/T4; 24 patients were classified as N2, and 16 patients were staged as N3. Curative treatment consisted of radiotherapy and simultaneous chemotherapy in clinical stages III and IV. Of 27 patients that were monitored, 52 percent were alive with no evidence of disease after three years. CONCLUSION: All patients were in advanced clinical stages of the disease. The three-year disease-free survival rate was 52 percent.

Reduced incidence and severity of acute radiation mucositis by WF10 (IMMUNOKINE) as adjunct to standard of cure in the management of head & neck cancer patients.

OBJECTIVE: To evaluate the role of WF10-immunotherapy in reducing oro-pharyngeal complications in head and neck cancer chemoradiotherapy. MATERIAL AND METHOD: Thirteen patients were enrolled and assigned either to WF10- (n = 6) or control group (n = 7). After completion of their initial (neoadjuvant) chemotherapy, patients received WF10 intravenous infusions at 0.5 mL/kg body weight/day for five consecutive days and repeated every 3 weeks, concomitantly to standard radiotherapy (6,600-7,500 cGy, 200 cGy/day). Control patients received radiotherapy alone. RESULTS: Patients in the WF10-group had a lower incidence of oro-pharyngeal complications grade > 2, including oral mucositis (1 vs. 5), dysphagia (2 vs. 7), oral pain (3 vs. 5), taste alteration (4 vs. 6) and weight loss (2 vs. 4). The statistical significances were achieved for the parameters of oral mucositis (p = 0. 048) and dysphagia (p = 0.009). CONCLUSION: WF10 appears to reduce severity of oro-pharyngeal complications associated with standard chemoradiotherapy for head and neck cancer.

Evaluation of radiation-induced xerostomia in patients with nnasopharyngeal carcinomas

Salivary glands are extremely susceptible to radiation injuries. The aim of this study was to evaluate radiation-induced xerostomia in patients with nasopharyngeal carcinomas, referring to Tabriz Imam Khomeini Hospital in 2005-2006. Thirty patients with nasopharyngeal carcinomas, who received conventional radiotherapy, were included in the present study. The patients' unstimulated saliva samples were collected at three intervals, i.e. before treatment, 3 weeks after the initiation of treatment and at the end of treatment by spitting, and measured with a graduated pipette. The differences in the mean values of the patients' salivary flow rates at three afore-mentioned intervals were statistically significant [p < 0.001]. Two-by-two comparison of the mean values of salivary flow rates of all the patients and of males and females, carried out separately, demonstrated statistically significant differences [p < 0.0025]. However, there were no statistically significant differences between males and females before treatment [p = 0.723], 3 weeks after the initiation of treatment [p = 0.724] and at the end of treatment [p = 0.595]. There were no statistically significant relationships between age and a decrease in salivary flow rate in the total sample [p = 0.76, r = -0.057], in males [p = 0.96, r = 0.011] and in females [p = 0.539, r = -0.208]. Conventional radiotherapy results in severe xerostomia in 3 weeks in patients with nasopharyngeal carcinomas. Age and sex do not influence radiotherapy-induced xerostomia

Tumor carcinóide de nasofaringe: relato de caso / Nasopharynx carcinoid tumor: case report

O artigo descreve o caso de um tumor carcinóide de nasofaringe confirmado por análise imuno-histoquímica. A topografia atingida é incomum nesta doença, que tem predileção por sítios gastrointestinais (apêndice íleo-cecal, íleo e reto), e em menor proporção por sítios do trato aerodigestivo, sendo mais comuns os brônquios e a laringe. Paciente de 55 anos apresentou-se com obstrução nasal, cefaléia e dor retro-orbitária, com exames complementares que evidenciavam volumosa massa em nasofaringe com extensão para cavidade nasal e base de crânio; sem doença em outra topografia. Foi realizada biópsia, via fossa nasal, cujo laudo histopatológico evidenciou tumor carcinóide de nasofaringe bem diferenciado, extremamente celular e monótomo à HE; ao AE1/AE3 apresentou reatividade para ceratina com formação de DOT paranuclear e cromogramina; S100 e citoqueratina negativos.Devido à irressecabilidade do tumor, foi indicada radioterapia paliativa com 70Gy em 35 frações. O resultado clínico foi satisfatório porém sem involução tumoral significativa. A radioterapia pode ser utilizada exclusivamente em tratamento paliativo, porém seus resultados no controle de doença local são ruins.

Neoadjuvant chemotherapy and radiotherapy versus radiotherapy alone in patients with advanced nasopharyngeal carcinoma

A randomized study was carried out between January 1987 and December 1993 at the Kuwait Cancer Control Centre, to evaluate the efficacy of neoadjuvant chemotherapy and radiotherapy over radiotherapy alone inpatients with locally advanced nasopharyngeal carcinoma. Forty three patients were randomized to recive either neoadjuvant chemotherapy and radiotherapy [Combination arm] or radiotherapy alone. All the patients had stage IV disease. The tolerance to combination arm was inferior to that of radiation arm. There was no difference in the locoregional control rate between the two arms. Response rate following chemotherapy was 88%, which increased to 94% following radiotherapy. The overall response rate in the radiotherapy arm alone was 95%. At the median one of year of the follow up the failure rate in the radiotherapy arm was 26% and in the combination arm 24%. Three patients in the combination arm and two patients in the radiotherapy arm developed distant metastses

Hyperfractionated re-irradiation using a 3-dimensional conformal technique for locally recurrent carcinoma of the nasopharynx; preliminary results

To evaluate the efficacy of hyperfractionated re-irradiation using a three-dimensional conformal radiotherapy (3-D CRT) technique in patients with locally recurrent carcinoma of the nasopharynx. Four patients with locally recurrent nasopharyngeal cancer were retreated with a hyperfractionated schedule using a 3-D CRT technique. Re-irradiation was delivered in 1.1-1.2 Gy fractions twice per day (BID), with interfraction intervals of more than 6 hours. The total dose ranged from 59.4 to 69.2 Gy. A 3-D CRT technique with 5- or 6-field coplanar and/or non-coplanar beams were employed during the entire treatment procedure. All four patients achieved complete remission of locally recurrent lesions, with marked improvement of subjective symptoms, immediately after re-irradiation. All are alive and well without evidence of disease after limited follow-up periods, which range from 7 to 20 months. So far, there have been no radiation-induced neurologic complications. Four patients with locally recurrent carcinoma of the nasopharynx were successfully treated by hyperfractionated re-irradiation using a 3-D CRT technique. A relatively high re-irradiation dose of more than 60 Gy may be safely delivered with no serious acute or late radiation-induced complications in patients with local recurrences and who were initially treated with doses greater than 70 Gy.

Tratamiento radiante del cáncer de nasofaringe: experiencia del Instituto de Oncología y Radioterapia de Mar del Plata / Radiation treatment of the nasopharyngeal carcinoma

Se analizaron los resultados terapéuticos de 28 pacientes con carcinoma de nasofaringe irradiados en el Instituto de Oncología y Radioterapia de Mar del Plata desde 1976 hasta 1984. El tratamiento consistió en radioterapia exclusiva en 23 pacientes y en 5 pacientes en radioterapia más quimioterapia. La sobrevida global libre de enfermedad a los 3 años fue de 43,5 por ciento. El sitio en que con mayor frecuencia se observó fracaso terapéutico, fue el tumor primario. En efecto, 13 pacientes (46%) fallaron en dicha área. Uno de los pacientes que recidivó en el tumor primario pudo ser rescatado con reirradicación del área nasofaríngea. Se pone en evidencia en este trabajo la importancia de administrar dosis altas al tumor primario (*7000cGy) para obtener una mayor tasa de control local, y la necesidad de lograr una combinación de agentes quimioterapéticos más efectiva para curar una mayor proporción de pacientes con carcinoma de nasofaringe

Sarcomas de partes blandas de localizaciones parameníngeas en el niño: valoración del tratamiento radiante / Childhood soft tissue sarcoma in parameningeal sites: assessment of radiation therapy

En un grupo de 21 niños con sarcomas de partes blandas de localizaciones parameningeas (nasofaringe, senos perinasales, órbita, fosas nasales y oido medio) tratados con la asociación radioterapia-poliquimioterapia se alcanzó una supervivencia del 27,09% En 12 niños, donde la irradiación estuvo localizada en el área del tumor con una dosis en el rango de 56 a 60 Gy,la supervivencia alcanzada fue de 20.83%, estabilizada a partir de los 38 meses de evoluciòn. En 9 niños la irradiación incluyó, además del tumor primario con dosis entre 55 y 65 Guy, la irradiación de todo el cráneo con dosis entre 24 y 30 Guy, con una supervivencia del 40 %, estabilizada en el mes 13 de la evolución. En ambos grupos se empleó la quimioterapia con la combinación vincristina,ciclofosfamida y actinomicin D (VAC) y además la adriamicina (VACA). La diferencia en la supervivencia alcanzada en ambos grupos es estadisticamente significativa a favor de la irradiación extendida al cráneo y demuestra la utilidad de esta en el tratamiento de estos tumores parameníngeos

Tratamiento radiante del cáncer de nasofaringe, experiencia del Instituto de Oncología y Radioterapia de Mar del Plata

Se analizaron los resultados terapéuticos de 28 pacientes con carcinoma de nasofaringe irradiados en el Instituto de Oncología y Radioterapia de Mar del Plata desde 1976 hasta 1984. El tratamiento consistió en radioterapia esclusiva en 23 pacientes y en 5 pacientes en radioterapia mas quimioterapia. La sobrevida global libre de enfermedad a los 3 años fue del 43,5%. El sitio en que con mayor frecuencia se observó fracaso terapéutico, fue el tumor primario. En efecto 13 pacientes (46%) fallaron en dicha área. Uno de los pacientes que recidivó en el tumor primario pudo ser rescatado con reirradiación del área nasofaringea. Se pone en evidencia en este trabajo la importancia de administrar dosis altas al tumor primario (> 7000 cGy) para obtener una mayor tasa de control local, y la necidad de lograr una combinación de agentes quimioterapéuticos más efectiva acrar una mayor proporción de pacientes con carcinoma de nasofaringe