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Purpose:To investigate the influence of MRI on the Chinese 1992 staging system of nasopharyngeal carcinoma(NPC).Methods:From Oct.1992 to Jan.1996,86 patients with NPC who had MRI and CT prior to radiotherapy were retrospectively analyzed.The total dose to the primary tumor was 60.4～85.0 Gy(median,72.5 Gy).The fractionation schedule used was five daily fractions of 1.8～2.0 Gy per week.The survival rates were estimated by the Kaplan-Meier method.Log-rank was used to identify the prognostic factors.Results:The loco-regional control rate at 5 year was 84.2%,distant metastasis-free survival 80.1%,disease-free survival 73.9% and overall survival 82.7% with a median follow-up interval of 65.5 months(range 2～108 months).According to the Chinese 1992 staging system,there were 25 vs 14(25 by CT and 14 by MRI) patients with T_(1),21 vs 8 with T_(2),31 vs 42 with T_(3) and 9 vs 22 with T_(4) lesions.As a result,42.9%(12/28) of cervical nodal and 28.6%(8/28) of retropharyngeal lymphadenopathy alone should downstage from N_(0) to N_(1).Conclusions:The influence of MRI on the Chinese 1992 staging system was significant and the authors observed a worse distribution of patient numbers as well as poorer separation of survival curves among different stage groups.
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Objective To study retrospectively the outcome and failing factors of nasopharyngeal carcinoma(NPC) treated with late-course unconventional fractionation radiotherapy(LCUCFR). Methods From January 1996 to December 2000, 133 such patients were analyzed retrospectively. All had been confirmed by histopathology as poorly differentiated squamous cell carcinoma, including 101 males and 32 females. All were treated by LCUCFR. The nasopharyngeal lesion radiation schedule was as follows; 1.An initial conventional fractionation 34.5Gy/18f for face and neck port, with 1.92Gy per daily fractionation;2.The above regimen was followed by 1.25-1.50Gy per fraction twice daily in 6-8 days for pre-auricular port;3.The above regiment was then followed by conventional boosting dose 1.90Gy and 1.30Gy(morning 1.90Gy and afternoon 1.30Gy) twice daily(with interval of 6-8 hours) in 6-8 days. The whole course was 5 fractions per week with the median of 78Gy over a median of 47days. The positive and negative lymph node in the neck were treated by conventional radiotherapy with a median of 67Gy and a dose of 50-55Gy in median interval of 43 days. Results The 5-year nasopharyngeal lesion and neck metastasis lymph node control rate was 92.9% and 96.4%, respectively. T1,T2,T3 and T4 stage local control rate was 100%,96.6%,96.6% and 78.4%,respectively. The overall 5-year survival and disease-free survival rate was 73.3% and 70.8%,respectively. The 5-year distant-free metastasis rate was 80.2%. Fourteen varietes were used to analyze the prognosis. Both univariate and multivariate analyses revealed that the distant metastasis, lower neck and superclavicle area as well as both neck lymph node metastases and local recurrence were prognostic factors for 5-year survival rate(Logrank test all P
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0.05). For all patients, the WR relapse rates were 0%(0/43) in Group A and 1.6%(1/63) in Group B and for the core patients, these rates were 0%(0/34) and 2.2% (1/46),respectively.Conclusions WR prophylactic irradiation is not advisable in treatment of cervical primary NHL, especially when chemotherapy was combined. It is to protect the major salivary glands from radiation damage and improve the patient's quality of life. However, it is extremely important to routinely examine WR by CT scan,pharyngorhinoscopy and WR biopsy to rule out primary WR NHL.
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Objective To evaluate the clinical characteristics,treatment,outcome and complications of child and adolescent nasopharyngeal carcinoma (NPC). Methods From January 1970 to April 1997, the records of 145 NPC patients younger than 21 years of age were reviewed. The clinical stages according to 92'Chinese NPC Staging System were :stageⅠin 1, Ⅱin 8, Ⅲ in 79 and Ⅳ in 57. All patients were treated with external beam radiotherapy. Before 1988, parallel opposed lateral pre-auricular portals were chiefly used in 75 patients and after 1988, parallel opposed lateral facio-cervical portals were adopted in 70. The radiation dose to the primary tumor ranged 45-80?Gy: 70?Gy in 50 cases and 32 of them also received chemotherapy. Results Distant metastasis developed in 26 cases, while local and/or regional recurrence in 14. The actuarial overall survival rates of 1-, 3-, 5, and 10-years were 96.3%, 79.9%, 76.5% and 69.4%, respectively. Among 45 dead cases, 16 did so of metastasis, 11 of local and/or regional recurrence and 18 of other reasons. Univariate analysis suggested that clinical stage, size and site of involved lymph nodes, skull base involvement were significant prognostic factors of survival, whereas sex、age、dose、therapeutic method and chemotherapy were not. Conclusions 1. Even though the majority of pediatric and adolescent NPC were advanced, it signifies a relatively good survival. 2. As the normal tissue of pediatric and adolescent patients tolerates radiation poorly, prudence should be meticulously practiced in deciding the radiation dose and radiotherapeutic fields.
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Objective To evaluate the clinical results of three dimensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From May 1999 to May 2001, 104 patients with pathologically confirmed esophageal carcinoma were randomly divided into conventional radiotherapy (CT) and three dimensional conformal radiotherapy(3DCRT) groups, with 52 patients in each arm. The patients in CT group received conventional radiotherapy in 2.0?Gy/f, 5 fractions a week to a total dose of 70?Gy in 7 weeks. The patients in 3DCRT group were first treated by the same fractionation in CT group to the dose of 40?Gy, and then treated by 3DCRT in 3.0?Gy/f, 5 fractions a week to the total dose of 70?Gy in 6 weeks. Results The 1-and 3-year local control rates were 80.2% and 60.5% in 3DCRT group and 61.6% and 31.7% in CT group(?2 = 4.87, P