Retrospective analysis on 77 cases of T4b hypopharyngeal carcinoma treated by non-surgical treatments / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the effectiveness, safety and factors influencing the clinical prognosis of patients with hypopharyngeal carcinoma in T4b by nonsurgical treatments. Methods: The clinical data of 77 patients with T4b hypopharyngeal cancer treated in the College of Otolaryngology Head and Neck Surgery of the Chinese People's Liberation Army General Hospital from January 2010 to June 2021 were analyzed retrospectively. All were males, aged(57.0±8.0)years old. Patients were treated with induction chemotherapy plus concurrent chemoradiotherapy. Kaplan Meier survival analysis was used to compare the effects of different factors on prognosis. Adverse reactions during treatments and the causes of death were analyzed. Results: 98.7% of 77 patients with T4b hypopharyngeal cancer completed the chemotherapy plan and 94.8% completed the radiotherapy plan. The most common adverse reactions were grade 2 radiation oral mucositis (50/77, 64.9%) and grade 2 leukopenia (50/77, 64.9%). The incidence of grade 3 severe hoarseness was 7.8% (6/77), one patient (1.3%) underwent gastrostomy due to dysphagia, and pronunciation and swallowing function were effectively preserved in other patients. The overall survival rate was 71.9% at 1 year, 45.6% at 3 years and 29.7% at 5 years. The location of tumor, the presence of liquefaction necrosis in tumor, the use of molecular targeted drugs and the approach of radiotherapy were independent factors,each of which that affected the prognosis of T4b patients with advanced hypopharyngeal cancer [HR (95%CI) were 1.867(1.085-3.213), 3.018 (1.437-6.335), 0.372 (0.181-0.764) and 2.158 (1.015-4.588), respectively, P<0.05]. The two leading causes of death with high incidence were disease recurrence (12/32, 37.5%) and cervical large vessel rupture and hemorrhage (11/32, 34.4%). Conclusions: Non-surgical comprehensive treatment offers a high laryngeal preservation rate in patients with T4b hypopharyngeal cancer. The location of tumor, the liquefaction necrosis within tumor, the use of molecular targeted drugs, and the approach of radiotherapy are independent prognostic factors.

Incidence and Step-wise Therapy Management for Appropriate Shocks of Implantable Cardioverter Defibrillator in Heart Failure Patients / 中国循环杂志

Objective: To study the incidence of ventricular arrhythmia (VT) in heart failure (HF) patients after cardiac resynchronization therapy (CRT-D) and identify the influencing factors for VT occurrence, to explore the impact of CRT-D shocks on mortality and the management of appropriate shocks. Methods: A total of 42 patients with successfully implanted CRT-D in our hospital from 2009-01 to 2015-04 were studied. There were 2 groups of patients: Ischemic cardiomyopathy group,n=12 including 8 patients for primary prevention and 4 for secondary prevention; Non-ischemic cardiomyopathy group,n=30 including 19 patients for primary prevention and 11 for secondary prevention. The patients with appropriate shocks received four step-wise therapy as drug, equipment parameter adjustments, revascularization and radiofrequency ablation (RA). Results: The patients in Ischemic cardiomyopathy group were followed-up for (38.1±24.0) months, 7 patients suffered from post-operative VT, 5 patients had CRT-D appropriate shocks. The patients in Non-ischemic cardiomyopathy group were followed-up for (27.5±17.8) months, 11 patients suffered from post-operative VT, 10 patients had CRT-D appropriate shocks. The occurrence rates of post-operative VT and CRT-D appropriate shocks were similar between 2 groups,P>0.05; the success rate for ATP treating VT was higher in Ischemic cardiomyopathy group (69% vs 55%),P<0.05. Cox regression analysis indicated that CRT-D as secondary prevention was the independent influencing factor for VT occurrence,P=0.001. During follow-up period, 9 patients with shocks died; the mortality in patients with shocks was higher than those without shocks (43% vs 0%),P<0.05. With four step-wise therapy, 80% patients in Ischemic cardiomyopathy group had no more shocks; with three step-wise therapy as drug, equipment parameter adjustments and RA, 90% patients in Non-ischemic cardiomyopathy group had no more shocks, 10% patients had reduced shocks. Conclusion: CRT-D as secondary prevention was the independent impact factor for post-operative VT occurrence, no matter appropriate or inappropriate shocks would elevate the risk of death in HF patients. Step-wise therapy was important to reduce appropriate shocks.