Clinical study of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#Using propensity score matching method (PSM) to investigate the clinical effect of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma.@*Methods@#From July 2007 to July 2018,174 postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma were enrolled in pre-PSM cohort, including 168 males and 6 females, the median age was 60 years old (ranged from 37 to 79 years old).Loco-regional control (LRC),progression-free survival (PFS) and overall survival (OS) were compared and analyzed between the patients treated with postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy (cisplatin was given in a dose of 80 mg/m2 on days 1, 22, and 43). After the propensity score matching (PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort. Survival rate were assessed with Kaplan-Meier method and Log-rank test.@*Results@#After the propensity score matching(PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort.The patients were followed up for 3-135 months, the median follow-up was 42 months. No significant differences in 3-year and 5-year LRC, PFS, OS were observed between the two groups (P>0.05) . For postoperative patients who had high-risk factors (extracapsular extension of nodal disease, and/or vascular embolism, and/or lymph node metastasis≥2, and/or positive surgical margin, and/or perineural infiltration),there were significant differences between the two groups in 3-year PFS (60.99% vs 84.49%,P<0.05), 5-year PFS (35.47% vs 56.97%,P<0.05) and 5-year LRC (41.02% vs 68.50%, P<0.05), but no significant difference was found in OS between the two groups (P>0.05).@*Conclusion@#Postoperative concurrent chemoradiotherapy was more efficacious than postoperative radiotherapy alone in terms of loco-regional control and PFS for high-risk postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma.

A retrospective study on combined modality therapy with or without surgery for advanced hypopharyngeal squamous cell carcinoma: an analysis of 119 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To compare the treatment outcomes for locally advanced hypopharyngeal carcinoma between surgery plus radio(chemo) therapy(SRT) and non-surgery chemoradiotherapy(CRT).@*Methods@#A total of 119 patients diagnosed with advanced hypopharyngeal carcinoma without distant metastases between 2010 and 2014 were identified in the Chinese People′s Liberation Army General Hospital, and they were divided into 2 groups: 42 cases in SRT group and 77 cases in CRT group. Patients′ clinical information was collected. Survival rates and prognostic factors were analyzed by the Kaplan-Meier method with SPSS 23.0 software. The survival rates, laryngeal preservation rates and complication rates were compared between the two groups using the chi-square test.Among the 119 patients, 112 were males and 7 were females. Age ranged from 27 to 78 years, with an average age of 57 years.@*Results@#There were no significant difference between the SRT and CRT group for five-year disease-free survival (DFS, 53.9% vs. 45.1%, χ2=1.251, P=0.263) and overall survival (OS, 54.9% vs. 45.6%, χ2=1.749, P=0.186). Compared to SRT group, CRT group did not showed the significant increase of treatment complications (χ2=0.858, P=0.354), with a higher laryngeal preservation rate (50.0% vs. 71.4%, χ2=6.493, P=0.011).@*Conclusions@#Advanced hypopharyngeal carcinoma is of high malignancy and poor prognosis. Combined modality treatment is a main approach for advanced hypopharyngeal cancer. SRT offers disease-free survival and overall survival rates equivalent to CRT, but with a higher laryngeal preservation rate.

Clinical features of inflammatory myofibroblastic tumor in the head and neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of inflammatory myofibroblastic tumor (IMT) in head and neck and to discuss its treatment.</p><p><b>METHODS</b>Twenty-seven cases of IMT in head and neck diagnosed at the Chinese PLA General Hospital from 2004 to 2012 were analyzed retrospectively. Among the 27 patients, 12 males and 15 females, age ranged from 8 to 77 years, with a median 43 years old. Treatment included: 1 with radiotherapy, 22 with surgery, 3 with surgery and postoperative radiotherapy, one with concurrent chemoradiotherapy followed by surgery. Of the 27 cases, 5 located in the neck, 6 in the nasal and paranasal sinus, 4 in the temporal bone, 3 in the throat, 2 in the parotid gland, 2 in the lower pharynx, 1 in the mandible, 1 in the maxilla, 1 in the masseter muscle, 1 in the amygdala and 1 in the pharynx nasalis.</p><p><b>RESULTS</b>Following-up time was 4-85 months, with a median of 26 months. Six cases lost follow-up, 1 case with malignant transformation and died, 16 cases survived with no recurrence, 4 cases relapsed, of whom 2 were alive with tumors and 2 died.</p><p><b>CONCLUSIONS</b>IMT in the head and neck has a tendency to be malignancy, with certain recurrence rate and mortality. Radical excision is still the first choice of treatment for IMT in head and neck.</p>

Retrospective analyses of postoperative survival of laryngeal carcinoma patients at late stage / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the postoperative survival rate of laryngeal carcinoma patient at stage III or IV whom accepted partial laryngectomy and total laryngectomy.@*METHOD@#We performed a retrospective cohort follow-up study of 126 patients of stage III or IV who underwent operation for laryngeal carcinoma in Chinese PLA General Hospital between January, 2005 and December, 2009. Survival rates were calculated by product-limit method.@*RESULT@#There were 80 patients at stage III and 46 patient at stage IV. Sixty five patients underwent partial laryngectomy and 61 patients underwent total laryngectomy. There were 24 patients in whole group died in the 5 years, 15 of them underwent partial and 9 accepted total laryngectomy. The 5-years survival rate of partial and total group were 62.58% and 68.74% respectively. The survival curve of both groups had no significant difference (P < 0.05).@*CONCLUSION@#For laryngeal carcinoma patients at later stage, with suitable operative indication, the partial laryngectomy could achieve an acceptable effect as well as total laryngectomy.

Research of postoperative quality of life of laryngeal carcinoma patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore and compare the effect of clinical characters on quality of life (QOL) of laryngeal carcinoma postoperative patients.@*METHOD@#We performed a retrospective cohort follow up study of 303 patients who underwent operation for laryngeal carcinoma. The Chinese version of the general and the head and neck specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC QLQ-H&H35) were used to measure the quality of life of those patients in the cohort, to study the relationship between QOL and clinical factors.@*RESULT@#In the 303 cases, there were 78 cases retaining the permanent tracheostomies (59 total laryngectomy and 19 partial laryngectomy); 4 patient retain the nasal feed pipe. Female patients were worse than male patients in the domain of physical function and global QOL (P<0.05). Older patients were worse than younger patients in the domain of physical function and speech (P<0.05). Patients with glottic tumors experience better global QOL than their peers with under glottic or supraglottic tumors. The patients with supraglottic tumor have more problem with swallowings (P<0.05). Earlier stage patients have better suitation in many domains than later stage patients, but III stage have more difficulty with swallowing than IV stage. Patients who accepted minimally invasive operation and laryngofissure have better QOL than those accepted partial laryngectomy or total laryngectomy; total laryngectomee have more problems with physical, emotion function, global QOL, sense, speech, cough and morbid feeling than patients with partial laryngectomy, but less problem with fatigue, pain, dyspnea, swollowing and dry mouth; Patients with partial horizontal laryngectomy have more difficulty with swallowing. In the multivariable analysis, the operation mode was an independent factor to speech problem. Patients who accepted neck dissction have more negative outcomes than patients without neck dissection. In the univariable analysis, the permanent tracheostomy was a notable factor which affected many domains in the quality of life; multivariable analysis showed that permanent tracheostomy was an important factor which worked on global quality of life.@*CONCLUSION@#The quality of life was affected by many clinical factors. The operation mode was an independent factor which affect speech problem. Decannulation after partial laryngectomy was very important to keep the quality of life.

Commissioning of GyroKnife digital cobalt-60 system for stereotactic radiotherapy and radiosurgery in dosimetric aspects / 中华放射肿瘤学杂志

Objective To introduce and evaluate the dosimetric characteristics of a GyroKnife cobalt-60 system for radiosurgery.Methods0.015 cm3 and 0.600 cm3 ionization chamber,EDR2 film and semiconductor dosimeter were used to measure the dose rate of center point for the four collimators.The diameter of the four collimators were 5 mm,12 mm,30 mm and 50 mm,respectively.0.015 cm3 ionization chamber was used to test the dose-time linear relationship and dose stability.0.015 cm3 ionization chamber and semiconductor was used to measure the dose error of phantom between treatment planning system (TPS)calculation and measurement.The film was used to measure the error of TPS calculation isodose lines width.ResultsThe results from the four measurement methods have no significant difference for the collimator 50 mm.But for collimator 5 mm great discrepancy appeared.The error between calculation by TPS and the measurement by semiconductor was biggest and the value was 4.8％.Most of the error was within 3.0％.The error of the 50％ isodose line along x-axis was biggest and the value was 4.9 mm,others are all within 2.0 mm.ConclusionThe dosimetric character of this system is suitable for stereotactic radiotherapy.

Commissioning of a GyroKnife digital 60Co system / 中华放射医学与防护杂志

Objective To introduce and evaluate the characteristics of a GyroKnife Digital Cobalt-60 System for stereotactic radiotherapy and radiosurgery in mechanical aspect.Methods To test the radiation safety,the dose rate required for radiation protection was measured by using an ionization survey meter ( Inovision Model 451 B,Cleveland,OH ).Micrometer was used to verify the accuracy of the table in movement and protractor to verify the rotation movement range.The 160 mm diameter polystyrene spherical phantom and film were used in measurement of the radiation Full Width at Half Maximum.And the difference between radiation isocenter and mechanical isocenter was also verified.Results Clinical requirement in radiation protection was met.The maximum error of table movement accuracy was 0.2 cm at Z axis; the maximum error of gantry movement accuracy was 0.1°.For all the collimators,radiation Full Width at Half Maximum ( FWHM ) was 2.55,5.40,10.50,and 18.55 mm and average penumbra was 5.0,12.4,30.1,and 51.5 mm,respectively.The maximum difference between mechanical center and radiation center was 1.41 mm.Conclusions Stereotactic radiotherapy and radiosurgery has good mechanical characteristics and is suitable clinic applications.

Clinical observation of 116 cases of laryngofissure avoiding tracheotomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical effect of laryngofissure without tracheotomy.@*METHOD@#One hundred and sixteen cases of laryngofissure without tracheotomy in our department were analyzed retrospectively.@*RESULT@#Of 116 cases, 101 cases had the laryngeal carcinoma; 9 cases had laryngeal stenosis; 6 cases had benign tumor of larynx. All the incisions were healed by first intention; and postoperative duration of hospital stay were 7 to 20 days. Three cases recurred in 101 cases of laryngeal carcinoma (2.97%), and underwent reoperation,the 5 year survival rate was 100%. One case recurred in 9 cases of laryngeal stenosis, and underwent reoperation of laryngoplasty with T-tube implanted. No recurrence in 6 cases of benign tumor of larynx.@*CONCLUSION@#Laryngofissure with out tracheotomy have the advantage of less trauma, fast rehabilitation and no destroying the normal respiratory functions. It is completely feasible so long as surgeons grasp the adaption of operation strictly and select suitable cases.

Clinical observation of 116 cases of laryngofissure avoiding tracheotomy / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the clinical effect of laryngofissure without tracheotomy.Method:One hundred and sixteen cases of laryngofissure without tracheotomy in our department were analyzed retrospectively.Result:Of 116 cases, 101 cases had the laryngeal carcinoma; 9 cases had laryngeal stenosis; 6 cases had benign tumor of larynx. All the incisions were healed by first intention; and postoperative duration of hospital stay were 7 to 20 days. Three cases recurred in 101 cases of laryngeal carcinoma (2.97%), and underwent reoperation,the 5 year survival rate was 100%. One case recurred in 9 cases of laryngeal stenosis, and underwent reoperarion of laryngoplasty with T-tube implanted. No recurrence in 6 cases of benign tumor of larynx.Conclusion:Laryngofissure without tracheotomy have the advantage of less trauma , fast rehabilitation and no destroying the normal respiratory functions. It is completely feasible so long as surgeons grasp the adaption of operation strictly and select suitable cases.

The effect of dose fractionation on overall survival in patients with limited-stage small cell lung cancer / 中华放射肿瘤学杂志

Objective To study the effect of different dose fractionation on overall survival in patients with limited-stage small cell lung cancer (LS-SCLC). Methods LS-SCLC patients treated with radical combined chemotherapy and radiotherapy (RT) between January 2001 and Dec 2007 were analyzed retrospectively. According to the dose fractionation schemes, patients were divided into three groups:conventional fractionated RT (1. 8 -2.0 Gy,once daily), hyperfractionated RT (1.4 Gy, twice daily) and hypofractionated RT (2. 5 Gy,once daily). Overall survival, disease free survival and pattern of failures of the three groups were compared. A total of 177 patients were enrolled, including 63 patients in conventional fractionated RT group, 79 in hyperfractionated RT group and 35 in hypofractionated RT group. Results The overall follow-up rate was 96. 6%. The patient numbers with follow-up of more than 2 and 5 years were 153 and 92, respectively. The median survival time of the entire group was 22. 4 months, and the 2-and 5-year survival rates were 43.4% and 23. 5%, respectively. The 2-year survival rates for three groups were 31%, 46% and 59% (x2 =7.94,P=0.019), respectively. The 2-year disease free survival for three groups were 20%, 31% and 40% ( x2 = 4. 86, P = 0. 088 ), respectively. In the pairwise comparisons,patients in hypofractionated RT group have better survival than those in conventional fractionated RT group ( x2 = 7. 81, P = 0. 005 ), the effect of hyperfractionated RT group lies between the hypo-and the conventional fractionated RT groups, but no significant differences were detected ( x2 = 2. 31, P = 0. 128; x2 = 2. 95, P =0. 086). The mildest side effect was found in the hypofractionated RT group. No statistically significant differences were found in the patterns of first failure. Conclusion The hypofractionated RT scheme showed potential survival benefits for patients with LS-SCLC and should be considered in the setting of randomized clinical trials.

The expression of PTEN and P16 protein in nasal inverted papilloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the expression of PTEN and P16 protein, and its relationship with the occurrence, development and prognosis of nasal inverted papilloma (NIP).@*METHOD@#The expressions of PTEN and P16 were detected in 27 cases with NIP and 10 cases with normal mucosa of sphenoid by immunohistochemistry and image analytical system, and were analyzed in NIP cases with different prognosis.@*RESULT@#The positive expression PTEN and P16 protein were both significantly decreased compared with normal sinus mucosa (P0.05).@*CONCLUSION@#Decreasing or depletion of PTEN might be a sign of NIP development and unfavorable prognosis, and P16 protein is also closely related with the occurrence of NIP.

Expression of OX40 and Bcl-2 in allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the role of OX40 and Bcl-2 in allergic rhinitis(AR).@*METHOD@#Twenty-three subjects of allergic rhinitis as experimental group were collected and 20 subjects of deflection of nasal septum as control group. OX40 and Bcl-2 expression were examined in biopsy specimens of AR patients and nasal septum patients by immunohistochemistry respectively. The relationship between OX40 and Bcl-2 expression was analyzed.@*RESULT@#OX40 and Bcl-2 expression increased in the AR patients. There were positive staining not only in CD4+ T cells,but also in vascular endothelial cell, epithelial cell and glandular epithelium cell (P < 0.01). Compared with control group, the expression of OX40 (0.239 4 +/- 0.033 5) and Bcl-2 (0.237 3 +/- 0.042 1) were significantly higher than that in control group (P < 0.01). The OX40 expression was closely related to Bcl-2 expression (r = 0.869 0, P < 0.05).@*CONCLUSION@#The abnormal expression of costimulatory molecule OX40 is well evidenced in AR. Bcl-2 expression is likely mediated by OX40 signal pathway.

Expression and significance of nuclear factor-kappaB and ICAM-1 mRNA in nasal mucosa of allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To clarify the pathogenesis of allergic rhinitis (AR) by detecting the activation of NF-kappaB and the expression of ICAM-1 mRNA in nasal mucosa of the patients with AR.@*METHOD@#AR patients were collected as experimental group and deflection of nasal septum patients as control group. Immunohistochemistry methods were used to examine the expression of NF-kappaB p50 and p65 subunits in the middle turbinate mucous tunic. ICAM-1 mRNA were detected by means of RT-PCR.@*RESULT@#NF-kappaB was strongly expressed in AR group. NF-kappaB p50 existed in cytoplasm and nucleus. NF-kappaB p65 was mainly expressed in cytoplasm and less in nucleus. While NF-kappaB was expressed little in control group. The difference of NF-kappaB p50 and NF-kappaB p65 expression between two groups were significantly (P < 0.01). ICAM-1 mRNA was more strongly expressed in AR group (P < 0.01) while feebly expressed in deflection of nasal septum group. The expression of ICAM-1 mRNA were significantly correlated with that of NF-kappaB p50 and NF-kappaB p65 (r = 0.899 5, P < 0.01; r = 0.7601, P < 0.01).@*CONCLUSION@#NF-kappaB plays a key role in AR. The excessively activated NF-kappaB promotes the transcription of ICAM-1 mRNA. ICAM-1 relates to the pathogenesis and development of AR.

Multiple auditory steady-state responses to bone conduction stimuli / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the accuracy of threshold using the multiple auditory steady state responses (MASSR) to bone conduction stimuli in a group of patients with conductive hearing loss.@*METHOD@#Thirty patients with conductive hearing loss were assessed by MASSR and by pure-tone audiometry, and compared the results of these two methods.@*RESULT@#The thresholds of MASSR and those of PTA were significantly correlated, and the accuracy of MASSR were similar to PTA for the patients with conductive hearing loss.@*CONCLUSION@#MASSR can be used to assess the hearing thresholds of patients with conductive hearing loss.

The characteristic of enlarged vestibular aqueducts syndrome in pure tone audiometry: low frequency air-bone gap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purposes of this study was to analyse the significant of low frequency air-bone gap in enlarged vestibular aqueduct (EVA) patients according to the pure tone audiogram and the benefit for clinic diagnosis of the EVA.@*METHOD@#The audiology testing include (1) play audiometry or pure tone audiometry, tympanometry, middle ear muscle reflex thresholds and stapedius muscle reflex; (2) High-resolution computed tomography (CT) scan of the temporal bone and magnetic resonance imaging was used for diagnoses the EVA.@*RESULT@#All the 78 patients (154 ears) were diagnosed as the typical EVA by CT or MRI. Inner ear malformations were found in 3 ears otherwise the structures of middle ear in all the patients were absolutely normal. The audiology analysis showed 154 ears were type A tympanogram including 126 ears with typical A, 25 ears with As, 3 ears with Ad type. In the 250 Hz pure-tone test:A-B gap were observed in 126 ears(126/154,81. 8%) with the different hearing loss degree: 1 ear mild, 11 ears moderate, 19 ears moderate severe, 40 ears severe and 53 ears profound. In the 500 Hz pure-tone test: A-B gap were found in 102 ears(102/154, 66. 2%) with the different hearing loss degree: 9. ears moderate, 17 ears moderate severe, 35 ears severe and 41 ears profound.@*CONCLUSION@#Our study suggested a 66. 2% -81. 8% possibilities to find the EVA through the pure-tone audiometry firstly in the basis of the normal tympanograms with the significant A-B gap.