Analysis of discipline construction of tumor radiotherapy in non-public hospitals in Zhejiang province / 中华放射肿瘤学杂志

Objective:To investigate the radiotherapy discipline construction and existing problems in non-public hospitals in Zhejiang province and put forward suggestions for improvement.Methods:In 2022, on-site inspection and investigation were carried out in 14 non-public hospitals in Zhejiang province, including equipment configuration and source, discipline setting, personnel qualification and professional experience, academic leaders and admission of patients, etc. Results:For 14 non-public hospitals in Zhejiang province, 19 treatment equipment, 15 positioning equipment and 77 quality control equipment were equipped, and a total of 249 radiotherapy practitioners were employed. A total of 4 224 patients were admitted throught 2022.Conclusion:Multiple problems exist in non-public radiotherapy hospitals in Zhejiang province, such as unscientific discipline setting, fewer professionals, lack of personnel training, unclear management mode, unqualified qualification of partial radiotherapy doctors, and insufficient refinement of clinical quality management, which need to be further improved.

Practice and thinking of standardized cultivation of master of public health / 中华医学教育探索杂志

In recent years, in the face of the risks and challenges of public health emergencies, the demand and supply of public health talents are relatively tight, and the reform and exploration of the standardized training of public health professionals has become one of the most urgent and important topics. This study analyzed the problems of curriculum system setting, implementation of practical links and composition of tutors in the training process, and learned that Wenzhou Medical University has carried out practical exploration in strengthening theoretical study, highlighting the combination of research and study, deepening professional practice, etc., which has achieved the orderly promotion of public health training supported by supporting reform measures; Take the post competence as the guidance, and vigorously improve the practicing ability; Based on the process and result assessment, promote the reform of training mode and other preliminary results. However, there are also shortcomings and deficiencies in accuracy, supply and effectiveness. Looking at the current situation, it is suggested to promote mechanism construction, increase skill training, develop training standards, improve supporting measures, establish expert committees and other reform ideas, and explore and implement a new model of degree education connection.

Varicella incidence and vaccination of children in kindergarten and primary school of Longhua District in Shenzhen / 中国学校卫生

Objective@#To understand the situation of varicella prevalence and vaccination of susceptible population in Longhua District，and to provide reference for the varicella immunization program.@*Methods@#A total of 23 706 children from 30 childcare facilities and primary schools in 6 streets were randomly selected throughout the Longhua District. Date on age, grade, recent year and dosage of vaccination, varicella incidence, the overview of vaccination were collected and analyzed.@*Results@#The rate of vaccination in childcare facilities and primary schools was 86.01%, including 55.61% of 1 dose and 30.41% of 2 doses of vaccine. The differences of rate vaccination rate between the childcare facilities and primary schools had statistical significance(χ2=154.95, P<0.05).Rate of no-vaccination,1 dose vaccination and 2 doses vaccination across 6 streets differed significantly(χ2=146.09, 103.93, 127.31, 146.09, P<0.05). There was an increasing positive association between grades and attack rate(χ2=8.65，P<0.05). The differences of attack rate between the childcare facilities and primary schools was of statistical significance(χ2=478.69, P<0.05). The differences of attack rate in street of no vaccination,1 dose vaccination and total attack rate showed statistical significance(χ2=54.49, 74.59, 151.49，P<0.05). There was an increasing linear trend of attack rate of primary school childrenby each year(χ2=24.28，P<0.05). The attack rate increased with time after 1 dose vaccination, immune protection was obtuined for a longer period time after additional doses of vaccine.Negative association was found between grades and protective efficacy rate of varicella. The protective rate and efficacy index of different doses of vaccine in different grades were correlated(r=0.80，0.63，P<0.05). It was most effective after 1 dose vaccination among children in junior grade in kindergarten and 2 dose vaccination in senior grade.@*Conclusion@#After the implementation of vaccination program in Longhua District, the vaccination rate of 2 doses significantly increased, but not for a long time. Varicella vaccine should be included in immunization programme to protect vulnerable populations.

Preliminary results of SBRT treatment of pulmonary oligometastasis from head and neck tumors / 中华放射肿瘤学杂志

Objective:To preliminarily evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic tumors from head and neck carcinoma.Methods:Clinical data of 24 patients with pulmonary oligometastasis from head and neck carcinoma undergoing SBRT in Zhejiang Cancer Hospital from January 2014 to May 2019 were retrospectively analyzed. Survival analysis was performed by Kaplan- Meier method. Results:Among the 24 patients, 12 cases were diagnosed with nasopharyngeal origin and 12 cases of non-nasopharyngeal origin. A total of 34 pulmonary metastatic lesions were treated with SBRT. The median follow-up time was 19.5 months. Thirteen cases developed new lesions after SBRT, and 9 of them occurred within 1 year after SBRT treatment. The actual 1-year local control rate was 95%. The median progression-free survival was 15.2 months, and the 1-and 2-year progression-free survival were 59% and 46%, respectively. The 2-and 3-years overall survival rate at were 71% and 51% fter lung metastasis, respectively. Univariate analysis showed that the patients with primary lesions located in nasopharynx and disease-free interval of more than 1 year had survival advantage. No more than grade 3 radiation-induced injury was observed in the whole cohort after SBRT, and the incidence of mild radiation-induced injury was 13%.Conclusions:SBRT is safe and effective in the treatment of pulmonary oligometastatsis from head and neck carcinoma, and it may be more effective for patients with primary tumors located in nasopharynx.

Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy / 中华放射肿瘤学杂志

Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.Methods A total of 150 AJCC 7th stage Ⅱ-ⅣB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study.Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure.A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria.The prediction value of two methods for A-ROM was statistically compared.Results The incidence rate of ≥ 3 grade A-ROM was 33.3％.In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P＜0.05).In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs.female:OR=0.141,95％CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95％CI=1.413-18.470,P=0.013).For MSC,gender,smoking,N stage and MSC-V55 were the independent predictors (male vs.female:OR=0.129,95％CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95％CI=1.224-16.164,P=0.023;N stage:OR=2.291,95％CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95％CI=1.008-2.033,P=0.045).The cutoff value of MSC-V55 was 7.70％,the area under ROC curve was 0.754,the sensitivity and specificity were 0.680 and 0.740,retrospectively (all P＜0.001).Conclusions Compared with OCC,MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.

Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy / 中华放射肿瘤学杂志

Objective@#To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.@*Methods@#A total of 150 AJCC 7th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared.@*Results@#The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis, V5, V10, V15, V45, V50, V55, V60, V65 and V70 of OCC and V5, V10, V50, V55, V60, V65, V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis, gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female: OR=0.141, 95%CI=0.037-0.538, P=0.004; smoking vs.non-smoking: OR=5.109, 95%CI=1.413-18.470, P=0.013). For MSC, gender, smoking, N stage and MSC- V55 were the independent predictors (male vs. female: OR=0.129, 95%CI=0.032-0.519, P=0.004; smoking vs.non-smoking: OR=4.448, 95%CI=1.224-16.164, P=0.023; N stage: OR=2.291, 95%CI=1.268-4.137, P=0.006; MSC-V55: OR=1.432, 95%CI=1.008-2.033, P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001).@*Conclusions@#Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.

Effects of oral nutritional supplement on short-term nutritional status and treatment tolerance in locally advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy / 中华放射肿瘤学杂志

Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group ( n=58) and control group ( n=56) . Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference ( P>0.05) . Radiotherapy interruption was lower, completion rate of 2 cycles of concurrent chemotherapy was higher( 78% vs 64%, P=0.02) and level of total serum protein and albumin was more stable ( P=0.003, 0.001) in the intervention group. No difference was found in acute toxicities between the two groups ( P>0.05) . During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group ( P<0.05) , while no statistically significant difference was found in PG-SGA between the two groups ( P>0.05 ) . Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status

Quality control report of tumor radiotherapy in Zhejiang province / 中华放射肿瘤学杂志

Objective To discover the existing problems and provide appropriate suggestions and countermeasures through the quality control inspection.MethodsA comprehensive quality control inspection was conducted for the radiotherapy equipment in 45 hospitals in Zhejiang province.The physical,technical,clinical and radiotherapy process and the parameters related to quality control were evaluated.Results As of December 31,2017,a total of 62 linear accelerators from 45 hospitals have been assessed.In the radiotherapy process,multiple quality control problems were identified in terms of radiotherapy equipment configuration,clinical work quality,radiotherapy technology and personnel qualifications.Besides,unreasonable equipment configuration,shortage of radiotherapy staff,clinical work flow and the quality assurance of physical radiotherapy remained to be resolved.Conclusion Regular quality control of radiotherapy plays a pivotal role in ensuring the accuracy,effectiveness and medical safety of radiotherapy.

Paranasal Sinus Invasion in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to evaluate the prognostic significance of paranasal sinus invasion for nasopharyngeal carcinoma (NPC) and its suitable position in the T classification. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) scans of 695 patients with previously untreated, biopsy-proven, non-metastatic NPC that was treated with intensity-modulated radiotherapy (IMRT) were reviewed retrospectively. RESULTS: The incidence of paranasal sinus invasion was 39.4% (274 of 695 patients). Multivariate analysis showed that paranasal sinus invasion was an independent negative prognostic factor for local failure-free survival (LFFS) (p < 0.05). According to the eighth American Joint Committee on Cancer (AJCC) staging system, 275 patients were classified as T3 classification. Of these, 78 patients (28.4%) developed paranasal sinus invasion (T3b) and 197 (71.6%) didn't (T3a). The estimated 5-year LFFS and overall survival (OS) rates for the patients with T3b and T3a classification were 88.6% versus 95.0% (p=0.047), and 84.5% versus 93.3% (p=0.183), respectively. The estimated 5-year LFFS and OS rates for the patientswith T4 classificationwere 89.5% and 83.2%,whichwere similarwith the outcomes of patients with T3b classification. CONCLUSION: MRI-determined paranasal sinus invasion is an independent prognostic factor of NPC treated by IMRT. Paranasal sinus invasion is recommended to classify as T4 classification in the 8th AJCC staging system for NPC.

Prognostic Value and Staging Classification of Lymph Nodal Necrosis in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‒determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system. MATERIALS AND METHODS: The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed. RESULTS: Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system. CONCLUSION: MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.

The impact of nutritional therapy on patients with locoregionally advanced nasopharyngeal carcinoma / 中华临床营养杂志

Objective To evaluate the impact of nutritional therapy during radiotherapy for patients with locoregionally advanced (Ⅲ-ⅣB) nasopharyngeal carcinoma (NPC) and identify factors that might influence nutritional status of the patients.Methods We retrospectively reviewed 117 patients with locoregionally advanced NPC (Ⅲ-ⅣB) treated with radical radiotherapy between December 2015 and March 2016 at Zhejiang Cancer Hospital.The patients were grouped into those who received nutritional therapy and those who did not during radiotherapy.Chi-square test was used for both inter-and intra-group comparison of nutritional status before (T0),during (T1) and after radiotherapy (T3).The patients were then grouped into those who experienced substantial weight loss (＞5％) and those who did not (≤5％),and Logistic regression was used to analyze factors that were potentially correlated with weight loss.Results Nutritional indicators were all on the decrease (T2 vs.T0,T1 vs.T0,P＜0.001),including weight,body mass index (BMI),albumin,pre-albumin (PA),and prognostic nutritional index (PNI).There was no significant difference between the group who received nutritional therapy and the one who did not in weight,albumin,PA,and PNI at a given time point (P＞ 0.05),but patients in nutritional therapy group completed radiotherapy in fewer days than those in the control group (45.8 d vs.46.0 d,P=0.023).Logistic regression revealed that patients with radiation-induced oral mucositis of grade≥3 (Odds ratio=3.232,P=0.021,95％ CI=1.198-8.820) and drop of pre-albumin by ＞15％ (Odds ratio=2.442,P=0.041,95％ CI=1.036-5.757) had greater risk of developing nutritional impairment.Conclusions Radiation-induced oral mucositis of grade≥3 might lead to deteriorating nutritional impairment in patients with locoregionally advanced NPC during radiotherapy,and drop of pre-albumin by ＞ 15％ was correlated with weight loss.Current nutritional support fell short of improving nutritional impairment during radiotherapy.

Research progress of plasma EBV DNA detection in the diagnosis and treatment of na-sopharyngeal carcinoma / 中国肿瘤临床

Nasopharyngeal carcinoma is one of the most common malignant tumors in the southern part of China. The main etiologi-cal factors of nasopharyngeal carcinoma include genetic susceptibility, dietary factors, and Epstein-Barr virus (EBV) infection. EBV de-oxyribonucleic acid (EBV DNA) can be persistently detected in the plasma of patients with nasopharyngeal carcinoma, and its levels correlate with the disease stage. After successful treatment, EBV DNA is rapidly cleared from the plasma of patients;however, signifi-cant increases in plasma EBV DNA levels are observed in patients with recurrent or metastatic diseases after treatment. Accumulating evidence suggests that EBV DNA detection is useful in the early diagnosis and screening, diagnosis of tumor recurrence or distant me-tastasis, prognosis, and tailored treatment of patients with nasopharyngeal carcinoma. This review summarizes the aforementioned progresses to provide a basis for future clinical and research efforts.

Analysis of memory function and MRI changes in nasopharyngeal carcinoma patients after radiotherapy / 中华放射医学与防护杂志

Objective To analyse the memory function and MRI changes in local-advanced nasopharyngeal carcinoma patients before-and after-radiation.Methods Clinical data,dosimetric data,digital span score and MRI of 14 cases with nasopharyngeal carcinom treated in Zhejiang Cancer Hospital from November 2015 to August 2016 were retrospectively analysed.There were 1 case at T2 stage,7 cases at T3 and 6 at T4.They received IMRT or TOMO therapy concurrent with 2 cycles Nedaplatin after 2-3 cycles PF/TP induction chemotherapy.Results The IMRT dosimetric data of 9 cases were available.For hippocampus and temporal lobe,the mean volume was (15.17 ± 2.17) and (95.07 ± 12.26) cm3,respectively,while the mean dose was (1 154.06 ±771.63) and (1 306.61 ±603.69) Gy,and the max dose (3 797.61 ± 1 450.98) and (5 394.17 ± 982.28) Gy,respectively.The equivalent uniform dose (EUD) was (2 233.28 ±872.73) Gy for hippocampus and (3 113.11 ±603.69) Gy for temporal lobe.10 patients received digit span score before-and 3 months after-radiotherapy.The mean score of forward digit span was 8.8 ± 1.8 before radiation and 8.1 ± 1.59 at 3 months after radiation(P ＞ 0.05),while thatof backward digit span decreased from 6.2 ± 1.04 before radiation to 5.3 ± 2.36 at 3 months after radiation (t =3.25,P ＜ 0.05).9 patients' MRI were available.Volume reduction of temporal lobe was observed (t =4.57,P ＜ 0.01) by voxel-based morphometry (VBM).Conclusions Radiation-induced injury to hippocampus and temporal lobe is inevitable in local-advanced nasopharyngeal carcinoma patients.There might be some connection between memory loss and temporal lobe volume atrophy after radiotherapy.Enrollment of larger sample analysis is expected.

Dose analysis of hippocampus in T3,T4nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy / 中华放射肿瘤学杂志

Objective To analyze the exposed dose of hippocampus(HC)of T3,T4nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy(IMRT). Methods The bilateral HCs were delineated and were divided into head(HH),body(HB)and tail(HT)for 62 nasopharyngeal carcinoma patients treated with IMRT.The dose parameters of HC were then analyzed. Results The mean dose of left and right HC was(1 127±704)cGy,(1 173±762)cGy. The mean dose of left HH,HB and HT was(1 732±1029)cGy,(820±632)cGy,(423±366)cGy(P=0.000);while the mean dose of right HH, HB and HT was(1 985±1101)cGy,(837±531)cGy,(432±343)cGy(P=0.000).The exposed dose and the volume exposed in different dose of HH were obviously higher than those of HB and HT.The dose parameters of HH,HB and HT decreased in turn. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus correlated with high exposed dose of HC. Conclusions The exposed dose of HH,HB and HT was different in nasopharyngeal carcinoma patients treated with IMRT.The exposed dose of HH was the highest,which should be emphasized especially. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus suggest high exposed dose of HC.

Progress in treatment of previously untreated oligometastatic nasopharyngeal carcinoma / 中华放射肿瘤学杂志

The treatment strategies and prognosis of previously untreated oligometastatic nasopharyngeal carcinoma (NPC) are extremely different due to the heterogeneity of this disease. More and more studies have found the survival advantages of oligometastatic NPC over NPC with multiple metastases. In addition to systemic chemotherapy,the primary tumor and metastatic lesions should be considered in the treatment of previously untreated oligometastatic NPC.Adding radical radiotherapy for primary tumor and aggressive managements for metastatic lesions to the systemic chemotherapy can substantially improve the survival of patients,even achieving a radical cure. Several molecular markers and prognostic models can screen out some patients who will benefit from aggressive treatment,but more studies are needed in the future.

Efficacy of radical radiotherapy for primary tumors in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To investigate the prognostic factors for survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma who received radical radiotherapy for primary tumors. Methods From 2008 to 2011,39 patients with newly diagnosed oligometastatic nasopharyngeal carcinoma received 1-6 cycles of chemotherapy and radical radiotherapy for primary tumors. In those patients,10 received conventional radiotherapy and 26 received intensity-modulated radiotherapy. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses,respectively. Results The median follow-up time was 38 months. The 1-, 2-,and 3-year overall survival rates were 97%,87%,and 70%,respectively,while the 1-,2-,and 3-year progression-free survival rates were 87%,65%,and 59%,respectively. Age,number of metastatic lesions, scheme of induction chemotherapy,and use of concurrent chemotherapy or not were independent prognostic factors for survival. The patients with no more than 3 metastatic lesions had a higher survival rate than those with more than 3 metastatic lesions(P=0.023).The patients undergoing chemotherapy with docetaxel had a significantly higher survival rate than those undergoing chemotherapy without docetaxel (P= 0.041). Conclusions Induction chemotherapy and radical radiotherapy for primary tumors can still achieve long-term survival in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma,particularly in young patients with no more than 3 metastatic lesions. Compared with chemotherapy without docetaxel, chemotherapy with docetaxel may provide a greater survival benefit for patients.

Preliminary results of the exposed dose of head,body and tail of the hippocampus in nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy / 中华放射肿瘤学杂志

Objective To analyze the radiation doses to the head, body, and tail of the hippocampus in intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma(NPC). Methods Ten NPC patients treated with IMRT were selected,and the head, body, and tail of both hippocampi were delineated on T1-weighted images. The doses to the hippocampus were then analyzed. WAIS-CR speech test results were tested by paired sample t-test. Results The mean doses to left and right hippocampi were 1 147±976 cGy and 1 011±602 cGy, respectively. The mean doses to the head, body, and tail of the left hippocampus were 1 739± 1 317 cGy, 890± 982 cGy, and 547± 688 cGy, respectively(P=0.042);the mean doses to the head,body,and tail of the right hippocampus were 1 691±942 cGy,744±483 cGy,and 531±603 cGy,respectively(P=0.002).The dose to the hippocampus decreased from the head to the tail, and the irradiated volume also decreased as the dose varied. Conclusions The dose to hippocampus decreases from the head to the tail in NPC patients treated with IMRT,which is worthy of attention.

Validation of T classifications in the 7th edition UICC staging system and recommendation of a simpliifed T classiifcations based on intensity-modulated radiotherapy / 中国癌症杂志

Background and purpose:The application of intensity-modulated radiotherapy (IMRT) has improved the local control rate of nasopharyngeal carcinoma greatly, which changed the predictive value of T classiifca-tions of TNM staging system. This study aimed to validate the predictive effect of T classiifcations in the 7th Union for International Cancer Control (UICC) staging system and discuss the simpliifcation of T classiifcations.Methods:We retrospectively reviewed the clinical data of 641 primary nasopharyngeal carcinoma patients at our center from January 2007 to June 2011. We evaluated the predictive effect of T classiifcations by Kaplan-Meier method and Cox regression model.Results:The 5-year overall survival (OS), local relapse-free survival (LRFS), progression-free survival (PFS) and distant metastasis free survival (DMFS) were 85.4%, 88.5%, 78% and 87.1%, respectively. The 5-year OS of T1, T2, T3 and T4 categories were 91.6%, 85.3%, 90.1% and 76.5%, respectively; LRFS were 93%, 85.3%, 91.5% and 84.4%; PFS were 88.2%, 77.3%, 80.8% and 70.9%; DMFS were 95.1%, 88.9%, 88.2% and 81.3%, respectively. The difference in survival curves between T1, T2 and T3 were not signiifcant (P>0.05). However, several prognostic indexes were signiifcantly different between T4 and T1, T2, T3. We merged the T1, T2 and T3 classiifcations as new T1, and the T4 classiifcation as new T2. The 5-year OS of new T1 and T2 were 89.1% and 76.5% (P=0.001); LRFS were 90.1% and 84.4% (P=0.028); PFS were 81% and 70.9% (P=0.001); DMFS were 90.8% and 81.2% (P=0.002). The survival curves were substantially separated. The simpliifed T classiifcations had obvious advantages when separately analyzed in different N stages.Conclusion:In the era of IMRT, the predictive effect of T classiifcations of the 7th UICC staging system has diminished. The simpliifcation of T classiifcations can ift with the new treatment and provide a better surviv-al prediction.

The clinical features and prognosis of radiotherapy associated sarcoma (RAS) following radiotherapy for nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and prognosis of radiotherapy associated sarcoma (RAS) in the head and neck following radiotherapy for nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>The clinicopathologic data, diagnosis, treatment and follow-up results of 11 patients with RAS diagnosed between January 1995 and December 2011 at Zhejiang Cancer Hospital were analyzed retrospectively. Among these patients, 6 were males and 5 were females. Patients' ages ranged from 33 to 66 years (median 50 years). The latency period for development of the RAS was between 3 years and 23 years (median 7 years) after irradiation. Overall survival rate was calculated using the Kaplan-Meier method and Log rank test.</p><p><b>RESULTS</b>All cases underwent surgery, of them 6 casesachieved radical resection3 cases left with microscopic positive resection margins and 2 caseshad palliative surgery. Among 11 patients, 4 had re-surgery after recurrence, including 1 case had repeated surgeries followed by chemotherapy and radioactive seed implantation. Follow-up time ranged from 2 to 102 months, andeight patients died The 2-year, 3-year and 5-year cumulative survival rateswere 45.5%, 30.3% and 15.2%, respectively. The median survival time was 15 months. Surgical resection with clear margins achieved significantly better prognosis (P = 0.04).</p><p><b>CONCLUSIONS</b>The incidence of RAS after radiation of NPC is generally low, but the treatment of RAS is very difficult, with poor prognosis.</p>

Clinical effect analysis of four kinds of neuroendoscopic operation mode in treatment of hydrocephalus / 重庆医学

Objective To evaluate the application effect and value of four kinds of neuroendoscopic operation mode in the treat-ment of hydrocephalus .Methods The four kinds of neuroendoscopic operation mode ,including endoscopic third ventriculostomy , septostomy of the septum pellucidum ,cyst ventriculostomy and ventrideperitoneal cavity ,were selected in 58 cases of hydrocephalus according to the indications .The treatment effects were analyzed and the application value was evaluated .Results Among 58 cases of hydrocephalus ,50 cases were significantly improved after operation ,the total effective rate was 86 .21% ,2 cases appeared some complications .The four kinds of operation mode could better treat hydrocephalus .Conclusion Neuroendoscopy is an ideal method in treating hydrocephalus and has the advantages of the slight trauma and fewer complications ,which is a method deserving to be promoted in clinic .