Comparison of different laryngeal preservation strategies based on chemoradiotherapy in locally advanced hypopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response（more than 80% tumor regression）, patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS（overall survival）, progression free survival（PFS）, locoregional recurrence-free survival（LRRFS） and LDFS. Results:In IC-directed group, 75.0%（57/76） patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%（109/155） patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%（HR 0.67; 95%CI 0.43-1.05; P=0.07） and 27.8% versus 39.8%（HR 0.68; 95%CI 0.46-0.99; P=0.04） between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.

Progress on Multi-disciplinary Combined Therapy for Locally Advanced Hypopharyngeal Carcinoma / 肿瘤防治研究

Given the important position and function of the hypopharynx, the preservation of organ function and survival improvement are equally important. The optimal role of multi-disciplinary combined treatment modality becoming increasingly important. The optimal laryngeal preservation strategy for hypopharyngeal cancer is under continuous exploration. With the constant research of surgery, radiotherapy, chemotherapy, and molecular targeted therapy, new laryngeal preservation strategies continue to emerge. Herein, we primarily summarize the advances in multi-disciplinary combined treatment and the future direction in the treatment of hypopharyngeal carcinoma.

The modified Valsalva maneuver in hypopharynx CT scan / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the significance and factors influencing of CT scan under the modified Valsalva maneuver. Methods:Clinical data of 52 patients with hypopharyngeal carcinoma diagnosed from August 2021 to December 2022 were collected, all patients had calm breathing CT scan and modified Valsalva maneuver CT scan. Compare the exposure effect of the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall, and glottis with each CT scanning method. The effects of age, neck circumference, neck length, BMI, tumor site, and T stage on the exposure effect were analyzed. Results:In 52 patients, 50 patients（96.15%） completed CT scan at once time. The exposure effect of the CT scan under modified Valsalva maneuver in the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall was significantly better than CT scan under calm breathing（Z=-4.002, -8.026, -8.349, -7.781, -8.608, all P<0.01）, while CT scan under modified Valsalva maneuver was significantly worse in glottis than CT scan under calm breathing（Z=-3.625, P<0.01）. In the modified Valsalva CT scan, age had no obvious effect on the exposure effect. The exposure effect was better with long neck length, smaller neck circumference, smaller BMI and smaller T stage. The exposure of postcricoid carcinoma was better than pyriform sinus carcinoma and posterior hypopharyngeal wall carcinoma. But differences were not all statistically significant. Conclusion:The anatomical structure of the hypopharynx was clearly under CT scan with modified Valsalva maneuver, which clinical application is simple, but the effect of glottis was worse. The influence of age, neck circumference, neck length, BMI, and tumor T stage on the exposure effect still needs further investigation.

Clinical characteristics and efficacy of second primary malignancies in hypopharyngeal carcinoma: an analysis of 216 real-world cases / 中华放射肿瘤学杂志

Objective:To evaluate the incidence, clinical characteristics and prognosis of second primary malignancies (SPMs) among patients with hypopharyngeal carcinoma (HPC) in real-world analysis.Methods:A total of 594 HPC patients admitted to Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2010 to 2018 were retrospectively analyzed.The incidence and clinical characteristics of HPC patients complicated with SPMs were analyzed. Clinical efficacy was compared among different groups.Results:With a median follow-up time of 66.9 months, SPMs were present in 36.4% (216/594) of HPC patients: 22.2% (132/594) were synchronous and 14.1% (84/594) were metachronous. The upper aerodigestive tract was the most common involved region. Compared with patients without SPMs, patients with synchronous and metachronous carcinoma in situ had similar 5-year overall survival (OS) of 42.2% vs. 44.5% ( P=0.958) and 62.2% vs. 44.5% ( P=0.240), respectively. Patients with synchronous invasive SPMs had a worse 5-year OS of 27.2% vs. 44.5% in their counterparts without SPMs ( P=0.001). Patients with metachronous invasive SPMs had similar 5-year OS of 50.2% vs. 44.5% in their counterparts without SPMs ( P=0.587). SPMs accounted for 42.5% of total death in metachronous invasive SPMs group. Conclusions:Patients with HPC have a high probability of developing SPMs. Moreover, the incidence of complicated with esophageal/gastric carcinoma in situ or metachronous SPMs exerts no effect on prognosis, while the occurrence of synchronous SPMs significantly affectes the prognosis of patients. However, the incidence of SPMs is still one of the main death causes in metachronous invasive SPMs group.

Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre / 中华耳鼻咽喉头颈外科杂志

To explore changing trend in prognosis of primary hypopharyngeal carcinoma and to analyze the reasons at the Eye, Ear, Nose and Throat Hospital of Fudan University. We retrospectively analyzed the clinical data of 461 patients with primary hypopharyngeal carcinoma treated at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2007 (Group 1) and 2010 to 2014 (Group 2) according to the inclusion criteria. 142 from Group 1, including 133 males and 9 females, rangedfrom 38 to 82 years old and 319 from Group 2, including 313 males and 6 females, ranged from 39 to 81 years old, were included in this work. The laryngeal function preservation rate, survival outcome, application and effect of pre-and post-operative adjuvant therapy were compared. SPSS 24.0 was used for statistical analyses. There were 62 patients with early disease (T1-2N0) including 18 in Group 1 and 44 in Group 2, in whom 3 (16.7%) underwent surgical procedures with laryngeal function preservation in Group 1, while, 30 (68.2%) underwent laryngeal function preservation surgery in Group 2. The laryngeal function preservation rate showed an obviously upward trend in recent years (χ(2)=13.617, 0.001), whereas, the recurrence-free survival rate (RFS) and overall survival rate (OS) showed no significant differences between two groups (0.469 and 0.808, respectively). Among the 399 patients with advanced disease, 124 were in Group 1 and 275 in Group 2. After propensity score matching (PSM) was used, the OS rate was significantly higher for Group 2 than Group 1 (0.017), while the application of laryngeal function preservation surgery was significantly higher in Group 2 (χ(2)=4.686, 0.030). The application rates of preoperative adjuvant therapy and postoperative adjuvant chemotherapy were significantly higher in group 2 than in group 1 (χ(2)=5.687, 0.017; χ(2)=19.407, 0.001). The application of laryngeal function preserving surgery significantly increases the retention rate of laryngeal functions in patients with early-stage hypopharyngeal carcinoma, with similar long-term survival outcomes. The application of comprehensive treatment including preoperative adjuvant therapy and postoperative adjuvant treatments, especially postoperative chemoradiotherapy, shows an obvious increase in the function preservation rate and long-term survival in patients with advanced hypopharyngeal carcinoma.

Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore changing trend in prognosis of primary hypopharyngeal carcinoma and to analyze the reasons at the Eye, Ear, Nose and Throat Hospital of Fudan University.@*Methods@#We retrospectively analyzed the clinical data of 461 patients with primary hypopharyngeal carcinoma treated at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2007 (Group 1) and 2010 to 2014 (Group 2) according to the inclusion criteria. 142 from Group 1, including 133 males and 9 females, rangedfrom 38 to 82 years old and 319 from Group 2, including 313 males and 6 females, ranged from 39 to 81 years old, were included in this work. The laryngeal function preservation rate, survival outcome, application and effect of pre-and post-operative adjuvant therapy were compared. SPSS 24.0 was used for statistical analyses.@*Results@#There were 62 patients with early disease (T1-2N0) including 18 in Group 1 and 44 in Group 2, in whom 3 (16.7%) underwent surgical procedures with laryngeal function preservation in Group 1, while, 30 (68.2%) underwent laryngeal function preservation surgery in Group 2. The laryngeal function preservation rate showed an obviously upward trend in recent years (χ2=13.617, P<0.001), whereas, the recurrence-free survival rate (RFS) and overall survival rate (OS) showed no significant differences between two groups (P=0.469 and 0.808, respectively). Among the 399 patients with advanced disease, 124 were in Group 1 and 275 in Group 2. After propensity score matching (PSM) was used, the OS rate was significantly higher for Group 2 than Group 1 (P=0.017), while the application of laryngeal function preservation surgery was significantly higher in Group 2 (χ2=4.686, P=0.030). The application rates of preoperative adjuvant therapy and postoperative adjuvant chemotherapy were significantly higher in group 2 than in group 1 (χ2=5.687, P=0.017; χ2=19.407, P<0.001).@*Conclusion@#The application of laryngeal function preserving surgery significantly increases the retention rate of laryngeal functions in patients with early-stage hypopharyngeal carcinoma, with similar long-term survival outcomes. The application of comprehensive treatment including preoperative adjuvant therapy and postoperative adjuvant treatments, especially postoperative chemoradiotherapy, shows an obvious increase in the function preservation rate and long-term survival in patients with advanced hypopharyngeal carcinoma.

Apatinib and S-1 combination therapy for the treatment of advanced head and neck neoplasms: Three case reports

Apatinib, one of the novel oral antiangiogenic agents, shows survival benefits in treating advanced or metastatic gastric adenocarcinoma. However, its efficacy in treating advanced head and neck neoplasms has not been reported. Herein, three elderly men with advanced head and neck neoplasms were treated with apatinib and S-1. Their initial diagnoses were hypopharyngeal carcinoma, metastatic squamous cell carcinoma of head and neck, and squamous cell carcinoma of the pyriform sinus. All patients underwent repeated chemotherapy but developed disease progression. As they refused radiotherapy due to its serious adverse reaction, apatinib was administered at a dose of 425 mg daily and S-1 at 60 mg twice daily. Thirty days after apatinib administration, the patients achieved partial response according to the Response Evaluation Criteria in Solid Tumors 1.1 standard. Mild toxicity or drug-related side effect was observed during the treatment. Therefore, apatinib and S-1 could be the new treatment option for advanced head and neck neoplasms. However, clinical trials are required to confirm their efficacy and safety.

Plummer-Vinson syndrome complicated with hypopharyngeal carcinoma: A case report and literature review / 吉林大学学报(医学版)

Objective: To observe the clinical manifestations of cervical esophageal webbed stenosis in the patients with Plummer-Vinson syndrome(PVS) and analyze its relationship with hypopharyngeal carcinoma, and to raise the clinicians' awareness of the disease. Methods: The diagnosis and treatment process of one patient with PVS complicated with hypopharyngeal carcinoma was summarized, and its clinical characteristics were analyzed in combination with relevant literatures.Results: A 39-year-old patient with PVS as a complaint by "dysphagia" was diagnosed as hypopharyngeal carcinoma by electronic laryngoscope and pathological biopsy. A lot of intraepithelial papillary capillary loops (IPCL) were seen on narrow band imaging(NBI) of the mucosa extending downward from the posterior and lateral walls of the hypopharynx to the upper part of the esophageal web. The hypopharyngeal mucosa with dense IPCL was found to have moderate to severe dysplasia. After 2 courses of induction chemotherapy for hypopharyngeal carcinoma, the symptoms disappeared and the tumor volume was significantly decreased.Conclusion: The occurrence of hypopharyngeal carcinoma is related to the mucosal changes of PVS. NBI technique is helpful for early diagnosis of hypopharyngeal and esophageal mucosal degeneration in the PVS patients.

Effect of vascular changes on prognosis after induced chemotherapy for advanced hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical characteristics of two groups(vascular classification declines or not in narrow band imaging (NBI) of patients with advanced hypopharyngeal carcinoma after induced chemotherapy, to follow-up and compare the survival differences between the two groups, and to explore the effect of vascular changes on clinical prognosis after induced chemotherapy in patients with advanced hypopharyngeal carcinoma.@*Methods@#Clinical data of 56 patients with advanced hypopharyngeal carcinoma from August 2014 to September 2016 in Beijing Tongren Hospital, Capital Medical University were collected. The patients were divided into two groups according to NBI vascular classification declines or not after induced chemotherapy. The survival of patients and the impact of different factors on the prognosis were retrospectively analyzed. SPSS 24.0 statistical software was used for analysis. Frequency data were compared between the two groups using χ2 test. Kaplan-Meier method and Cox regression analysis were employed for survival analysis and Log-Rank test was used for inter-group comparison, P<0.05 was statistically significant.@*Results@#There was significant difference in overall survival rate(OS) between two groups of patients with advanced hypopharyngeal carcinoma after induced chemotherapy (P<0.05). Multivariate analysis showed that NBI vascular classification changes after induced chemotherapy was the impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy.@*Conclusion@#In addition to recurrence and metastasis, NBI vascular classification changes is the important impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy. Patients with NBI vascular classification declines have significant survival benefit. The patients with advanced hypopharyngeal carcinoma should be checked with NBI examination before and after induced chemotherapy. NBI should be included in the routine screening indicators for prognosis of advanced hypopharyngeal carcinoma.

Analysis of lymph node metastasis for hypopharyngeal carcinoma based on computed tomography / 中华放射肿瘤学杂志

Objective To explore the pattern of lymph node metastasis and provide guidance for the delineation of clinical target volume for patients diagnosed with hypopharyngeal squamous cell carcinoma (HSCC).Methods A total of 123 patients who were initially diagnosed with HSCC by electrolaryngoscope and computed tomography (CT) of the head and neck in Shandong Tumor Hospital between 2014 and 2017 were recruited in this study.The lymph node metastasis was evaluated based on the diagnostic criteria of CT scan.The lymphatic metastasis ratio (LMR) at each node level was calculated.Analysis of variance (ANOVA) andx2 test were used to analyze the relationship between LMR and primary tumors.Results Among 123 patients,primary tumors were originated from the pyriform sinus (PS) in 101 cases (82.1％),posterior pharyngeal wall (PPW) in 15 (12.2％) and postcricoid (PC) in 7 (5.7％),respectively.The overall LMR was calculated as 84.6％ (n=104),in detail,84.2％ for patients with primary tumors originating from PS,93.3％ for those from PPW and 71.4％ for patients from PC,respectively.For PSderived tumors,the ipsilateral neck LMR at the level Ⅰa,Ⅰb,Ⅱa,Ⅱb,Ⅲ,Ⅳ,Ⅴ,Ⅵa,Ⅵb,and Ⅶ was 0,3.0％,66.3％,42.6％,46.5％,10.9％,5.0％,2.0％,7.9％,and 11.9％,respectively,and 0,0,14.9％,5.0％,3.0％,2.0％,0,0,3.0％,and 2.0％ for the contralateral neck.For PPW tumors,the ipsilateral neck LMR at the level Ⅰa,Ⅰb,Ⅱa,Ⅱb,Ⅲ,Ⅳ,Ⅴ,Ⅵa,Ⅵb,and Ⅶ was 6.7％,6.7％,66.7％,46.7％,46.7％,20.0％,0,13.3％,33.3％,and 60.0％,respectively,and 6.7％,6.7％,33.3％,26.7％,20.0％,20.0％,0,0,13.3％,and 33.3％ for the contralateral neck.For PC tumors,the ipsilateral neck LMR at the level Ⅱa,Ⅱb,Ⅲ,Ⅳ,Ⅴ and Ⅵb was 71.4％,28.6％,14.3％,14.0％,14.0％,and 14.3％,respectively,and the LMR at the level Ⅱa was 14.3％ for the contralateral neck.No lymph node metastasis occurred in other lymph node levels.The mean levels of lymph node metastasis for the T1-T4 stage tumors were 2.4,1.9,2.2,3.3 with statistical significance (P =0.023),and 2.2,4.5 and 1.6 for patients with the tumors originated from PS,PPW and PC (P=0.000).The PPW invasion was significantly correlated with the level Ⅶ metastasis (P=0.000),and PC or esophageal invasion was intimately correlated with the level Ⅵ metastasis (P=0.002 and 0.001).Conclusions The most common lymphatic metastasis includes ipsilateral neck Ⅱa,Ⅲ,and Ⅱb,whereas the level Ⅰ and Ⅴ are rarely observed.For PPW-derived tumors,the LMR at the level Ⅶ is up to 60.0％.The incidence of PC or esophageal invasion enhances the risk of level Ⅵ lymph node metastasis.

Preliminary Study on the Effect of Supraglottic Laryngeal Carcinoma and Hypopharyngeal Carcinoma on Swallowing Function / 听力学及言语疾病杂志

Objective To explore the effects of supraglottic laryngeal carcinoma and hypopharyngeal carcino-ma on swallowing functions .Methods The data of 32 patients with supraglottic laryngeal carcinoma (laryngeal car-cinoma group) ,20 patients with hypopharyngeal carcinoma (hypopharyngeal carcinoma group) and 81 cases of nor-mal persons of the same age (50～79) as a control (normal control group) who were diagnosed and treated in our department from 2015 December to 2017 February were evaluated by repeated saliva swallowing test ,watian drink-ing water test ,and endoscopic examination of swallowing .Results In the laryngeal carcinoma group ,we found swallowing dysfunctions in 17 cases(53 .13％ ,17/32) .In the hypopharyngeal carcinoma group ,we found swallo-wing dysfunctions in 15 cases(75 .00％ ,15/20) .For 81 cases of normal persons (normal control group) ,there were swallowing dysfunctions in 11 cases(13 .58％ ,11/81) .The statistical analysis of the laryngeal carcinoma and hypo-pharyngeal carcinoma groups with abnormal swallowing functions were significantly higher than the normal control group (P<0 .001) .In the laryngeal carcinoma group ,according to the anatomic site ,the tumors were divided into two groups :from 21 cases of epiglottis and fringe group ,we found swallowing dysfunctions in 14 cases (66 .67％ , 14/21);out of 11 cases of ventricular bands + laryngeal ventricle group , swallowing dysfunctions in 3 cases(27 .27％ ,3/11) .The differences between the two groups were significant (P<0 .05) .In the hypopharyngeal carci-noma group ,out of 14 cases of pyriform sinus ,swallowing dysfunctions were in 10 cases(71 .43％ ,10/14);out of 6 cases of posterior hypopharyngeal wall carcinoma ,swallowing dysfunctions in 5 cases(83 .33％ ,5/6) .The differ-ences between the two groups were insignificant (P>0 .05) .Conclusion Supraglottic laryngeal carcinoma and hypo-pharyngeal carcinoma all have effects on swallowing functions and increase the incidence of dysphagia .In the supra-glottic laryngeal carcinoma ,the primary tumor location has influence on the swallowing functions .

Cervical lymph node metastasis regularity of hypopharyngeal carcinoma and its influence on prognosis / 中国肿瘤临床

Objective:To investigate the regularity of cervical lymph node metastasis of hypopharyngeal carcinoma and its influence on patient prognosis,to guide the therapeutic strategies for hypopharyngeal carcinoma.Methods:A total of 140 hypopharyngeal squmous cell carcinoma patients who received surgery in Tianjin Medical University Cancer Institute and Hospital from January 2000 to December 2016 were analyzed retrospectively.χ2test was adopted for the analysis of the counting data,and Kaplan-Meier method was used for survival analysis,and the Cox regression model was used to analyze the factors affecting the prognosis.Results:The total rate of lymph node metastasis was 68.6% of the total 140 patients.The rate of occult lymph node metastasis in cN0 patients was 25.0%.The rate of bilateral lymph node metastases was 25%.The most common areas of lymph node metastasis are region II,Ⅲ,andⅣ.The rates of lymph node metastasis were 10.7%,10.4%,7.9% in regionⅠ,ⅤandⅥ,respectively.The total rate of extranodal extension were 66.7%.Univariate analysis showed that cervical lymph node metastasis was closely related to tumor pathological grade(P=0.012),and was not related to gender,age,primary tumor site,tumor T stage(P<0.05).The 3-year and 5-year overall survival rates of patients were 61.0% and 49.1%, respectively.Cox regression analysis showed that the diameter of metastatic lymph nodes(P=0.012),number(P=0.039),and extranodal extension(P=0.010)were significantly related to the survival of patients with hypopharyngeal carcinoma.When the diameter of metastatic lymph nodes≥2.8 cm,number≥2,with extranodal extension,the prognosis is poor.Conclusions:Hypopharyngeal carcinoma has a dismal prognosis,with high rate of lymph node metastasis.Cervical lymph node metastasis is an important factor of the prognosis.The active treatment strategy for the lymph nodes is the key to improve the therapeutic effect of hypopharyngeal carcinoma.

The value of semiquantitative parameters of DCE-MRI in predicting and monitoring efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma / 实用放射学杂志

Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.

The value of semiquantitative parameters of DCE-MRI in predicting and monitoring efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma / 实用放射学杂志

Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.

Transoral radiofrequency coblation surgery for the treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation(RFC).@*Methods@#Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled. Among these patients, 15 suffered from pyriform sinus carcinoma, 4 suffered from postcricoid carcinoma, and 3 suffered from posterior hypopharyngeal wall carcinoma. According to the AJCC 2002 guideline, the tumor stages were T1N0M0 for 3 patients, T2N0M0 for 9 patients, T1N1M0 for 1 patient, T1N2M0 for 1 patient, T2N1M0 for 4 patients, and T2N2M0 for 4 patients respectively. All patients with N+ underwent concurrent neck dissection; 2 patients underwent concurrent prophylactic tracheotomy; 17 underwent post-operative radiotherapy for 50-66 Gy. The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.@*Results@#All patients except 2 underwent the TOS successfully, while the two patients were treated with open approach surgery due to unsure safe margin. Most patients returned to oral feeding within one week. Among the 18 patients with complete follow up data, 3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence, multiple primary esophageal carcinoma, and distant metastasis 4 years after surgery (5.6%). According to the Kaplan-Meier method, the 5-years local control rate and survival rate were 57.8% and 67.5% respectively. All patients had no disorders in speech, swallowing and respiration during the follow up.@*Conclusions@#The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage, which is useful in lowering the operation difficulty. The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.

Expression of STIM1 gene in human hypopharyngeal carcinoma cell line FaDu and its effect on FaDu cell apoptosis / 局解手术学杂志

Objective To study the expression of STIM 1 gene in human hypopharyngeal carcinoma cell line FaDu and its effect on FaDu cell apoptosis .Methods Lentivirus infection was used to knock STIM 1 down in FaDu cells .Group STIM1-siRNA: the expression of STIM1 in FaDu cell was inhibited by STIM 1-siRNA lentivirus .Group control:FaDu cells were infected by negative control siRNA lentivirus . Real-Time PCR was applied to identify the efficacy of lenticirus infection and the expression of STIM 1 in FaDu cells.Western blot was used to identify the expression of STIM 1 protein after lenticirus infection .Flow cytometry assay was performed to detect the apoptosis of FaDu cells in the two groups.The data were statistically analyzed with SPSS 17.0 software.Results Compared with GAPDH (Ct=12.08 ±0.05),the expression of STIM1 in FaDu cells was significant expressed (Ct=22.21 ±0.05,P<0.001).Real-Time PCR analysis the relative mRNA expression of STIM1 in FaDu cells of control group and STIM 1-siRNA group were (1.00 ±0.08) and (0.12 ±0.01) respectively (P<0.001). Western blot showed that the expression of STIM 1 gene and protein in FaDu cells were inhibited significantly after STIM 1-siRNA lentiviral in-fection,which was in accordance with the results of Real-Time PCR analysis.Flow cytometry assay showed that the siRNA-mRNA group had a higher apoptosis percentage (9.81 ±0.56)% compared to the control group (4.36 ±1.32)%,with statistically significant difference (P<0.05).Conclusion STIM1 gene correlated significantly with FaDu cell apoptosis .It inhibits apoptosis of FaDu cells ,and it may be a potential diagnostic and therapeutic target for the hypopharyngeal carcinoma .

Research on functions and mechanisms of MicroRNA-203 on migration of human hypopharyngeal carcinoma cells / 局解手术学杂志

Objective To determine the roles and underlying molecular mechanism of MicroRNA-203 on the migration of human hypo-pharyngeal carcinoma cells. Methods The potential MicroRNA-203 target genes were searched by bioinformatic miRNA target prediction tools and KEGG database,and a large number of candidates was identified. The MEKK1 was selected for further investigation. This gene is known to play a role in tumor metastasis. The MicroRNA-203’s binding sites in MEKK1’s mRNA 3’UTR were analyzed by luciferase report-er assays. Nextly,the protein expression of MEKK1 in Fadu-Lv-MicroRNA-203 cells was determined by Western blot assay. The regulation of MEKK1’s mRNA expression by MicroRNA-203 was analyzed by qRT-PCR. Transwell cell migration assays were performed to confirm the im-pact of MicroRNA-203 on hypopharyngeal carcinoma metastasis. Results The expression level of endogenous MicroRNA-203 was negatively correlated with the mRNA and protein expression levels of MEKK1 in hypopharyngeal carcinoma cells. Transwell migration assay results showed that MicroRNA-203 overexpression inhibited hypopharyngeal carcinoma cell migration ability. Furtherly,MEKK1 can promote hypo-pharyngeal carcinoma cell migration ability. Conclusion MEKK1 is a direct target of MicroRNA-203. MicroRNA-203 plays a role in hypo-pharyngeal carcinoma cell migration ability through MEKK1.

Nursing of patients with laryngeal functions preservation in hypopharyngeal carcinoma / 中国实用护理杂志

Objective To explore the effective and systematic clinical nursing methods,in order to improve the successful rate of preservation of laryngeal function in hypopharyngeal carcinoma,promote laryngeal function recovery,and improve the life quality of patients.Methods 103 patients with hypopharyngeal carcinoma underwent the operation with preservation of laryngeal function were selected.Detailed psychological nursing and health education were given before the operations,while multi mode communication,intensifying the nursing of respiratory tract,diet nursing,observation of complications,rehabilitation guidance and the hospital discharge guidance after operations were given.And the nursing effects were observed.Results 94 patients got healing by first intention(91.26％).Laryngeal functions were completely restored in 70 patients (67.96％) and partially restored in 33 patients (32.04％).About the postoperative complications,21 cases got stress ulceration,6 cases got pharyngeal fistula,5 cases got cardiac arrhythmia,1 case got ARDS and 1 case got pneumothorax.Conclusions The strict and systematic nursing method can improve the successful rate of surgery,reduce the postoperative complications,reduce the economic burden of the patients,promote laryngeal function recovery and improve the life quality of patients.

Treatments Results and Prognostic Factors in Locally Advanced Hypopharyngeal Cancer / 대한방사선종양학회지

PURPOSE: The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with locally advanced hypopharyngeal carcinoma. MATERIALS AND METHODS: Between October 1985 to December 2000, 90 patients who had locally advanced stage IV hypopharyngeal carcinoma were studied retrospectively. Twelve patients were treated with radiotherapy alone, 65 patients were treated with a combination of chemotherapy and radiotherapy, and 13 patients were treated with surgery and postoperative radiotherapy with or without neoadjuvant chemotherapy. Total radiation dose ranged from 59.0 to 88.2 Gy (median 70 Gy) for radiotherpay alone. Most patients had ciplatin and 5-fluorouracil, and others had cisplatin and pepleomycin or vincristin. Median follow-up period was 15 months. Kaplan-Meier method was used for survival rate and Cox proportional hazard model for multivariate analysis of prognostic factors. RESULTS: Overall 3- and 5-year survival rates were 27% and 17%, respectively. The 2-year locoregional control rates were 33% for radiotherapy alone, 32% for combined chemotherapy and radiotherapy, and 81% for combined surgery and radiotherapy (p=0.006). The prognostic factors affecting overall survival were T stage, concurrent chemoradiation and treatment response. Overall 3- and 5-year laryngeal preservation rates in combined chemotherapy and radiotherapy were 26% and 22%, respectively. Of these, the 5-year laryngeal preservation rates were 52% for concurrent chemoradiation group (n=11), and 16% for neoadjuvant chemotherapy and radiotherapy (n=54, p=0.012). CONCLUSION: Surgery and postoperative radiotherapy showed better results than radiotherapy alone or with chemotherapy. Radiotherapy combined with concurrent chemotherapy is an effective modality to achieve organ preservation in locally advanced hypopharyngeal cancer. Further prospective randomized studies will be required.

Partial Horizontal Laryngectomy and Epiglottiplasty / 华中科技大学学报（医学）（英德文版）

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat somepatients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriformfossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4 % in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7 % after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.