Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer / Correlação dos achados de PET-CT, RM e histopatologia no seguimento de pacientes com carcinoma nasofaríngeo

Abstract Introduction: Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the postradiotherapy period is improved. Objective: The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. Methods: A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients' age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. Results: Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). Conclusions: Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Resumo Introdução: As opções de tratamento cirúrgico são limitadas para o carcinoma nasofaríngeo por várias razões, inclusive aspectos epidemiológicos e histológicos, proximidade de estruturas importantes, drenagem linfática carregada e dificuldade de garantir uma margem cirúrgica segura; portanto, o tratamento primário é geralmente radioterapia e quimioterapia. Com a tecnologia atual de radioterapia, o sucesso oncológico aumentou e a qualidade de vida dos pacientes durante o período pós-radioterapia é garantida. Objetivo: O papel da ressonância magnética e da tomografia computadorizada por emissão de pósitrons no seguimento de pacientes com carcinoma nasofaríngeo recorrente, inicialmente tratados com radioterapia, foi avaliado em relação aos achados histopatológicos. Método: Foram incluídos no estudo 110 pacientes com carcinoma nasofaríngeo que receberam radioterapia. Pacientes com suspeita de recorrência de acordo com o exame endoscópico nasofaríngeo e com achados de ressonância magnética foram solicitados a fazer tomografia computadorizada por emissão de pósitrons. Foram feitas biópsias de 40 pacientes com lesões suspeitas nas imagens de tomografia computadorizada por emissão de pósitrons. Os pacientes foram avaliados segundo idade, sexo, presença/ausência de realce por contraste na ressonância magnética, valores SUVmax de lesões nasofaríngeas e cervicais, estágios T/N no diagnóstico inicial, recorrência histopatológica e histórico de esvaziamento cervical. Resultados: A recorrência foi observada em 8 pacientes (20,0%). Entre esses, 4 (10,0%) apresentaram recorrência na nasofaringe e 4 (10,0%) no pescoço. Pacientes com recorrência eram do sexo masculino, apresentavam idade mais avançada, estágio avançado T/N, realce por contraste na ressonância magnética e maiores valores de SuvMax nasofaríngeo e cervical na tomografia computadorizada por emissão de pósitrons. Entretanto, essas diferenças não foram estatisticamente significantes. Apenas o histórico de esvaziamento cervical foi significantemente mais comum entre aqueles com recorrência (p < 0,001). No entanto, na análise multivariada, aqueles com um valor de SUVmax nasofaríngeo superior a 4,58 apresentaram um risco 7,667 vezes maior de recorrência (p = 0,036). Conclusão A ressonância magnética e a tomografia computadorizada por emissão de pósitrons devem ser avaliadas em conjunto no seguimento da doença. Pacientes com valor de SUVmax mínimo de 4,58 na tomografia computadorizada por emissão de pósitrons após realce com contraste na sequência T2 na ressonância magnética podem ser considerados mais adequados para biópsia. Biópsias em pacientes com um valor de SUVmax menor do que 4,58 podem ser evitadas. Dessa forma, podemos evitar o estresse cirúrgico para o paciente e custos desnecessários.

Less is more: role of additional chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal cancer management

Concurrent chemoradiation therapy (CCRT) has played the most important and central role in the definitive therapy for the patients with locoregionally advanced stage nasopharynx cancer. The addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to CCRT have been widely accepted with the rationale of improving distant control in the clinical practices. This review article investigated the role of IC and AC based on 11 recent meta-analysis publications, and found that the clinical benefits obtained by the additional IC or AC to CCRT, at the cost of the increased risks of more frequent and more severe side effects, seemed not big enough. More intervention is not always better, however, less seems frequently good enough. The author would speculate that ‘less is more’ and would advocate CCRT alone as the current standard.

Clinical significance of homocysteine level detection before and after radiotherapy in patients with nasopharynx cancer / 国际检验医学杂志

Objective To investigate the clinical significance of detecting the homocysteine (Hcy) level by enzymatic cycling as‐say before and after radiotherapy in nasopharynx cancer .Methods 62 cases of definitely diagnosed nasopharynx cancer in our hos‐pital from September 2013 to September 2014 were included into the observation group and 60 individuals undergoing the physical examination were enrolled as the control group .The venous blood was collected once in the control group and was collected before radiotherapy and at 1 week ,1 month after the radiotherapy beginning in the observation group .The enzymatic cycling assay was used to test the Hcy level .Then the detection results were compared between the two groups .Results The Hcy level had no statis‐tically significantly difference among different stages of nasopharynx cancer before radiotherapy (F= 0 .15 ,P= 0 .86) .The Hcy level before radiotherapy and at 1 week after radiotherapy in the observation group were significantly higher than that in the control group ,the difference was statistically significant (t= - 12 .1 ,P< 0 .05 ;t= - 7 .32 ,P= 0 .00) .The Hcy level at 1 month after radio‐therapy in the observation group had no statistical difference compared with that in the control group (t= - 1 .45 ,P = 0 .15) .The Hcy level at 1 week and 1 month after radiotherapy in the observation group was significantly reduced ,which showed statistical difference compared with before radiotherapy (t= - 5 .22 ,P= 0 .00 ;t= - 13 .56 ,P= 0 .00) .Conclusion The Hcy level in the pa‐tients with nasopharynx cancer is significantly increased ,whereas with the conducting radiotherapy ,which shows the decreasing trend ,indicating that the Hcy level has certain guidance value for the diagnosis and treatment of nasopharynx cancer ,but the Hcy level has no obvious difference among different stages of nasopharynx cancer .

Clinical value of Rta protein antibody IgG of EB virus in diagnosis for nasopharynx cancer / 国际检验医学杂志

Objective To evaluate the clinical value of Rta protein antibody IgG of EB virus(Rta/IgG)in the diagnosis of naso‐pharyngeal carcinoma patients in Zhuhai .Methods A total of 75 patients with nasopharyngeal cancer diagnosed by histopathologi‐cal detection without therapy were recruited into nasopharyngeal cancer group ,100 healthy persons were selected into control group ,there were 19 patients in liver cancer ,gastric cancer ,lung cancer ,lymphoma group and cervical cancer group .Rta/IgG and EB virus antibody of shell (VCA/IgA) were detected by enzyme‐linked immunosorbent assay .Results The positive rate of Rta/IgG in the nasopharyngeal cancer group was significant higher than those of liver cancer ,gastric cancer ,lung cancer ,lymphoma group and cervical cancer and control group(P0 .05) .The sensitivity rates of Rta/IgG single detection ,VCA/IgA single detection ,com‐bined detection of Rta/IgG and VCA/IgA were 81 .3% ,89 .3% ,94 .6% respectively ,while the specificity rates were 93 .0% ,84 . 0% ,80 .0% respectively .Conclusion Rta/IgG is a sensitive and specific serologic parameter for nasopharynx cancer diagnosis ,but it is not a proper maker for evaluating clinical stage of nasopharynx cancer .The combined detection of Rta/IgG and VCA/IgA could improve the diagnosis rate of nasopharyngeal carcinoma in Zhuhai .

Effect of triptolide on apoptosis of nasopharynx cancer / 中国药理学通报

Aim Toexploretheinhibitioneffectof triptolide on nasopharynx cancer, and the mechanism. Methods Theinhibitionofcellproliferationwasde-tected by MTT assay;the cell apoptosis was analyzed by flow cytometry with propidium iodide staining. The ex-pressions of glucose regulated protein 78 ( GRP-78 ) , Akt and pAkt in cells were examined by Western blot;the effect of triptolide on reactive oxygen species ( ROS) accumulation was detected by ROS Fluorescent Probe-DHE.Results MTTassayshowedthatthe growth of nasopharynx cancer was inhibited by triptol-ide , and the inhibition occurred in a dose and time-de-pendent manner following triptolide treatment in CNE-2Z nasopharynx cancer cells. Propidium iodide staining revealed that the apoptosis of CNE-2 Z cells was in-duced remarkably by triptolide. After CNE-2Z cells treated with 25, 50,100 nmol·L-1 of triptolide for 24 h, the apoptosis rate was 14%,26. 9% and 34. 4% re-spectively. Western blot experiment showed that the expression of GRP-78 had no significant change follow-ing triptolide treatment in CNE-2 Z nasopharynx cancer cells for 24 h, but the expression and the phosphoryla-tion level of Akt were strikingly decreased. The experi-ment of ROS uncovered that CNE-2 Z nasopharynx cancer cells increased generation of ROS after treat-ment with triptolide for 4 hours, and acted cells in a dosedependentmanner.Conclusions Triptolidecan inhibit the growth of CNE-2 Z nasopharynx cancer cells in a dose and time-dependent maner. The mechanism may be related with the point that triptolide can induce oxidative stress, incease ROS, inhibit the expression and the phosphorylation level of Akt,then promote the apoptosis of CNE-2Z cells.

A Case of Mucoepidermoid Carcinoma in Nasopharynx / 대한이비인후과학회지

Mucoepidermoid carcinoma of nasopharynx, a kind of primary adenocarcinoma of the the nasopharynx, is very rare and about 21 cases of mucoepidermoid carcinoma occurring in the nasopharynx were reported to date in the English literature. We recently experienced a case of mucoepidermoid carcinoma of the nasopharynx in a 31-year-old woman, who presented with nasopharyngeal mass and left lateral neck mass. We present this case with a review of the literature.

Evaluation of Xerostomia Following 3 Dimensional Conformal Radiotherapy for Nasopharyngeal Cancer Patients / 대한방사선종양학회지

PURPOSE: This study is to evaluate the xerostomia following 3-dimensional conformal radiation therapy (3D CRT) in nasopharynx cancer patients using the xerostomia questionnaire score (XQS). MATERIALS AND METHODS: Questionnaire study was done on 51 patients with nasopharynx cancer who received 3D CRT from Dec. 2000 to Aug. 2005. 3D CRT technique is based on "serial shrinking field" concept by 3 times of computed tomography (CT) simulation. Total target dose to the primary tumor was 72 Gy with 1.8 Gy daily fractions. Xerostomia was assessed with 4-questions XQS, and the associations between XQS and time elapsed after RT, age, sex, stage, concurrent chemotherapy, and parotid dose were analyzed. RESULTS: Concurrent chemotherapy was given to 40 patients and RT alone was given to 11 patients. The median time elapsed after 3D CRT was 20 (1~58) months and the mean XQS of all 51 patients was 8.4+/-1.9 (6~14). XQS continuously and significantly decreased over time after 3D CRT (x(2)=-0.484, p or=35 Gy was significantly higher than or=35 Gy were suggested to adversely affect radiation-induced xerostomia.

Application Review on Ploidy Analysis of Nasopharynx Cancer DNA / 浙江中医药大学学报

DNA ploidy can more really reflect the content of DNA,which has long history in the relation study with tumor.In many factors influencing malignant tumor prognosis,more and more scholars think DNA ploidy is the prognosis factor only second to clinical time,most important and separate.In recent years,DNA ploidy analysis has got new progress in clinical nasopharynx cancer study.

Nasopharynx cancer incidence in Metro Manila and Rizal provinces: 1980-1992

Incidence was derived from published data from 2 population-based registries-the Philippine Cancer Society-Manila Cancer Registry and Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Covil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period of 1988-1992 the combined age-standardized incidence rates (ASR) were: 6.8 for male nasopharynx cancer (NPC) (ranked sixth) and 3.2 among females (ranked thirteenth). NPC for both sexes were highest among Asian populations. Within the region, Philippine rates were third highest, following the Singapore Chinese and Vietnamese. Age-specific rates in males reached 10 per 100,000 at age-group 40-49 years, and 5 per 100,000 females at age-group 45-49 years, continuing to rise with increasing age. There were some significant differences in ASRs between some cities and municipalities but the differences were more striking among males as female rates were lower. Rates had increased only very slightly in the 13-year period between 1980-1992 but total cases had triples. NPC ASRs among male Filipino migrants to the USA were only half of that observed in Philippine residents, but were still higher than the rates among White residents. A similar decrease was seen among female migrants, and in Los Angeles the rates of Filipinos and non-Hispanic White females were already similar

The nucleotide sequence of PCR-EBV product obtaining from NPC patients

EVB DNA fragments from 3 biopsies obtained from Vietnamese patients with NPC have been examined by PCR detection method, using a mixture of primers TH1,2. PRC products were cloned by using vector PCM TM II and were sequenced on Automated sequencer. The result showed that our PCR products were similar to the specific sequence of EBV have been reported in EMBL data library, confirmed that PCR products are specific fragments of EBV, we can successfully use the mixture of primers TH1,2 in PCR detection of EBV DNA in biopsies of NPC patients