Retrospective analysis of patients with nasopharyngeal carcinoma treated during 1976-1985: survival after local recurrence.

PURPOSE: To study the value of re-irradiation, the overall survival and pattern of failures for patients with nasopharyngeal recurrence. METHODS AND MATERIALS: All the 891 patients with local recurrence following radiotherapy for nasopharyngeal carcinoma during 1976-1981 were retrospectively analyzed. Only 70% of them had local failure alone at the time of detection, and the T-stage distribution (by Ho's system) was 31% rT1, 16% rT2, 51% rT3, and 1% rT?. Seven hundred and six (79%) patients had been re-irradiated with various techniques and doses. Among those who failed, 50 had further irradiation. RESULTS: The overall 5- and 10-year actuarial cancer-specific survival rates were 14% and 9%, respectively. Patients with rT3 disease had the worst prognosis. Successful local salvage was achieved in 32% of those re-irradiated (26% of the whole series). The highest control rate was achieved by those treated with external radiotherapy to 60 Gy (equivalent) or above. Only 8/50 patients responded to the third course of radiotherapy. The cumulative incidence of late post-re-irradiation sequelae was 24%, and the treatment mortality rate 1.8%. Besides local failure, 54% had regional relapse and/or distant metastasis. Thus, only 16% of recurrent patients were totally disease-free at final assessment. CONCLUSION: The overall prognosis for patients with nasopharyngeal recurrence was grave. High dose re-irradiation could achieve successful local salvage in a substantial number of patients with early recurrence, but late complications did occur. Furthermore, high incidence of failure at other sites was observed.

Nasopharyngeal carcinoma: local control by megavoltage irradiation.

This is a retrospective analysis of the long-term local control in 4128 patients with non-disseminated nasopharyngeal carcinoma treated solely by megavoltage irradiation during the years 1976-1985. The T-stage distribution according to Ho's classification was T1 37%, T2 14% and T3 49%. Different fractionation schedules had been employed at different periods, and the median dose to the primary target was equivalent to 65 Gy by time dose fractionation calculation. In 8% (344) of patients the tumour failed to regress completely after the basic course, but 89% (148/167) of those suitable for salvage with additional irradiation eventually attained complete local remission. The cumulative incidence of local failure was 24% (5% persistence, 19% recurrence). The 10-year actuarial local failure-free survival was 67%. While patients with T2 and T3a tumours achieved local control comparable to T1, those with T3c-d had the poorest control (with highest incidence of persistence and advanced recurrence). T-stage adjusted analyses suggested a significant trend of dose-response: the odds ratios for local failure were 1.16 and 1.86, respectively, when patients given 60-63 Gy and 55-59 Gy were compared with those given 64 Gy or above (p value = 0.0018). Patients treated during 1981-1985 achieved higher local failure-free survival than those treated during 1976-1980 (75% versus 70% at 5 years, p value = 0.0013). The possible attributes are studied, and ways for future optimization of treatment discussed.

Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: overall survival and patterns of failure.

This is a retrospective analysis of 5037 patients with squamous cell carcinoma of the nasopharynx treated during the years 1976-1985. The stage distribution according to Ho's classification was 9% Stage I, 13% II, 50% III, 22% IV, and 6% Stage V. Only 4488 (89%) patients had a full course of megavoltage radiation therapy. The median equivalent dose to the nasopharyngeal region was 65 Gy and cervical region in node-positive patients 53 Gy. Seventy percent (906/1290) of the node-negative patients had no prophylactic neck irradiation. The overall actuarial 10-year survival rate was 43%, and the corresponding failure-free survival 34%. Altogether, 4157 (83%) patients achieved complete remission lasting more than 6 months, but 53% (2205/4157) of them relapsed after a median interval of 1.4 years. The 10-year actuarial local, regional, and distant failure-free rates were 61%, 64%, and 59%, respectively. Thirty-eight percent (338/891) of all patients with local recurrence achieved second local remission. The local complete remission rate with aggressive re-irradiation alone was 47% (333/706). But 37% (124/338) of the responders recurred the second time. The incidence of distant failure correlated significantly with both the N-stage and the T-stage, with the highest (57%) occurring in patients with N3 disease. The incidence of nodal relapse in node-negative patients was 11% (44/384) among those given prophylactic neck irradiation, but 40% (362/906) among those without. Therapeutic irradiation achieved a complete regional remission rate of 90% (306/339). However, despite successful salvage, these patients had a significantly higher distant failure rate than those without nodal relapse, even if they remained local-failure-free (21% vs 6%). Patients treated during 1981-1985 achieved significantly better treatment results than those treated during 1976-1980, especially in terms of the overall survival (57% vs 47% at 5-year), the overall failure-free survival (42% vs 35% at 5-year), and the local failure-free rate (70% vs 63% at 5-year). The possible contributing factors are discussed.

In vitro studies into the release of chlorhexidine acetate, prednisolone sodium phosphate, and prednisolone alcohol from cold cure denture base acrylic.

An investigation was carried out into the release of chlorhexidine acetate, prednisolone sodium phosphate, and prednisolone alcohol from a cold cured acrylic denture base material. The drugs were added at 10% w/w with the powder phase of the material. Water, at the concentrations of 10%, 20%, and 30% of the monomer phase of the material was added to chlorhexidine-containing and chlorhexidine-free samples. Spectrophotometric and bioassay measurements of the release of chlorhexidine demonstrated protracted delivery to 140 days. The daily release rate was increased by the addition of water to the material and at 30% water incorporation the release was greater and increased up to 190 days. The release pattern of prednisolone sodium phosphate was similar to that of chlorhexidine without the addition of water. Prednisolone alcohol was released for a much shorter period and at lower levels. Scanning electron microscopic examination of the polished, etched, and fractured surfaces of the material demonstrated that chlorhexidine acetate and prednisolone sodium phosphate were incorporated into the interbead matrix areas of the material. The irregularities in the material increased with the addition of water. Prednisolone alcohol produced minimal changes in the specimens except after soaking in water for 140 days when numerous small defects could be seen in the matrix zones at high magnification. The use of materials such as water to increase porosity appears a simple method of improving the release pattern of drugs from acrylic. However, the strength of the resulting material would require support from an existing intraoral prosthesis or appliance.

The effects of drug and water incorporation upon some physical properties of cold cured acrylic.

The addition of drugs to the cold cured acrylics has been demonstrated to variably affect their mechanical properties. This study investigated the effects, to the mechanical properties of a cold cured denture base material, of the addition of drugs and water. Chlorhexidine acetate was incorporated into the denture reline material at 10% w/w in the polymer phase of the material. Specimens also contained 10, 20, or 30% water w/w in the monomer phase of the material with or without the drug. The hardness of the specimens decreased with the addition of water to drug containing or drug-free specimens. Furthermore, there was a significant reduction in the modulus of elasticity of the material with the addition of drugs and water or water alone, which was progressive as the amount of water increased. The load at fracture was similarly reduced as the water incorporation increased. The results demonstrated the considerable effects drug and water incorporation had upon the material. However, this would not negate the use of the material in the oral cavity in the reline or rebase situation employing existing prostheses. Moreover, the reduction in material strength may have the advantage of progressive loss of material with a resulting improved release pattern of the contained drug.