Association between Pretreatment Serum High-density Lipoprotein Cholesterol and Treatment Outcomes in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma Treated with Chemoradiotherapy: Findings from a Randomised Trial.

Background: To investigate the relationship between the pretreatment serum lipid concentrations and the clinical outcomes in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) who were treated with a combination of chemotherapy and radiotherapy. Methods: From August 2002 to April 2005, 400 patients with stage III or stage IVa nasopharyngeal carcinoma were recruited for a randomised clinical trial of induction chemotherapy combined with radiotherapy or concurrent chemoradiotherapy. Pretreatment serum lipid concentrations were examined in 342 patients. Both univariate and multivariate analyses were conducted to investigate the association of serum lipid levels with different treatment outcomes. Results: The 5-year failure-free survival rate for the low- high-density lipoprotein cholesterol (HDL-C) and high-HDL-C groups was 52.1% and 65.5%, respectively (p=0.017), and the 5-year overall survival rate was 64.7% and 72.5%, respectively (p=0.094). The pretreatment serum level of HDL-C was a favourable prognostic factor of overall survival and failure-free survival in a Cox regression model with HR 0.65 (95% CI 0.43-0.97; p=0.036) and 0.60 (95% CI 0.41-0.88; p =0.008). No significant correlation was observed between the prognosis of patients with NPC and serum levels of total cholesterol (TC), triglyceride (TG), or low-density lipoprotein cholesterol (LDL-C). Conclusions: The pretreatment serum level of HDL-C was an independent prognostic factor for patients with locoregionally advanced nasopharyngeal carcinoma who were treated with chemoradiotherapy.

Prognostic factors on overall survival of newly diagnosed metastatic nasopharyngeal carcinoma.

BACKGROUND: To investigate factors associated with overall survival in patients with newly diagnosed metastatic nasopharyngeal carcinoma. MATERIALS AND METHODS: Two hundred and two consecutive patients with pathologically confirmed nasopharyngeal carcinoma with distant metastasis at diagnosis seen between December 2007 and May 2011 were reviewed. Patient, tumor and treatment factors were analyzed for their significance regarding overall survival. RESULTS: The median follow-up time was 22 months. At the time of this report, 116 patients had died. For 112 patients, cause of death was nasopharyngeal carcinoma. The 1, 2, 3, and 4-year overall survival rates were 75.6%, 50.2%, 39.2%, and 28.2%, respectively. Cox regression multivariate analysis showed that T-stage (p=0.045), N-stage (p=0.014), metastasis number (p<0.001) and radiotherapy for nasopharynx and neck (p<0.001) were significant factors for overall survival. CONCLUSIONS: Early T-stage and N-stage, solitary metastasis in a single organ were good prognostic factors for patients with newly diagnosed metastatic nasopharyngeal carcinoma. Radiotherapy should be strongly recommended in systemic treatment.

Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy.

BACKGROUND: To investigate the clinical feature and the local failure patterns after intensity-modulated radiotherapy for nasopharyngeal carcinoma. METHODS: Between March 2007 and July 2009, 710 patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. The magnetic resonance imagings obtained at recurrence were registered with the original planning computed tomography for dosimetry analysis. RESULTS: With a median follow-up of 38 months, 34 patients have developed local recurrence (32 cases valid). The incidence of invasion to nasopharynx, parapharyngeal space and the retropharyngeal space by the primary tumors was 100%, 75.0% and 62.5%, respectively, but 78.1%, 34.4% and 21.9% at recurrence, respectively. The rate of invasion to ethmoid sinus was 3.1% by the primary tumors but 28.1% at recurrence (p=0.005). The topographic analysis of the local failure patterns showed "central" in 16 patients; "marginal" in 9; and "outside" in 7. The median volumes of primary gross tumor were 45.84 cm(3) in the central failure group, 29.44 cm(3) in the marginal failure group, and 21.52 cm(3) in the outside failure group, respectively (p=0.012), and the median volumes of primary clinical target1 were 87.28 cm(3), 61.90 cm(3) and 58.74 cm(3) in the three groups, respectively (p=0.033). CONCLUSIONS: In patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy, the recurrent tumors had their unique characteristic and regularity of invasion to adjacent structures. "Central" failure was the major local failure pattern. The volumes of primary gross tumor and clinical target1 were significantly correlated with recurrent patterns. Employ more aggressive approaches to tumor cells which will be insensitive to radiotherapy may be an effective way to reduce the central failure.

[Value of postoperative adjuvant chemotherapy in locally advanced rectal cancer patients with ypT1-4N0 after neo-adjuvant chemoradiotherapy].

OBJECTIVE: The purpose of this study was to investigate the value of postoperative chemotherapy for locally advanced rectal cancer patients who reached pathological ypT1-4N0 after neo-adjuvant chemoradiotherapy. METHODS: We performed a retrospective study of 104 patients treated with preoperative chemoradiotherapy followed by radical resection, who achieved pathological ypT1-4N0, between Mar 2003 and Dec 2010. There were 73 patients who received postoperative adjuvant chemotherapy, and the other 31 patients did not. The distribution of final pathologic stages for these patients was ypT1-2N0 in 39 cases and ypT3-4N0 in 65 cases. RESULTS: The median follow-up was 41 months. The 3-year overall survival rate (OS) and recurrence-free survival rate (RFS) for the whole group (ypT1-4N0) were 93.4% and 85.3%, respectively. The 3-year OS and RFS in the adjuvant chemotherapy group and non-adjuvant chemotherapy group were 95.5%, 88.6% and 88.6%, 77.2%, respectively. There were no significant differences in 3-year RFS (P = 0.108) and OS (P = 0.106) between the two groups. The 3-year local recurrence and distant metastasis rates in the adjuvant chemotherapy group were 4.1% (3/73) and 5.5% (4/73), while for the non-adjuvant chemotherapy group, the 3-year local recurrence rate and distant metastasis rate were 3.2% (1/31) and 16.1% (5/31), respectively. Significant difference was found in distant metastasis rates (P = 0.030) between the two groups, but not in local recurrence rates (P = 0.676).Further subgroup analysis indicated that for the ypT1-2N0 patients, there were no significant differences in 3-year OS (P = 0.296) and RFS (P = 0.939) between the adjuvant and non-adjuvant chemotherapy groups, while negative results displayed in 3-year local recurrence rates (P = 0.676) and distant metastasis rates (P = 0.414). However, for patients with ypT3-4N0, significant differences were showed in both the 3-year OS (P = 0.034) and RFS (P = 0.025), and further analysis revealed that the 3-year distant metastasis rate was significantly higher in the non-adjuvant chemotherapy group than in the adjuvant chemotherapy group (P = 0.010) , but with non-significant difference in the 3-year local recurrence (P = 0.548). CONCLUSIONS: Adjuvant chemotherapy may not improve survival for ypT1-2N0 patients. However, it may be clinically meaningful for ypT3-4N0 patients by decreasing distant metastasis rate. Further randomized controlled clinical trials are needed to confirm our results.

3D-image-guided high-dose-rate intracavitary brachytherapy for salvage treatment of locally persistent nasopharyngeal carcinoma.

BACKGROUND: To evaluate the therapeutic benefit of 3D-image-guided high-dose-rate intracavitary brachytherapy (3D-image-guided HDR-BT) used as a salvage treatment of intensity modulated radiation therapy (IMRT) in patients with locally persistent nasopharyngeal carcinoma (NPC). METHODS: Thirty-two patients with locally persistent NPC after full dose of IMRT were evaluated retrospectively. 3D-image-guided HDR-BT treatment plan was performed on a 3D treatment planning system (PLATO BPS 14.2). The median dose of 16 Gy was delivered to the 100% isodose line of the Gross Tumor Volume. RESULTS: The whole procedure was well tolerated under local anesthesia. The actuarial 5-y local control rate for 3D-image-guided HDR-BT was 93.8%, patients with early-T stage at initial diagnosis had 100% local control rate. The 5-y actuarial progression-free survival and distant metastasis-free survival rate were 78.1%, 87.5%. One patient developed and died of lung metastases. The 5-y actuarial overall survival rate was 96.9%. CONCLUSIONS: Our results showed that 3D-image-guided HDR-BT would provide excellent local control as a salvage therapeutic modality to IMRT for patients with locally persistent disease at initial diagnosis of early-T stage NPC.

[Research progress on pathologic complete response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer].

Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for patients with locally advanced rectal cancer. Controversy on whether patients should receive radical surgery after pathological complete response (pCR) after neoadjuvant chemoradiotherapy has remained since pCR patients have shown favorable long-term outcome. Progress in multidisciplinary modalities has been made, including MRI, PET/CT imaging studies, genetic expression profiling, etc. The methods of predicting pCR response are inspiring. In this article, we review the methods for prediction and prognostic effect of pCR response when patients with locally advanced rectal cancer are treated with neoadjuvant chemoradiotherapy.

Pretreatment body mass index as an independent prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy: findings from a randomised trial.

OBJECTIVE: To investigate the relationship between the pretreatment body mass index (BMI) and the clinical outcomes in patients with locoregionally advanced nasopharyngeal carcinoma treated with combination of chemotherapy and radiotherapy. METHODS: From August 2002 to April 2005, 400 patients with stage III or stage IVa nasopharyngeal carcinoma were recruited for a randomised clinical trial of induction chemotherapy combined with radiotherapy or concurrent chemoradiotherapy. The patients were divided into four groups of underweight (BMI<18.5kg/m(2)), normal weight (BMI 18.5-22.9kg/m(2)), overweight (BMI 23.0-27.4kg/m(2)) or obese (BMI≥27.5kg/m(2)) according to the World Health Organization classifications for Asian populations. The differences in the long-term survival, of these four BMI groups were analysed. RESULTS: The 5-year failure-free survival rates for the underweight, normal weight, overweight and obese groups were 44%, 61%, 68% and 73%, respectively (p=0.014), and the 5-year overall survival rates were 51%, 68%, 80% and 72% (p=0.001), respectively. BMI was a strongly favoured prognostic factor of overall survival and failure-free survival in a Cox regression model. CONCLUSIONS: Pretreatment body mass index was a simple, reliable independent prognostic factor for patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy.

Value of transrectal ultrasonography for tumor node metastasis restaging in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy.

OBJECTIVE: To explore the value of transrectal ultrasonography (TRUS) for tumor node metastasis (TNM) restaging for patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy (neo-CRT). METHODS: One hundred and forty-nine patients with locally advanced rectal cancer (cT3-4 or cN+) who underwent TRUS after neo-CRT were retrospectively reviewed. TRUS restaging was compared with the results of post-operative pathological TNM findings. RESULTS: After neo-CRT, the accuracy of TRUS for diagnosing T-staging was 30.9%, with 60.4% (90/149) of cases overestimated. The sensitivity of TRUS for T-staging (T0 vs T1 vs T2 vs T3 vs T4) were 16.3%, 0%, 12.5%, 42.6% and 75.0%, respectively. The accuracy of TRUS for diagnosing N-staging after neo-CRT was 81.2%, with the sensitivities of N0 and N+ were 93.3% and 31.0%, respectively. After neo-CRT, 27.5% (41/149) of patients achieved pathologically complete response (pCR). The sensitivity, specificity, positive predictive value and negative predictive values of TRUS for pCR were 17.1%, 99.1%, 87.5% and 75.9%, respectively. CONCLUSIONS: TRUS can be applied for restaging T4 and N0, and has potential for screening out patients with pCR in those with locally advanced rectal cancer after neo-CRT, although some stages are overestimated for T-staging and its sensitivity for predicting pCR is low.

Post-radiation CT changes and recurrent nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is endemic in Southern Asia. Radiation therapy remains the mainstay of treatment strategies for NPC. Although approximately 19% - 56% of patients develop a recurrent disease 5 years after their primary treatment, recognition of post-radiation changes and early detection of relapse are important in improving the outcome of NPC. Our aim was to analyze the post-radiation changes and recurrent diseases related to NPC using computed tomography (CT) scans and to investigate their relationship. METHODS: CT scans of 510 pathologically proven NPC patients who have been followed up for more than 2 years after radiation were reviewed. The tumor's response to the radiation therapy and its relevance to recurrence were evaluated. RESULTS: For patients who were followed up for more than 2 years, their CT scans-obtained within 3 months, during the 4th to the 6th month, and beyond 7 months after radiation therapy, showed a normal nasopharyngeal cavity with a slight thickening in the wall in 93.5%, 95.0% and 84.8% of the patients respectively. The degree of tumor regression had no significant relevance to the risk of recurrence within the initial 3 months (P = 0.094). During this term, the relapse rates in the cases in which the nasopharyngeal walls were displayed as normal, slightly or moderately thickening, or with obvious residual masses on CT scans were 7.1%, 11.7%, 23.5% and 23.1% respectively. The degree of tumor regression beyond 3 months after radiation therapy had a considerable reverse relevance to the risk of recurrence (P = 0.000). The relapse rates were 13.2%, 14.1%, 10.2% and 2.1%, respectively, in the cases with a normal and a slightly thickening nasopharyngeal wall during the 4th to the 6th month, the 7th to the 12th month, the 13th to the 24th month, and beyond 25 months after radiation. In contrast, the percents in cases with moderate or more aggressive thickening walls in the corresponding periods were 62.5%, 88.9%, 100% and 100%. Within 6 months after radiation therapy, shown by CT scans, the metastatic lymph nodes disappeared, markedly decreased, slightly decreased, or enlarged in 37.4%, 51.8%, 4.7%, and 0.4%, respectively, of the patients. During 6 to 12 months after radiation therapy, the proportions were 78.5%, 19.2%, 0.6% and 1.7% correspondingly. Beyond 12 months, the proportions were 83.7%, 7.9%, 0%, and 8.4%. The regression degree of the malignant nodes after radiation therapy showed a remarkable reverse relevance to the risk of recurrence in lymph nodes (P = 0.000). In the cases with disappearing, markedly decreased, slightly decreased, or enlarged malignant nodes within six months after radiation, the relapse rates were 2.9%, 4.5%, 12.5% and 100%, respectively. CONCLUSIONS: If the nasopharyngeal walls are shown to remain moderately thick on a CT scan beyond 6 months after radiotherapy, the risk of relapse will increase. The baseline images taken within 3 months after radiotherapy and regular follow-up studies are the key to pick up the tumor recurrences in an earlier stage.