Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

BACKGROUND: Gross target volume of primary tumor (GTV-P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity-modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to find a suitable cut-off value of GTV-P for prognosis prediction. METHODS: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver operating characteristic (ROC) curves were used to identify the cut-off values of GTV-P for the prediction of different endpoints [overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS)] and to test the prognostic value of GTV-P when compared with that of the American Joint Committee on Cancer T staging system. RESULTS: The 358 patients with locally advanced NPC were divided into two groups by the cut-off value of GTV-P as determined using ROC curves: 219 (61.2%) patients with GTV-P ≤46.4 mL and 139 (38.8%) with GTV-P >46.4 mL. The 3-year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV-P ≤46.4 mL than in those with GTV-P > 46.4 mL (all P < 0.05). Multivariate analysis indicated that GTV-P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve verified that the predictive ability of GTV-P was superior to that of T category (P < 0.001). The cut-off values of GTV-P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively. CONCLUSION: In patients with locally advanced NPC, GTV-P >46.4 mL is an independent unfavorable prognostic indicator for survival after IMRT, with a prognostic value superior to that of T category.

[Efficacy of Yanshu injection (a compound Chinese traditional medicine) combined with concurrent radiochemotherapy in patients with stage III nasopharyngeal carcinoma].

OBJECTIVE: To evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage III nasopharyngeal carcinoma. METHODS: Sixty patients with stage III nasopharyngeal carcinoma were randomized into Yanshu group and control group (n = 30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy (IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy. RESULTS: The 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7%, 80.0% for Yanshu group, and 96.7%, 90.0%, 83.3%, 76.7% for the control group, respectively, with no significant difference between the two groups (P = 0.565). The 1-year, 2-year, 3-year and 4-year progression-free survival rates were 96.7%, 90.0%, 83.3%, 70.0% for Yanshu group, and 90.0%, 86.7%, 76.7%, 66.7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0.05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group (P < 0.05). CONCLUSIONS: Yanshu injection combined with radiochemotherapy in patients with stage III nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.

[Effect of radiotherapy on the thyroid of patients with nasopharyngeal cancer].

OBJECTIVE: To determine the effect of radiotherapy on the thyroid of patients with nasopharyngeal cancer. METHODS: Thyroid dynamic imaging was performed on 51 patients with nasopharyngeal cancer who had the metastasis of the jugular lymph node before and after the radiotherapy. The peak time of the thyroid artery perfusion and the constant K were obtained. The levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) in the blood serum were measured at the same time. RESULTS: The peak time of the left and right thyroid artery perfusion before the radiotherapy was (14.5+/-2.1)s and (15.1+/-1.9)s, respectively, while that after the radiotherapy was (19.3+/-3.2)s and (20.2+/-3.5)s, respectively. There was significant difference between the pre- and post-radiotherapy (P<0.001). The constant K of the left and right thyroid before the radiotherapy was significantly higher than that after the radiotherapy (0.0265+/-0.0074 vs. 0.0173+/-0.0062; 0.0249+/-0.0065 vs. 0.0167+/-0.0053, P<0.001, respectively). The level of FT3 and FT4 was significantly higher than that after the radiotherapy, but the TSH level had no obvious change[(4.76+/-0.95) pmol/L vs. (3.85+/-0.71) pmol/L,P<0.001; (18.63+/-3.84) pmol/L vs. (15.69+/-3.27) pmol/L,P<0.001; (1.17+/-0.52) mU/L vs. (1.22+/-0.76)mU/L ,P>0.05, respectively]. CONCLUSION: The peak time of the thyroid artery perfusion and the constant K which reflect blood stream status after the radiotherapy are all damaged in patients with nasopharyngeal cancer. The level of FT3 and FT4 in the blood serum is dropped but the TSH level has no obvious change.