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Objective:To analyze the clinical efficacy and prognostic factors of intracranial primary diffuse large B-cell lymphoma (DLBCL).Methods:Clinical data of 205 patients pathologically diagnosed with intracranial primary DLBCL at Sun Yat-sen University Cancer center from March 2001 to September 2020 were retrospectively analyzed. Among them, 101 patients were male and 104 female, the median age was 54 years old. Non-germinal center B cell (GCB) subtype accounted for 74.1%(126/170). A total of 177 patients received high-dose methotrexate (HD-MTX) and 91 patients received rituximab. After induction chemotherapy, 59 patients (30.4%) achieved complete response (CR), 112 patients (57.7%) achieved partial response (PR) or stable disease (SD). A total of 83 patients received consolidation or salvage radiotherapy, and only 14 patients received autologous stem cell transplantation (ASCT). The influence of pathological type, chemotherapy, rituximab treatment, radiotherapy and radiotherapy mode, ASCT and other factors on the overall survival (OS) and progression free survival (PFS) was evaluated. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by COX model.Results:The median follow-up time was 34 months. The 5-year OS and PFS rates were 55.6% and 44.2%, respectively. GCB subtype, chemotherapy with HD-MTX, rituximab treatment, remission status after induction chemotherapy, and radiotherapy were favorable prognostic factors for OS or PFS, in which the last three were the independent prognostic factors. Consolidation radiotherapy in patients who obtained CR after induction chemotherapy did not significantly improve survival, while salvage radiotherapy in patients who achieved PR/SD after induction chemotherapy significantly improved both OS and PFS(both P<0.01). Consolidation radiotherapy showed no significant survival difference compared with consolidation ASCT. Conclusions:The non-GCB subtype of intracranial primary DLBCL is related to poor prognosis. The addition of rituximab to HD-MTX based induction chemotherapy can improve survival. Radiotherapy is still an important treatment for intracranial primary DLBCL, and there are limitations of ASCT in practical clinical application.
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Objective:To investigate the clinical feasibility of the Unity radiotherapy system guided by magnetic resonance imaging.Methods:Twenty-four patients were enrolled and received a total of 384 fractions of treatment at Unity system. According to the treatment site, all patients were divided into head-neck, abdomen-thorax, pelvic, spine and limb groups. The patients were set-up without external laser. And then, the time required at different stages in online treatment process and the registration error of each fraction were separately calculated. The geometric deformations of MR images were weekly measured by using MR geometric deformation phantom. At last, the Arccheck was used to perform the dose verification of reference plan, online plan and offline plan.Results:The mean duration of radiotherapy in the five groups were 29.1, 27.6, 26.6, 25.6 and 32.0 min, respectively. The set-up errors in the left-right, superior-inferior and anterior-posterior direction in the five groups were: head-neck group (0.08±0.06 cm, 0.16±0.13 cm, 0.08±0.05 cm), abdomen-thorax group (0.23±0.18 cm, 0.50±0.47 cm, 0.12±0.1 cm), pelvic group (0.25±0.19 cm, 0.32±0.25 cm, 0.11±0.09 cm), spine group (0.46±0.38 cm, 0.26±0.26 cm, 0.13±0.07 cm) and limb group (0.33±0.30 cm, 0.34±0.23 cm, 0.08±0.06 cm), respectively. In the central region, the geometric deformation of MR was less than 0.3 mm, and that of the sphere with a diameter of 500 mm was less than 2.1 mm. The meanγ pass rate of the reference plan, online plan and offline plan were 97.92%, 97.84% and 94.58%, respectively.Conclusions:MR-guided radiotherapy has great potential for clinical application, whereas the process of Unity system is relatively complex. The synergy of different departments has a great impact on the treatment, which needs further optimization.
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Objective:To preliminarily observe the feasibility of different immobilization techniques for total skin irradiation (TSI) using helical tomotherapy.Methods:Three eczema scrophuloderma patients treated with TSI in Sun Yat-sen University Cancer Center were immobilized with low-temperature thermoplastic in a prone position, diving suit combined with negative pressure vacuum bag in a supine position, low-temperature thermoplastic combined with vacuum bag in a supine position, respectively. Different immobilization effects were observed. The conformity index (CI) of the target area, heterogeneity index (HI) of the target area, and the mean dose (D mean) of the target area were calculated. Results:Three immobilization methods could achieve satisfactory immobilization effects, and all the dosimetric parameters of radiation treatment plans met the clinical requirements. The average set-up errors in the left and right, head and foot, and abdomen and back directions of three patients were (0.26±3.40) mm, (-2.63±4.63) mm and (6.13±4.86) mm, respectively. The CI, HI andD mean were0.56±0.09, 1.186±0.059 and (2586.56±63.28) cGy. Conclusions:Low-temperature thermoplastic or diving suits can be combined with vacuum bags for immobilization in TSI. The epidermal dose can be increased with bolus through the dose-building effect, which can provide a safe and reliable method for TSI in helical tomotherapy.
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Objective:Based on the AAPM TG-263, a Content-Based Standardizing Nomenclatures (CBSN) was proposed to explore the feasibility of its standardization verification for organs at risk (OAR) of nasopharyngeal carcinoma (NPC).Methods:The radiotherapy structure files of 855 patients with nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT) from 2017 to 2019(15 of whom showed clinical anomalous structures) were retrospectively collected and processed. The Matlab self-developed software was used to obtain the image position, geometric features, first-order gray histogram, and the Gray-level Co-occurrence Matrix′s texture features of the OAR contour outlined by the doctor to establish the CBSN Location Verification model and CBSN Knowledge Library. Fisher discriminant analysis was employed to establish a CBSN OAR classification model, which was evaluated using self-validation, cross-validation, and external validation, respectively.Results:99%(69/70) of the simulated anomalous structures were outside the 90% reference range of the CBSN Knowledge Library and the characteristic parameters significantly differed among different OARs (all P<0.001). The accuracy rates of self-validation, cross-validation and external verification of the CBSN OAR classification model were 92.1%, 92.0% and 91.8%, respectively. Fourteen cases of clinical abnormal structures were successfully detected by CBSN with an accuracy rate of 93%(14/15). In the simulation test, the accuracy of the left and right location verification reached 100%, such as detecting the right eye lens named Len_L. Conclusion:CBSN can be used for OAR verification of NPC, providing reference for multi-center cooperation and standardized radiotherapy of NPC patients.
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Objective:To investigate the feasibilityof the adaptive radiotherapy using high-field MR-Linac systems for head neck cancers and perform the evaluation of target coverage and dose criteria.Methods:This study investigated 128 treatment plans of six patients who were treated on 1.5T MR-Linacsystems in Sun Yat-sen University Cancer Center in 2019, compared the differences in target coverage and dose criteria between the dose accumulation in the adaptive radiotherapy using MR-Linac systems and the reference plans, and evaluated the target coverage and dose criteria of each fraction of adaptive plan based on daily MRI anatomy.Results:There was no significant change in the target coverage and dose criteria for each treatment fraction(<1%). However, the change of lens dose was significant (maximum 98%). In addition, the result showed that there was no significant difference in target coverage and dose criteria between the dose accumulation in adaptive radiotherapy using MR-Linac systems and reference plans.In contrast, the average dose to lens was increased by 31.7%.Conclusions:It is feasible to perform adaptive radiotherapy using 1.5T MR-Linacsystems for head neck cancers according tothe evaluation of target coverage and dose criteria. Additionally, since the actual dose tolens was quite different from the reference plan, the lens exposure should be considered in clinical practice.
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OBJECTIVE@#To investigate the accuracy of automatic segmentation of organs at risk (OARs) in radiotherapy for nasopharyngeal carcinoma (NPC).@*METHODS@#The CT image data of 147 NPC patients with manual segmentation of the OARs were randomized into the training set (115 cases), validation set (12 cases), and the test set (20 cases). An improved network based on three-dimensional (3D) Unet was established (named as AUnet) and its efficiency was improved through end-to-end training. Organ size was introduced as a priori knowledge to improve the performance of the model in convolution kernel size design, which enabled the network to better extract the features of different organs of different sizes. The adaptive histogram equalization algorithm was used to preprocess the input CT images to facilitate contour recognition. The similarity evaluation indexes, including Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD), were calculated to verify the validity of segmentation.@*RESULTS@#DSC and HD of the test dataset were 0.86±0.02 and 4.0±2.0 mm, respectively. No significant difference was found between the results of AUnet and manual segmentation of the OARs (@*CONCLUSIONS@#AUnet, an improved deep learning neural network, is capable of automatic segmentation of the OARs in radiotherapy for NPC based on CT images, and for most organs, the results are comparable to those of manual segmentation.
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Humans , Databases, Factual , Image Processing, Computer-Assisted , Nasopharyngeal Carcinoma/radiotherapy , Nasopharyngeal Neoplasms/radiotherapy , Organs at Risk , Tomography, X-Ray ComputedABSTRACT
Objective To retrospectively analyze the prognostic factors for locoregionally recurrent early?stage extranodal nasal?type natural killer/T?cell lymphoma ( NKTCL) . Methods A total of 56 patients with early?stage extranodal nasal?type NKTCL, who had locoregional recurrence after initial treatment and then received salvage treatment from 1995 to 2014, were enrolled as subjects. The effects of salvage treatment on the overall survival ( OS) rate were analyzed after initial treatment and recurrence. Univariate and multivariate prognostic analyses were performed on the OS rate after recurrence. Results The median follow?up time was 35. 9 months after initial treatment and 14. 8 months after recurrence. The 3?year OS rate was 73% after initial treatment and 58% after recurrence. Compared with chemotherapy alone, radiotherapy?containing salvage treatment significantly improved the OS rates after initial treatment and recurrence ( P=0. 040, 0. 009 ) , and re?irradiation also significantly improved the OS rates after initial treatment and recurrence (P=0. 018, 0. 019). Most (84%) of the acute and late adverse reactions after re?irradiation were grade 1?2 ones. The univariate and multivariate analyses showed that the Karnofsky Performance Status score, radiotherapy in initial treatment, and radiotherapy in salvage treatment were influencing factors for the OS rate after recurrence. Conclusions Radiotherapy achieves improved survival and tolerable toxicities, making it indispensable in the treatment of locoregionally recurrent extranodal nasal?type NKTCL.
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Objective Combination of chemotherapy regimens and chemoradiotherapy to the curative effect of locally advanced nasopharyngeal carcinoma is unclear. The carcinoma radiotherapy adverse reaction and curative effect were investigated in nedaplatin plus fluorouracil in the same period radiotherapy(Group NF)compared with cisplatin(DDP)in the same period (Group DDP)in the treatment of locally advanced nasopharyngeal. Method Patients with locally advanced(ⅢandⅣB)nasopharyngeal carcinoma(NPC)in Sun yat?sen university cancer hospital were enrolled and divided into two groups:222 cases in the NF group and 165 cases in the DDP group. The adverse reaction,5?year progression?free survival(PFS)and overall survival(OS)for 5 years were evaluated in two groups. Results The 5?year PFS in the NF and DDP group was 85.13%and 82.42%,respectively, with no significant difference. The 5?year OS in the NF and DDP group was 85.58% and 82.42%,respectively, with no significant difference. The proportion of oral mucositis in the NF group was significantly lower than that in the DDP group. Conclusion Nedaplatin plus fluorouracil radiation therapy has similar curative effect ,adverse reaction with cisplatin plus the same radiation therapy in the treatment of locally advanced nasopharyngeal carcinoma.
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Objective To propose a new suggestion for the clinical downstaging of nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT) without changing the current T,N,and M staging system.Methods We reviewed the records of 536 NPC patients treated in Sun Yat-Sen University Cancer Center from January 2002 to December 2006.The Kaplan-Meier method was used to calculate the disease-specific survival (DSS) rate,and the log-rank test was used for survival difference analysis.The Cox regression model was used to calculate the hazard ratio (HR) of each subset.ResultsAccording to the 7th edition of UICC/AJCC staging system,the 5-year DSS rates of stage Ⅰ-Ⅲ patients (except T3N2M0) were all more than 85%(P>0.05),those of stage ⅣA and ⅣB patients were 71.8% and 46.2%,respectively (P=0.171),and that of stage ⅠVC patients was only 24.0%.In stage Ⅲ,the 5-year DSS rate of non-T3N2M0 patients (91.5%) was significantly higher than that of T3N2M0 patients (78.6%)(P=0.042),but there was no significant difference in DSS between T3N2M0 patients and stage ⅣA and ⅣB patients.Based on the above results,new stage Ⅰ included T1-3N0-1M0 and T1-2N2M0,new stage Ⅱ included T3N2M0,T4N0-2M0,and TxN3M0,and new stage Ⅲ included TxNxM1.The 5-year DSS rates of new stage Ⅰ,Ⅱ,and Ⅲ patients were 93.3%,72.7%,and 24.0%,respectively (P=0.000).Compared with new stage Ⅰ patients,new stage Ⅱ and Ⅲ patients had HRs of 4.01 and 16.76,respectively,for 5-year DSS.Conclusions In the era of IMRT,the new clinical staging system (stages Ⅰ,Ⅱ,and Ⅲ) helps with prognostic evaluation and clinical treatment.
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Objective To develop a MOSAIQ Integration PlatformCHN (MIP) based on the workflow of radiotherapy (RT) and to meet the actual requirements in China and the special needs for the radiotherapy department.Methods MIP used C/S (client-server) structure mode running on the local network in the hospital and its database was based on the Treatment Planning System (TPS) and MOSAIQ database.Five network servers,as the core hardware,supplied data storage and network service based on cloud services.The core software was developed based on Microsoft Visual Studio Platform using C# network programming language.The MIP server could simultaneously offer network service for about 200 workstations,including entry,query,statistics,and print of data.Results MIP had 15 core function modules,such as Notice,Appointment,Billing,Document Management (application/execution),and System Management,which almost covered the whole workflow of radiotherapy.Up to June 2016,the recorded data in the MIP were as follows:13546 patients,13533 plan application forms,15475 RT records,14656 RT summaries,567048 billing records,and 506612 workload records.Conclusions The MIP based on the RT workflow has been successfully developed and used in clinical practice.It is an important part of radiotherapy information system construction with the advantages of intuitive operation,real-time performance,data security,and stable operation.It is digital,paperless,user-friendly,and convenient for the retrieval and statistics of data as well as information sharing and department management,and can significantly improve the efficiency of the department.More functions can be added or modified to enhance its potentials in research and clinical practice.
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Objective To investigate the influence of neutrophil-lymphocyte ratio (NLR) on radiosensitivity and prognosis,the relationship between NLR and clinical features,and the clinical value of NLR in patients with nasopharyngeal carcinoma (NPC).Methods 2006 to 2011 in the cancer center of Zhongshan University admitted to the newly diagnosed nasopharyngeal cancer patients in 266 cases.The association of pretreatment NLR with radiotherapy doses 20,40,and 60 Gy and therapeutic effect at 3 months after radiotherapy was analyzed,as well as the influence of NLR on overall survival (OS),local recurrence-free (LRF),and distant metastasis-free (DMF) rates.The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis.Results NLR showed differences across patients with different T stages and sexes (P=0.039,0.032).The patients with NLR≤3 had significantly higher OS,LRF,and DMF rates compared with those with NLR＞ 3 (P=0.004,0.025,0.045).As NLR increased,the radiosensitivity in patients with NPC was reduced gradually,and radiosensitivity showed a significant difference between sensitive group and moderately sensitive group (P=0.043).When the radiotherapy dose was 40 Gy,the tumor regression group had a lower NLR than the residual tumor group (P=0.025).Conclusions In patients with NPC,an increased pretreatment NLR is an adverse prognostic factor,and NLR can be used as a simple and convenient method to evaluate the prognosis of patients with NPC.
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Objective To analyze the clinical features,treatment methods,and prognostic factors for early primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.Methods A retrospective analysis was performed on the clinical data,treatment outcomes,and survival of 32 patients with early pulmonary MALT lymphoma from March 2001 to September 2013.The median age of those patients was 56 years.Twenty-three patients had stage ⅠE disease and nine had stage Ⅱ E disease.According to the marginal zone B-cell lymphoma prognostic index (MZLPI),twenty-three patients were scored as 0 and nine as 1.Nine patients received radiotherapy,eight patients underwent surgery alone,three patients underwent surgery plus chemotherapy,and twelve patients received chemotherapy alone.The Kaplan-Meier method was adapted for calculating the OS,PFS and the log-rank test was used for survival difference analysis and univariate prognostic analysis.Results The 5-year sample size was 22.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 84.5％ and 73.2％,respectively.Radiotherapy yielded an overall response rate of 100％,including a complete response rate of 66.7％ and a partial response rate of 33.3％.The univariate analysis showed that non-radiotherapy treatment was a prognostic factor for poor PFS.The patients treated with radiotherapy had significantly higher 5-year PFS rates than those treated without radiotherapy (100％ vs.63.0％,P=0.029),while there was no significant difference in 5-year OS rate between these two groups (100％ vs.78.8％,P=0.129).Age older than 60 years,an ECOG score of 2,and an MZLPI score of 1 were prognostic factors for poor PFS (P=0.041,0.018,and 0.044) and OS (P=0.001,0.001,and 0.003).Conclusions The prognostic factors for early pulmonary MALT lymphoma include age,ECOG score,and MZLPI score.Low-dose involved-field radiotherapy (24-30 Gy) can improve local control and survival.
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Objective This aim of this study was to understand the distribution of pretreatment serum LDH in NPC of each radiotherapy-related typing,and its relationship with prognosis.Methods We collected the pretreatment data of LDH in 2 665 newly diagnosed NPC who underwent radical radiotherapy between January 1,2000 and December 31,2005 at Sun Yat-sen University Cancer Center.Pretreatment serum LDH levels and survival analysis were analyzed in four kinds of radiotherapy-related typing of NPC.Results Distribution of radiotherapy-related types of 2 665 NPC were 74.6％ (1 987 cases),15.1％ (404 cases),8.6％ (229 cases),1.7％ (45 cases) for Types Ⅰ (no primary and regional recurrence and no distant metastasis),Ⅱ (primary or regional and no distant metastasis),ⅢⅡ (no primary and regional recurrence,and distant metastasis),Ⅳ (primary or regional recurrence,and distant metastasis),respectively.Increased LDH patients Ⅰ,Ⅱ,Ⅲ,Ⅳ-type proportion were:9.6％ (191/1 987),15.8％ (64/404),18.8％ (43/229),35.6％ (16/45).274 cases of type Ⅲ and Ⅳ,there were 81 cases of liver metastasis,which increased LDH levels in 34 cases,accounted for 42％.Total follow-up rate was 95.2％.The OS,LRFS,and DMFS curves for the increased LDH level group and the normal LDH level group was significant (P =0.000,0.000,0.000).Further analysis showed that the above main difference caused by the type Ⅱ (P =0.000).Conclusions Pretreatment levels of serum LDH are associated with radiotherapyrelated typing of NPC,particularly associated with type Ⅲ and type Ⅳ liver metastasis.And mainly type Ⅱ has poor prognosis.
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Objective To investigate the differences in clinical features and prognosis between patients with stage Ⅰ E-Ⅱ E nasal cavity natural killer (NK)/T-cell lymphoma (NC-NKTL) and Waldeyer's ring NK/T-cell lymphoma (WR-NKTL).Methods A retrospective analysis was performed on 273patients with NK/T lymphoma who were initially treated in our hospital from January 1991 to December 2011.Of these patients,184 had Ann Arbor stage Ⅰ E disease,and 89 had stage Ⅱ E disease;209 had NCNKTL,and 64 had WR-NKTL.A total of 258 patients (94.5％) were first treated with chemotherapy.The majority of patients received CHOP or CHOP-like chemotherapy.The median dose of radiotherapy was 54Gy.Results Compared with NC-NKTL patients,WR-NKTL patients had significantly higher percentages of individuals in stage Ⅱ E and individuals with B symptoms (P ＜0.05 for both).The overall response rates of the two groups after treatment were similar (88.7％ vs 87.9％,P =0.869).The follow-up rate was 96.3％.196 patients were followed up for at least 5 years.The 5-year overall survival (OS) and progression-free survival (PFS) were 52.6％ and 41.4％,respectively.The 5-year OS of NC-NKTL patients was nonsignificantly higher than that of WR-NKTL patients (57.0％ vs 39.0％,P =0.062),while the 5-year PFS of NC-NKTL patients was significantly higher than that of WR-NKTL patients (46.7％ vs 25.8％,P =0.019).Conclusions Patients with early-stage WR-NKTL are more prone to systemic symptoms and cervical lymph node metastasis and have poorer prognosis,as compared with patients with early-stage NC-NKTL,so radiotherapy and prophylactic irradiation should be considered in early stage.
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Objective To retrospectively analyze the treatment results and prognostic factors in patients with primary bone lymphomas (PBL).Methods Thirty-one patients with PBL treated between April 1994 and May 2009 at Sun Yat-sen University Cancer Center were analyzed.All patients were diagnosed by pathology.Twenty-two patients had stage Ⅰ E, 4 patients had stage Ⅱ E and 5 patients had stage ⅣE diseases.One patient was treated with surgical resection alone, 1 patient with radiotherapy (RT) alone, 2 patients with chemotherapy (CT) alone and 4 patients with resection followed by chemotherapy.The remaining 23 patients received CT combined with RT.The median radiation dose was 50 Gy.Results The median follow-up time was 45.2 months.The follow-up rate was 83.9%.Nine patients had a follow-up time of 10 years.The 5-year and 10-year overall survival rates were 92% and 92%, respectively.The 5-year and 10-year disease-free survival rates were 79% and 70%, respectively.In the group who received non-combined chemoradiotherapy, the complete response rate was 50%, the incidence of progression or recurrence was 2/8 and the median recurrence time was 6.8 months.In the group who received combined chemoradiotherapy, the complete response rate was 65%, the incidence of progression or recurrence was 13% and the median recurrence time was 39.1 months.In univariate analyses, favorable prognostic factors for survival included age≤50 years (χ2=5.32,P=0.021) and ECOG PS score 0-1(χ2=5.48,P=0.019).Favorable prognostic factors for DFS included IPI score≤1(χ2=7.81,P=0.005) and ECOG PS score 0-1(χ2=18.70,P=0.000).Conclusions Treatment results of patients with PBL can be generally well.CT combined with RT appears to be the treatment of choice.RT dose ≥40 Gy is safe and feasible.Younger age and better performance status are associated with a better outcome.
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AIM:To investigate the efficiency of 2-methoxyestradiol (2-ME) as radiosensitizing agent for the treatment of lung cancer cells. METHODS:Cell line A549 and GLC-82 originated from human non-small cell lung cancer were cultured in vitro. Study group (2-ME in different concentrations) and control group without 2-ME were set up. Cell proliferation was measured by MTT assay that lung cancer cells were treated with 2-ME for 24 h,then the cells were exposed from 0 to 8Gy radiation,and the survival fraction was determined by clone forming test. Flow cytometry was used to measure the effects of 2-ME on cell cycle distribution. RESULTS:MTT assay showed minimum effective concentration value was 0.15625×10~(-6) mol/L in GLC-82 and 1.25×10~(-6) mol/L in A549 cells. Compared to control group,exposed GLC-82 cells or A549 cells to minimum effective concentration of 2-ME for 24 h before irradiation resulted in an enhancement of radiation. The protection enhancement factor was 1.98 and 2.06 in GLC-82 and A549 cells,respectively. Flow cytometry analysis of cell cycle progression demonstrated G_2/M phase arrest in both cells in a dose dependent manner. No obvious change of CDK2 activity in both GLC-82 cells and A549 cells was observed. CONCLUSION:2-ME enhances radiosensitivity by G_2/M phase arrest in the cell cycle.
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Objective To investigate the expression and clinical significance of Ku70 in nasopha ryngeal oarcinoma(NPC).Methods The expression of Ku70 protein in 223 specimens of nasopharyngeal carcinoma was examined by immunohistochemistry.Based on the levels of ku70 immunoreactivities,the 223 specimens were divided into high Ku70 expression group and low Ku70 expression group.The correlation of Ku70 expression with clinicopathologic features and prognosis of NPC was analyzed according to the clinical data. Results The rate of high Ku70 expression was 63.7%.Univariate survival analysis suggested that the overall survival rate was significantly lower in high KuTO expression group than in low Ku70 expression group (X2 = 7.88,P = 0.005).Cox multivariate analysis indicated that T stage,N stage and M stage were the independent prognostic predictors (X2 = 8.02,7.22,36.86;P =0.005,0.007,0.000),but not with gender, age or pathological type(X2 = 0.08 ,1.04,2.34;P = 0.780,0.308,0.126),the influence of Ku70 on the o verall survival rate was close to critical value(P = 0.085).Conclusions Ku70 is positively expressed in the majority of NPC.KuT0 expression has significant correlations with T stage and N stage.The results of our study suggest that Ku70 is a valuable prognostic factor of NPC.
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Objective To investigate the role of radiotherapy (RT) and prognostic factors in the combined modality treatment (CMT) of patients with stage ⅠE-ⅡE extranodal nasal type NK/T-cell lym-phoma. Methods From Dec. 1990 to Dec. 2006,177 patients who were diagnosed and treated in our hos-pital were retrospectively analyzed,induding 37 received chemotherapy (CT) alone ( median 4 cycles), 128 received CT (median 3 cycles) followed by RT (median 52 Gy) ,6 received RT alone (median 58 Gy) and 6 received RT ( median 54 Gy) followed by CT ( median 5 cycles). Results The overall response ( CR + PR) rate after initial CT was 60.8% compared with 83.8% after RT ( x2 = 28.63, P < 0.01 ). The 5-year overall survival (OS) and progress-free survival (PFS) rates were 46.2% and 36.8% ,respectively. The lo-cal control rates were 80.9% for RT ( alone or with CMT) and 50.0% for CT alone (x2 = 14.39, P < 0.01 ), and corresponding 5-year OS and PFS were 53.4% vs. 18.3 % ( x2 = 23.38, P < 0.01 ) and 45.0% vs. 10.9% (x2 =23.46,P <0.01 ),respectively. Compared with CT alone,the following definitive RT for patients who achieved response or not after initial CT significantly improved the local control [83.5%, 76.2% vs. 50.0% (x2 = 14.13,P <0.01;x2 =5.78,P <0.01)] and 5-year OS[56.2%,48.6% vs. 18.3%(x2 =28.87,P <0. 05;x2 =4.80,P <0.05)]. Concinsions Compared with CT alone, RT a-chieves better tumor response, local control and survival of patients not only with tumor response but also with local progression after CT. Definitive RT should be the reasonable choice of treatment for early stage extran-odal nasal type NK/T-cell lymphoma.
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Objective To analyze clinical features and treatment results of primary non-Hodgkin lymphoma of bone (PLB) and further to investigate the rational treatment. Methods Clinical data of 26 patients with PLB were analyzed. Twenty-three (88.5 %) patients received radiotherapy in combination with chemotherapy, three received chemotherapy alone, and three patients also received surgical resection. Results The pathological types of lymphoma in the patients were diffused large B-cell iymphoma (DLBCL) in 15 patients (57.7 %), small B-cell lymphoma in 1 patient(3.8 %), B-cell lymphoma with unclassified subtypes in 4 patients (15.5 %), T-cell lymphoma in 5 patients (19.3 %,among which anaplastic large cell lymphoma in 3 patients), and unclassified lymphoma in one patient (3.8 %). Of the 26 cases of PLB, 15 were at stage Ⅰ, 3 at stage Ⅱ, 3 at stage Ⅲ and 5 at stage Ⅵ. The 3- and 5-year overall survival rates were 59.16 % and 31.37 %respectively. In the eleven patients who died of lymphoma, three had Iocol-regional relapse, and nine had systemically involved lymphoma. The radiation-induced bone fracture had not been observed after local radiotherapy with median dose of 50 Gy. Conclusion Pelvis maybe a common primary site of PLB, and DLBCL type are the most observed histological subtype. The optimal treatment for PLB is radiotherapy combined with chemotherapy. Local regional radiotherapy with median dose of 50 Gy can be safe and feasible.
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Objective To analyze the treatment results of primary nasopharyngeal carcinoma(NPC)treated by four different external beam radiation therapy(EBRT)techniques in Sun Yat-sen University Cancer Center in the beginning of the 21 st century.Methods The data of 1093 hospitalized primary NPC patients treated in Sun Yat-sen University Cancer Center between December 2001 and June 2003 were retrospectively analyzed.The stage distribution(by AJCC/UICC,2002)was 63,439,358 and 233 patients in Stage Ⅰ,Ⅱ,Ⅲ and Ⅳa+Ⅳb.Definitive radiotherapy was given to all patients and the median total dose was 70 Gy.Four different EBRT techniques were used:812 patients with fluoroscopy simulation conventional radiotherapy(CR),155 patients with CT simulation conventional radiotherapy(CT-sim CR),69 patients with three dimensional conformal radiotherapy(3DCRT)and 57 patients with intensity modulated radiotherapv(IMRT). Results The 5-year local failure-free rate(LFFR),nodal failure-free rate(NFFR),and distant metastasis-free rate(DMFR)were 86.8%,95.3%and 83.2%,respectively.The 5-year progressionfree survival(PFS)and overall survival(OS)were 66.9%and 77.9%,respectively.Different EBRT techniques influeneed the OS and the LFFR of patients,the 5-year OS and LFFR of group CR,CT-sim CR,3DCRT and IMRT were 75.9%,83.5%,87.2%,86.6% and 84.5%,96.4%,91.0%,91.7%,respectively(P=0.014 and 0.006).The morbidity and severity of xerostomia and trismus were sigficantly lower in group 3DCRT and IMRT than in group CR and CT-sim CR(P=0.000 and=0.023). Conclusion The CT simulation technique,3DCRT and IMRT can improve the OS,LFFR and life qualitv of patients with primary NPC.