ABSTRACT
Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.
ABSTRACT
Objective:Continuous acquisition of swallowing images of head and neck cancer patients by using MRI technique was performed to observe and measure the movement regularity and maximum displacement of the soft palate, tongue and larynx.Methods:From July 2018 to October 2018, 20 patients with primary head and neck cancer were chosen randomly, 17 male and 3 female. The median age was 58.5 years (28 to 78 years). Among the 20 patients, 7 patients were diagnosed with nasopharyngeal carcinoma, 3 patients with oral cancer, 5 patients with oropharyngeal cancer, 3 patients with hypopharyngeal cancer, and 2 patients with nasal and paranasal sinuses cancer. Two patients were classified as stage Ⅰ-Ⅱ, 8 patients as stage Ⅲ and 10 patients as stage Ⅳ according to the eighth edition of AJCC.Results:The displacement of the upward movement of the soft palate during swallowing was (1.06±0.31) cm and followed the pattern normal distribution. The displacement of backward movement of the soft palate was (0.83±0.24) cm, which also almost normally distributed. The displacement of backward tongue movement was (0.77±0.22) cm and followed the normal distribution pattern. The displacement of upward tongue movement was 0 in patients with tongue depressor for image acquisition. The mediandisplacement of upward tongue movement in patients without tongue depressor was 1.23 cm (0.59 to 1.41 cm). The displacement of upward laryngeal movement was (1.14±0.22) cm and followed the normal distribution pattern, and the median displacement of forward laryngeal movement was 0.4 cm (0.27 to 0.90 cm).Conclusions:Swallowing movement may occur in head and neck cancer patients during radiotherapy. It can also cause the movement of gross tumor volume (GTV) and surrounding normal tissues. Therefore, extensive attention should be paid to the individual distance between GTV and planning gross tumor volume (PGTV) when making radiotherapy plans, aiming to ensure the prescription dose of cancer.
ABSTRACT
Objective:To investigate the patterns of regional lymphatic spread and the value of elective neck treatment (ENT) in oral mucosal melanoma (OMM).Methods:In this retrospective analysis, 61 OMM patients with no distant metastasis treated in Cancer Hospital of Chinese Academy of Medical Sciences between 1984 and 2016 were recruitred. The regional lymph node distribution of cN+ disease, the value of ENT in cN 0 disease, the failure patterns and prognostic factors were retrospectively analyzed. Results:Overall, 55.7% of the patients were clinical/pathological cN+ . The most frequently involved locations were the level Ⅰ b (76%), followed by level Ⅱ and level Ⅲ. For cN 0 patients, the 5-year regional failure-free survival rate was 91.7% in patients who received at least ipsilateral level Ⅰ b-Ⅲ ENT and 52.4% in patients who did not receive at least ipsilateral level Ⅰ b-Ⅲ ENT ( P=0.036). The regional failure rate was 6% for patients treated with at least ipsilateral leve Ⅰ b-Ⅲ ENT, while in their counterparts who did not receive at least ipsilateral level Ⅰ b-Ⅲ ENT was 46%( P=0.035). For the regional failure pattern, the most frequently failure sites were level Ⅰ b (93%), level Ⅱ(50%) and level Ⅲ(36%). Conclusions:The cervical lymph node metastasis rate is relatively high in OMM patients. The pathway of regional LN spread follows a regular pattern. The most frequently involved regions for clinical/pathological cN+ and regional failure are both level Ⅰ b-Ⅲ. Elective treatment including at least ipsilateral level Ⅰ b-Ⅲ ENT should be recommended for OMM patients with cN 0.
ABSTRACT
Objective:To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging (MRI), aiming to guide the delineation of clinical target area.Methods:Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed. All patients received head and neck MRI before treatment. The diagnosis of lymph node metastasis and the delineation of primary gross target volume (GTV p) and lymph nodes target volume (GTV nd) were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion. The cut-off points of GTV p and GTV nd were defined by establishing the receiver operating characteristic curve. All patients were divided into the high GTV p, low GTV p and high GTV nd and low GTV nd groups. Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis. Results:A total of 326 patients were included in this study, 295 of whom were diagnosed with cervical lymph node metastasis, accounting for 90.5%. The most common involved area was Level Ⅱ a, followed by Level Ⅲ, Level Ⅱ b, Level IV, Level Ⅶ a (retropharyngeal), Level V a, and Level V b. The incidence of retropharyngeal lymph node metastasis was 21.5%, and the incidence was 53.1% in patients with primary tumor located in the posterior pharyngeal wall. Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall ( P=0.002), bilateral cervical lymph node metastasis ( P=0.020), larger GTV p (greater than 47 cm 3, P=0.003), and larger GTV nd (greater than 22 cm 3, P=0.023) were significantly associated with the occurrence of retropharyngeal lymph node metastasis. Conclusions:The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma, especially in patients with primary tumors in the posterior pharyngeal wall, bilateral cervical lymph node metastasis and larger primary burden. Therefore, for patients with these risk factors, it is highly recommended that the clinical target area should be delineated to include the retropharyngeal lymph node drainage area.
ABSTRACT
Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.
ABSTRACT
Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3,T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume.Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed.All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ).The LNM ratio of each node level was calculated.The risk factors of LNM were identified by univariate and multivariate logistic regression analyses.Results LNM was found in 156 of 272 patients (57.1％).According to the location of primary lesions,all patients were divided into group A (n=72;unilateral without midline involvement),group B (n=86;unilateral with midline involvement) and group C (n=114;giant or central).In group A,the LNM ratio at ipsilateral level Ⅱ,Ⅲ and Ⅳ was 36.3％,26.4％ and 6.9％,whereas 13.9％,8.3％ and 1.4％ at the contralateral level,respectively.In group B,the LNM ratio at ipsilateral level Ⅱ,Ⅲ and Ⅳ was 1.9％,29.1％ and 11.6％,whereas 18.6％,14.0％ and 1.2％ at the contralateral level,respectively.In group C,the LNM ratio at the left neck level Ⅱ,Ⅲ and Ⅳ was 24.6％,23.7％ and 2.6％,whereas 21.9％,26.3％ and 6.1％ at the right neck,respectively.Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3％,25.0％,P=0.093).Ipsilateral level Ⅲ metastasis (OR=2.929,95％CI 1.041-8.245,P=0.042) and clinical N stage (OR=0.082,95％CI 0.018-0.373,P=0.001) were associated with contralateral LNM.Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009)metastasis were risk factors of the ipsilateral level Ⅳ metastasis.Conclusions Neck levels Ⅱ and Ⅲ are the high-risk LNM regions,whereaslevels Ⅳ and Ⅴ are the low-risk areas.Ipsilateral level Ⅱor Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM.Contralateral neck LNM rarely occurs in cN0 stage patients.
ABSTRACT
Objective@#To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3, T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume.@*Methods@#Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses.@*Results@#LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72; unilateral without midline involvement), group B (n=86; unilateral with midline involvement) and group C (n=114; giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%, 29.1% and 11.6%, whereas 18.6%, 14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%, 25.0%, P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929, 95%CI 1.041-8.245, P=0.042) and clinical N stage (OR=0.082, 95%CI 0.018-0.373, P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis.@*Conclusions@#Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients.
ABSTRACT
Objective@#To analyze the clinical features, diagnosis and prognosis of patients with primary lymphoepithelial carcinoma of the parotid gland.@*Methods@#Clinical data of 13 patients diagnosed with lymphoepithelial carcinoma of the parotid gland in our hospital from 2009 to 2017 were retrospectively analyzed. The median follow-up time was 38.5 months. All patients received radiotherapy after operation.@*Results@#Of 13 patients, 9 cases were male and 4 female. The median age was 33 years. At the initial diagnosis, 9 cases had primary lesions limited to the parotid gland, and 4 cases of lymph node metastases located in Ⅰb and Ⅱ regions of the neck. According to UICC2010 staging, 1 case was classified as stage Ⅰ, 1 as stage Ⅱ, 6 as stage Ⅲ and 5 as stage Ⅳ, respectively. Eleven surgically pathological specimens were tested with EBER in-situ, and 10 cases were positive for EBER. No patient died in the whole group. The 3-year overall survival rate was 100%. The 3-year progression-free survival rate was 76%. The 3-year local control rate was 92%. The 3-year metastasis-free survival rate was 84%.@*Conclusions@#The incidence of lymphoepithelial carcinoma of the parotid gland is relatively low. The pathological features are associated with EB virus. It is prone to present with cervical lymph node metastasis. The possibility of lymph node metastasis of nasopharyngeal carcinoma to the parotid gland should be excluded before treatment. At present, surgery combined with postoperative radiotherapy is the main treatment. The overall survival is favorable. Local recurrence and distant metastasis are the main causes of treatment failure.
ABSTRACT
Objective To analyze the clinical features,diagnosis and prognosis of patients with primary lymphoepithelial carcinoma of the parotid gland.Methods Clinical data of 13 patients diagnosed with lymphoepithelial carcinoma of the parotid gland in our hospital from 2009 to 2017 were retrospectively analyzed.The median follow-up time was 38.5 months.All patients received radiotherapy after operation.Results Of 13 patients,9 cases were male and 4 female.The median age was 33 years.At the initial diagnosis,9 cases had primary lesions limited to the parotid gland,and 4 cases of lymph node metastases located in Ⅰb and Ⅱ regions of the neck.According to UICC2010 staging,1 case was classified as stage Ⅰ,Ⅰ as stage Ⅱ,6 as stage Ⅲ and 5 as stage Ⅳ,respectively.Eleven surgically pathological specimens were tested with EBER in-situ,and 10 cases were positive for EBER.No patient died in the whole group.The 3-year overall survival rate was 100％.The 3-year progression-free survival rate was 76％.The 3-year local control rate was 92％.The 3-year metastasis-free survival rate was 84％.Conclusions The incidence of lymphoepithelial carcinoma of the parotid gland is relatively low.The pathological features are associated with EB virus.It is prone to present with cervical lymph node metastasis.The possibility of lymph node metastasis of nasopharyngeal carcinoma to the parotid gland should be excluded before treatment.At present,surgery combined with postoperative radiotherapy is the main treatment.The overall survival is favorable.Local recurrence and distant metastasis are the main causes of treatment failure.
ABSTRACT
Objective To analyze the clinical treatment modalities and clinical prognosis of patients diagnosed with primary nasopharyngeal adenoid cystic carcinoma (NACC).Methods The medical records of 46 patients with NACC between March 1971 and November 2015 were retrospectively analyzed.Among them,22 patients were male and 24 female.The median age of all patients was 47 years (range:23-74 years).Among them,34 patients received radiotherapy alone including 25 patients treated with conventional radiotherapy and 9 receiving intensity-modulated radiation therapy (IMRT).Five patients underwent salvage surgery for the residual tumors after radiotherapy.Twelve patients were treated with a comprehensive treatment modality (surgery combined with radiotherapy).Results The median follow-up time was 66.0 months (range:11.0-270.6 months).The 5-and 10-year overall survival,locoregional failure-free survival,and distant metastasis failure-free survival rates were 70％ and 40％,64％ and 47％,70％ and 62％,respectively.In the radiotherapy alone group,12(35％) cases obtained complete response,13 had partial response and 9 remained stable after radiotherapy.The 5-year overall survival and locoregional failure-free survival rates in the radiotherapy alone and combined therapy groups were 69％ and 74％,63％ and 66％,respectively (all P＞ 0.05).Conclusion The course of NACC is relatively slow.Radiotherapy is recommended for patients with high sensitivity towards radiotherapy.Salvage surgery is feasible for those who are insensitive to radiotherapy or with residual tumor after radiotherapy.
ABSTRACT
Objective@#To investigate the change trend of late complications of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) after 5-year follow up according to the clinician-and patient-reported outcomes.@*Methods@#From 2014 to 2015, NPC patients surviving> 5 years after radical IMRT at our outpatients department and were followed up 3 years later. The late complications were evaluated by the clinician based upon the CTCAE 4.0 rating criteria and assessed by patients themselves into 5 grades including very good, good, fair, poor and very poor.@*Results@#A total of 116 NPC patients were included in the first survey with a median follow-up time of 6.5 years (range, 5.0-11.3 years). During the second survey, 21 patients were lost to follow-up, 7 patients developed nasopharyngeal recurrence or metastases, 7 patients had second primary tumors and 81 patients were eligible for final analysis. In the first survey, the most common clinician-reported ≥grade 2 late complications were subcutaneous fibrosis (n=17, 21.0%) and hearing impairment (n=13, 16.0%). The most frequent patient-reported "poor" and "very poor" late complications included dental caries (n=27, 33.3%), subcutaneous fibrosis (n=17, 21.0%) and hearing impairment (n=12, 14.8%). During the second survey, the most common complications were aggravated or new late complications occurred including hearing impairment (n=16, 20.0%), dental caries (n=16, 20.0%) and posterior cranial neuropathy (n=9, 11.0%).@*Conclusions@#The incidence of late complications is high after radical IMRT for NPC. During the long-term survival, subcutaneous fibrosis and hearing impairment are the main late complications. The incidence of hearing impairment, dental caries and posterior cranial neuropathy is increased over time. The symptoms of hearing impairment and dental caries are aggravated in partial patients.
ABSTRACT
Objective To evaluate the clinical efficacy,failure pattern and prognostic factors of the malignant mucosal melanoma of the head and neck ( MMHN) in a single center. Methods The treatment pattern,clinical efficacy, failure pattern and prognostic factors of 194 M0MMHN patients admitted to our institution from 1982 to 2017 were retrospectively analyzed.Results The 5-year overall survival (OS),local recurrence-free survival ( LRFS ), regional recurrence-free survival ( RRFS ) and distant metastasis-free survival (DMFS) were 41. 4%,57. 8%,76. 5% and 46. 5%,respectively. The failure rate was calculated as 74. 6%(141/189).Among them,40% (56/141) had distant metastasis as the first pattern of treatment failure,37%(52/141) had local relapse,15%(21/141) had regional relapse,5%(7/141) had concurrent distant metastasis and local/regional relapse and 3% ( 5/141) had concurrent local and regional relapse. Multivariate analysis demonstrated that surgical margins (P=0. 001) and adjuvant radiotherapy (P=0. 000) were the independent prognostic factors for LRFS. Conclusions Surgery combined with radiotherapy can yield relatively high LRFS in the comprehensive treatment of MMHN.Distant metastasis is the major failure pattern.
ABSTRACT
Objective It has been confirmed that Epstein-Barr virus ( EBV) is associated with the occurrence and development of the nasopharyngeal carcinoma ( NPC ) . We investigated the clinical significance of plasma concentrations of EBV-DNA in patients with NPC. Methods Since October,2013 to December,2016,471 patients were analyzed. The significantly associated between EBV-DNA before treatment and staging, tumor burden was analyzed. The survival rate of EBV-DNA before and after treatment was calculated. Results The median copies of pretreatment plasma EBV-DNA in patients is 137 copies,( range 0-494000) ,which is correlated with T stage,N stage,M stage,clinical stage and tumor burden load and that is statistically significant. Overall survival ( OS,P=0. 007) ,progression-free survival ( PFS,P=0. 011) and distant metastasis-free survival ( DMFS,P=0. 003) were significantly lower among patients with pretreatment plasma EBV-DNA more than 1300 copies/ml. Patients with detectable plasma EBV-DNA had significantly worse OS (P=0. 016),PFS (P=0. 000) and DMFS (P=0. 000) than patients with undetectable EBV-DNA after treatment. Cox multivariate analyze suggests that T stage and EBV-DNA after treatment were independent prognostic factors for OS,however the plasma EBV-DNA after treatment ( P=0. 006,0. 001) and N stage ( P=0. 037,0. 017) were independent prognostic factors for PFS and DMFS. Conclusions The plasma EBV-DNA level was significantly correlated with staging and tumor load before treatment in patients with NPC,and the prognosis of patients with higher copies before treatment could be worse. The plasma EBV-DNA after treatment is predictive for OS,PFS and DMFS.
ABSTRACT
Objective To explore the risk factors influencing the outcomes of radiation brain injury after intensity-modulated radiotherapy (IMRT) in patients diagnosed with nasopharyngeal carcinoma.Methods Clinical data of 1 300 nasopharyngeal carcinoma patients treated with IMRT in our hospital during 2006 and 2013 were retrospectively analyzed.Fifty-eight patients presented with radiation brain injury after IMRT.MRI data of these patients during 3-24 months follow-up were collected.The clinical efficacy in the treatment of radiation brain injury was evaluated according to RECIST guidelines.Results Forty-six patients with intact follow-up data were enrolled.The median latency of radiation brain injury was 34 months.Patients were divided into the response (CR+PR) and non-response groups.The risk factors influencing the response rate during 10-12 months and 18-24 months were identified and analyzed.Univariate analysis demonstrated that gender,age,smoking history,T stage,and high-intensity treatment exerted no significant effect upon the objective remission rate during these two time intervals periods.Patients treated with gangliosides obtained high response rate.The response rate was 68.8％ in 10-12 months (P=0.000),and 81.8％ in 18-24 months (P=0.008).Multivariate analysis revealed that use of gangliosides was a favorable factor for mitigating radiation brain injury in two time intervals (OR=19.8 and 13.5;P=0.001 and 0.005).Conclusions Use of gangliosides probably accelerates the healing of radiation brain injury,whereas the clinical efficacy remains to be elucidated by prospective clinical trials.
ABSTRACT
Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with epithelial-myoepithelial carcinoma (EMCa).Methods A retrospective analysis was performed for 18 EMCa patients, who received initial therapy or initial adjuvant therapy in our hospital from 1999 to 2015, to investigate their survival.Among these patients, 8(44%) underwent surgery alone, 9(50%) received adjuvant radiotherapy, and 1(6%) received radical concurrent chemoradiotherapy.Locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were compared between these groups.The Kaplan-Meier mtthod was used to calculated survival rates and log-rank test was used to compare the LRFS.Results With a median follow-up time of 46 months, 5 patients developed LRR, and the 5-year LRFS and OS rates were 69% and 93%, respectively.The patients treated with radiotherapy had a significantly higher 5-year LRRFS rate than those not treated with radiotherapy (71% vs.57%, P=0.569).Conclusions LRR is the main failure mode of EMCa treatment, and further improving local control is the key to improved survival.
ABSTRACT
Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with inflammatory myofibroblastic tumor (IMT).Methods A retrospective analysis was performed for 58 IMT patients who completed initial therapy or initial adjuvant therapy in our hospital from January 2002 to January 2017 to evaluate their failure patterns and survival.The LRR and survival rates were compared between groups.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for survival difference analysis and univariate prognostic analysis.Results The median follow-up time was 34 months.Among the 58 patients,50 underwent surgery alone,and 8 underwent surgery and adjuvant therapy.Seventeen patients experienced treatment failure,16 patients developed LRR,3 patients developed distant metastasis,including 2 patients with local failure,and 5 patients died of tumor recurrence or metastasis.The 5-year LRRFS was 75%,and the 5-year OS rate was 90%.The univariate analysis showed that resection margin and local staging were influencing factors for LRRFS (P=0.018,0).Conclusions Radical resection combined with adjuvant therapy is the key to improving the treatment outcome of IMT.
ABSTRACT
Objective To evaluate the dosimetric effects of air cavity on primary tumor and organs at risk (OARs) during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma patients.Methods Nine patients with nasopharyngeal carcinoma had CT simulation before treatment and on the 25 fraction of radiotherapy.Radiotherapy plan1 was first created by delineating the target volumes and OARs on the first CT image, which was then copied and merged with the second CT image.Air cavity that was formed following tumor volume regression was delineated on the first CT image, and the density of air cavity was set to zero.A new gross target volume (GTV) was formed by subtracting the air cavity from the original GTV, and the new CT image was named CTAir.Plan2 was then created by calculating the dose distribution on CTAir using the same portals and parameters as Plan1.Assuming that Plan1 and Plan2 were both used throughout the course of radiotherapy, the dosimetric parameters of nasopharyngeal tumor and OARs in the absence and presence of air cavity were then compared using the paired t-test.Results Dmean, D95, D90, D10, and D5 of tumor were significantly higher in plan2 than in plan1(P=0.000, 0.001, 0.001, 0.001, and 0.005, respectively), with a<0.5 Gy increase in dose.A dose build-up effect was observed within the tumor region posterior to the air cavity, where the highest dose was 1.4 cm posterior to the air cavity, resulting in a dose difference of 0.36 Gy.In addition, D2cc and D1cc of the brain stem were significantly higher in plan2 than in plan1(P=0.036 and 0.044, respectively).Dmax of the optical chiasm, left optical nerve, and right optical nerve were also increased in the presence of air cavity (P=0.438, 0.434, and 0.477, respectively), but the change in dose was<0.12 Gy.Conclusions Air cavity induces a small but negligible increase in the tumor and OARs dose in patients with nasopharyngeal carcinoma during IMRT.However, closer monitoring should be conducted for patients with OARs that is close to or has surpassed tolerance prior to radiotherapy.
ABSTRACT
PURPOSE: This study was conducted is to identify the prognostic value and staging categories of magnetic resonance imaging (MRI)–detected intracranial extension in nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) to determine whether it is necessary to subclassify the T4 classification NPC. MATERIALS AND METHODS: A total of 335 nonmetastatic T4 classification NPC patients with MRI treated between March 2004 and June 2011 by radical IMRT were included. The T4 classification patients were subclassified into two grades (T4a, without intracranial extension vs. T4b, with intracranial extension) according to the site of invasion. RESULTS: The frequency of intracranial extension was 40.9% (137 of 335 patients). Multivariate analysis identified subclassification (T4a vs. T4b) as an independent prognostic factor for local failure-free survival (p=0.049; hazard ratio [HR], 0.498) and overall survival (p=0.004; HR, 0.572); however, it had no effect on regional failure-free survival or distant failure-free survival (p > 0.050). CONCLUSION: For patients with T4 classification NPC, those with MRI-detected intracranial extension are more likely to experience local failure and death after IMRT than patients without intracranial extension. According to the site of invasion, subclassification of T4 patients as T4a or T4b has prognostic value in NPC.
Subject(s)
Humans , Classification , Magnetic Resonance Imaging , Multivariate Analysis , Neoplasm Staging , Prognosis , Radiotherapy, Intensity-ModulatedABSTRACT
To investigate the potential risk factors for parotid gland failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods The clinical data of 1096 NPC patients who underwent IMRT in our hospital from January 2005 to December 2012 were analyzed retrospectively.Among these patients, 13 patients experienced parotid gland recurrence, and the recurrence in 12 patients was analyzed.A case-control study was performed with the side of the parotid gland with recurrence as the case group and the side of the parotid gland without recurrence as the control group.The association of parotid gland failure with the extent of tumor invasion, IMRT dose distribution, and local recurrence was analyzed.The differences between groups were analyzed with χ2 test or Fisher′s the exact probability test.Results Among the 12 patients, 11 had stage III-IV primary NPC;after definitive IMRT, 9 had local tumor residues.The median time of parotid gland recurrence was 16(8-43) months.Of all the patients who experienced recurrence, 8 had recurrence in the superficial lobe of the parotid gland, 1 in the deep lobe, and 3 in both superficial and deep lobes.Recurrence was in the same side of primary tumor (P<0.001).Compared with the controls, the side of the parotid gland with recurrence had higher rate of cervical puncture/surgery (P=0.025).Parotid gland recurrence was often complicated by ipsilateral lymph node recurrence (67% vs.8%, P=0.003), as well as the tendency of ipsilateral primary lesion recurrence (42%vs.8%;P=0.059).Conclusions For NPC patients, the recurrence rate in the parotid gland is very low. Parotid gland recurrence may be related to locally advanced NPC, residues after treatment, the history of cervical puncture/surgery, and locoregional recurrence.The low radiotherapy dose in the parotid gland caused by IMRT may be an important reason for parotid gland recurrence.
ABSTRACT
Objective To investigate the treatment outcome of primary mucosal melanoma of the nasal cavity and paranasal sinuses and the role of radiotherapy in the treatment of this disease .Methods The clinical data of 52 patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses who were admitted to our hospital from 2001 to 2014 were analyzed retrospectively.Among these patients, 18 received surgery alone, 31 received surgery combined with radiotherapy ( 24 received surgery and postoperative radiotherapy and 7 received preoperative radiotherapy and surgery ) , and 3 received radiotherapy alone.The surgery+radiotherapy group and the surgery group were matched using propensity score matching.Results The median follow-up was 59 months.The 5-year local control ( LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of all patients were 49%, 48%, 22%, and 45%, respectively.After matching, the surgery+radiotherapy group had a significantly higher LC than the surgery group (88%vs.43%, P=0.028), but the two groups had similar 5-year DMFS (67%vs.57%, P=0.955), 5-year DFS (58%vs.24%, P=0.131), and 5-year OS (67%vs. 67%, P=0.727 ) .The negative margin rates in the preoperative radiotherapy+surgery subgroup and the surgery+postoperative radiotherapy subgroup were 100%and 50%, respectively ( P=0.004) .Conclusions Surgery combined with radiotherapy can improve the LC rate in patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses, and preoperative radiotherapy can increase the negative margin rate.