Ten-Year Outcomes Of Intensity-Modulated Radiotherapy (IMRT) Combine With Chemotherapy Versus IMRT Alone For Stage II Nasopharyngeal Carcinoma In The Real-World Study (RWD).

OBJECTIVES: The aim was to define the role of chemotherapy in stage II nasopharyngeal carcinoma (NPC) and to identify the toxicity of chemotherapy for these patients in the era of intensity-modulated radiotherapy (IMRT). METHODS: Between January 2002 and December 2013, 169 patients with stage II NPC were analyzed. Of these patients, 149 patients treated with chemotherapy were divided into three groups as follows: neoadjuvant chemotherapy followed by IMRT (NCT) group, concurrent chemotherapy with IMRT (CCRT) group, and neoadjuvant chemotherapy followed by CCRT (NC+CCRT) group. In addition, 20 patients received IMRT alone. We retrospectively assessed the 10-year survival and acute adverse effects in the patients using SPSS software. RESULTS: The median follow-up time was 93 months (2-160 months). The 10-year OS of the NCT, CCRT, NC+CCRT groups vs the IMRT alone group was 69.8%, 63.4%, 69.7% vs 72.4%, respectively (P=0.664, 0.940, and 0.998, respectively). Both univariable and multivariable analyses showed that the addition of chemotherapy to IMRT did not significantly improve the 10-year survival outcomes. The hematotoxicity and mucous reaction of patients with chemotherapy were more serious than those with IMRT alone (P=0.007 and 0.049). Distant metastasis for stage II NPC patients mostly occurred within 3 years, which is very different from patients with advanced NPC. CONCLUSION: Patients with stage II NPC who are treated with IMRT may obtain satisfactory long-term survival outcomes. The additional chemotherapy cannot significantly increase survival; however, it may remarkably increase treatment-associated acute toxic reactions.

[Four hypotheses about the effects of soil nitrogen availability on fine root production and turnover].

With global changes such as increasing temperature and enhanced N deposition, soil nitrogen (N) availability is predicted to increase substantially, and how fine root dynamics responds to the altered soil N has become one of the key questions in terrestrial ecology. As such, a number of hypotheses have been proposed to explain the relationship between increasing soil N availability and fine root production, mortality, and turnover. This article considered four major hypotheses: with increasing soil N availability, 1) both fine root production and turnover rate would increase, 2) both fine root production and turnover rate would decrease, 3) fine root production would decrease while fine root turnover rate would increase, and 4) fine root production would increase while fine root turnover rate would decrease. Current evidence suggests that the patterns depicted in hypothesis 1) and 2) could both occur in nature and may reflect characteristics of different species. Hypotheses 3) and 4) were thought to characterize only a transient stage of the responses of fine root dynamics to increasing N availability. To better understand the response of root dynamics to increasing soil N, future studies should consider: 1) the definition of fine roots and heterogeneity in fine root structure and function; 2) methods used in estimating fine root production and turnover rate; 3) changes of soil N availability both in space and time. More attention should also be paid to the influences of mycorrhizal infection on root dynamic responses to soil N availability.