[Radiation-induced sarcoma in patients with nasopharyngeal carcinoma: a single-institution retrospective study].

Objective:To analyze the clinical features, treatment methods and prognosis of radiation-induced sarcoma（RIS） of the head and neck after radiotherapy for nasopharyngeal carcinoma（NPC）, and explore its treatment strategies. Methods:A retrospective analysis was conducted on RIS patients after radiotherapy for NPC in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2013 to October 2022. The time of onset, lesion location, pathological subtypes, imaging features and treatment outcomes were described, and the median survival time was statistically analyzed through follow-up. Results:This study included 10 patients with an interval of 2-27 years between NPC and RIS. The nasopharynx was the more common site of RIS, and osteosarcoma was the main pathological type. The median overall survival was 18 months. The median survival was 40 months in the surgery combined with the chemotherapy group, and 12 months in the surgery alone group. The 1-and 2-year cumulative survival rates were 48% and 36%, respectively. Prognostic analysis showed that gender, age of onset, time of sarcoma onset after radiotherapy and treatment methods might not be influencing factors for prognosis, and osteosarcomas presented a poorer prognosis than other pathological types. Conclusion:RIS is one of the most severe long-term adverse effects in patients with NPC. The prognosis of RIS is poor, and complete surgical resection of the tumor can improve patient survival rates. In cases where complete surgical resection is challenging, radiotherapy or chemotherapy may offer some improvement in tumor control.

Clinical outcomes of patients with nasopharyngeal carcinoma treated with antibiotics for radiation-induced mucositis: a retrospective study.

OBJECTIVE: To examine the effects of antibiotic administration on radiation-induced oral and oropharyngeal mucositis, and on the prognosis of patients with nasopharyngeal carcinoma (NPC). METHODS: We retrospectively analyzed data for patients with NPC with grade 1/2 or 3/4 mucositis. Forty-two patients with grade 3/4 mucositis received antibiotics. Univariate survival analysis was assessed by Kaplan-Meier survival curves, survival curves were compared using log-rank tests, and multivariate analysis was carried out by Cox regression. RESULTS: A total of 463 patients with NPC were included in the study (194 grade 1/2 mucositis, 269 grade 3/4 mucositis). Univariate analyses identified T-stage, N-stage, clinical stage, type of treatment, and antibiotic use as factors affecting overall and disease-free survival. Multivariate analysis also determined that T-stage, N-stage stage, type of treatment, and antibiotic usage were independent factors affecting overall and disease-free survival. Mucositis improved in 32 of the 42 patients who received antibiotics (76.19%). However, red blood cell count and hemoglobin levels decreased in all patients after antibiotic treatment. CONCLUSIONS: Antibiotics may be effective for the treatment of severe radiation-induced mucositis (grade 3/4) during chemoradiotherapy, but may potentially adversely affect the prognosis of patients with NPC.

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma.

PURPOSE: To investigate the clinical characteristics of nasopharyngeal carcinoma (NPC) and a concomitant hepatitis B virus (HBV) infection, as well as the potential effects of HBV infection and antiviral therapy on prognosis. METHODS: We conducted a retrospective chart review of all NPC patients from December 2010 to December 2014. After collecting medical records and conducting follow-ups on patients, a total of 876 eligible NPC patients were included. For each patient, medical records were reviewed. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis. RESULTS: Among the 876 participants, 106 (12.1%) patients were HBV-infected patients. The hepatitis B surface antigen-positive [HBsAg(+)] group had a lower CD4+ T cell count than the HBsAg(-) group (P = .048). Among patients with stage I/II NPC, 5-year overall survival (OS), disease-free survival (DFS), relapse-free survival, and distant metastasis-free survival (DMFS) of the HBsAg(+) group were 82.5%, 70.7%, 87.7%, and 76.6%, respectively, whereas those of the HBsAg(-) group were 91.4%, 86.0%, 93.8%, and 92.1%, respectively. Statistically significant differences in OS, DFS, and DMFS existed between both groups (P = .017, .018, and .004, respectively). The multivariate analysis indicated that HBsAg status and N stage are independent risk factors affecting OS, DFS, and DMFS of NPC patients. A statistically significant difference in 5-year DMFS existed between the antivirus (90.0%) and no-antivirus groups (70.0%) (P = .043). CONCLUSIONS: Hepatitis B virus infection is an independent risk factor for early stage NPC, which may be associated with its reduced immune functions compared to the HBsAg(-) group. Anti-HBV treatment may improve the prognosis of HBV-infected NPC patients.

A study on the value of narrow-band imaging (NBI) for the general investigation of a high-risk population of nasopharyngeal carcinoma (NPC).

BACKGROUND: This study aims to explore the feasibility of narrow-band imaging (NBI) applied for the diagnostic screening of a high-risk population of nasopharyngeal carcinoma (NPC) and increase the accuracy rate of nasopharyngeal biopsy and the diagnosis rate of early-stage patients. METHODS: The positive high-risk population of NPC to EB virus antibody was followed up. At the same time, serological screening and pharyngorhinoscopy were carried out. The specific methods were as follows: (1) all subjects received nasopharyngeal examinations through both the HD endoscopic white light mode (WL) and NBI mode, (2) nasopharyngeal biopsy was conducted on positive subjects with microscopic examination, and, finally, (3) a comparative analysis was conducted between the biopsy pathology results and microscopy results. In addition, the following comparative indicators were recorded under different modes: sensitivity, specificity, accuracy, positive likelihood ratio, and negative likelihood ratio. Then, the area under the ROC curve and the kappa coefficient were calculated. RESULTS: A total of 115 subjects were detected to be positive by microscopic examination under the WL mode. Among these subjects, 19 subjects were diagnosed with NPC. In addition, 24 subjects were detected to be positive by microscopic examination under the NBI mode. Among these subjects, 23 subjects were diagnosed with NPC. Under the WL mode, the specific values of the comparative indicators were as follows: sensitivity, 82.61%; specificity, 0%; and area under the ROC curve, 0.413. Furthermore, the WL mode in the diagnosis on the high-risk population of NPC exhibited poor consistency with the biopsy pathology results (kappa coefficient = - 0.069). Under the NBI mode, the specific values of the comparative indicators were as follows: sensitivity, 100%; specificity, 98.96%; and area under the ROC curve, 0.995. Furthermore, the NBI mode in the diagnosis on the high-risk population of NPC exhibited relatively satisfactory consistency with the biopsy pathology results (kappa coefficient = 0.973). Therefore, the NBI mode is significantly superior to the WL mode. CONCLUSION: NBI endoscopic examinations should be conducted on a routine basis for high-risk populations of NPC. This can decrease the frequency of biopsies and enhance diagnostic effects.

Diagnosis of nonexophytic nasopharyngeal lesion with endoscopy-guided core needle biopsy after narrow band imaging.

BACKGROUND: Due to the obstruction of the surrounding structures or stiff mucosa, the primary and recurrent nonexophytic nasopharyngeal carcinoma (NE-NPC) patients are difficult to be diagnosed histologically by traditional forceps biopsy. RESULTS: All the 15 cases had adequate biopsy for histological diagnosis. There were 5 cases of primary and 7 cases of recurrent NE-NPC, and 3 cases of inflammatory lesion. The histopathological diagnosis was consistent with the follow-up visit. The bleeding quantity during the CNB procedure ranged from 1 to 5 ml (mean 1.93 mL). The pain score during CNB were between 2 and 7 (mean 4.20). There were no serious complications. MATERIALS AND METHODS: From April 2009 to March 2016, after conventional white-light and novel narrow-band imaging, nasal endoscope-guided core needle biopsy (CNB) were performed on 15 cases of nonexophytic nasopharyngeal lesion with a semiautomatic biopsy gun. CONCLUSIONS: CNB is able to get adequate biopsy specimens and thus the diagnosis accuracy of CNB is high for NE-NPC. Nasal endoscope-guided CNB is the direct approach with a short distance in the tissue before reaching the tumor. It has the advantages of minimal trauma, short operative time, and no serious complications. It is simple, safe, and worth of application in clinic.

Clinical outcomes of residual or recurrent nasopharyngeal carcinoma treated with endoscopic nasopharyngectomy plus chemoradiotherapy or with chemoradiotherapy alone: a retrospective study.

BACKGROUND: Local residual and recurrent nasopharyngeal carcinoma (NPC) generally shows treatment failure after standard radiotherapy with or without concurrent chemotherapy. Whether endoscopic nasopharyngectomy might provide an additional therapeutic advantage remains controversial. Therefore, we retrospectively compared the clinical prognoses of patients with residual or recurrent NPC treated with endoscopic nasopharyngectomy combined with chemoradiotherapy (CRT) with those of patients treated with CRT alone. METHODS AND MATERIALS: A total of sixty-two patients with local residual or recurrent NPC were studied retrospectively: 36 patients received endoscopic nasopharyngectomy combined with CRT, whereas 26 patients who refused the surgery or had surgical contraindications received CRT alone. Serum Epstein-Barr virus (EBV) DNA levels were measured pre- and post-treatment. The differences in prognosis between the two treatment regimens and the pre- and post-treatment changes in EBV-DNA levels were analyzed. RESULTS: The median follow-up time was 31 months, with a 3-year overall survival (OS) of 51.40% and a 3-year disease-free survival (DFS) of 46.86%. The surgery + CRT group had a better OS than the CRT alone group did (χ2 = 4.054, P = 0.044). The pretreatment EBV-DNA levels showed a positive correlation with the clinical staging of recurrent NPC (χ2 = 11.674, P = 0.009). Patients with negative pretreatment serum EBV-DNA levels showed a superior OS to those of patients who tested positive for EBV-DNA (>0 copy/mL) (χ2 = 9.833, P = 0.002). The post-treatment EBV-DNA levels, compared with the pretreatment levels, decreased significantly in the surgery + CRT group (Z =  - 3.484, P = 0.000). In contrast, the EBV-DNA levels after CRT alone did not decrease significantly (Z =  - 1.956, P = 0.051). Multivariate analysis indicated that local staging, pretreatment EBV-DNA load, and the treatment method were independent risk factors for OS. Subgroup analysis indicated that the patients who tested negative for EBV-DNA before the treatment and those who received surgery + CRT showed a better OS than those who received CRT alone. CONCLUSIONS: The pretreatment serum EBV-DNA level was associated with disease prognosis. The combination therapy preceded by surgery can effectively decrease the copy number of EBV-DNA. Patients with local intermediate- and late-stage NPC, especially those negative for EBV-DNA, may consider opting for surgery followed by post-operative adjuvant radiotherapy or chemotherapy.

Influence of endoscopic sinus surgery on the quality of life of patients with early nasopharyngeal carcinoma and the analysis of prognosis-related factors.

The aim of this study is investigate the influence of endoscopic sinus surgery on the quality of life and prognosis of patients with early nasopharyngeal carcinoma. Patients initially diagnosed with early nasopharyngeal carcinoma and received surgical treatment were matched with nasopharyngeal carcinoma patients who received chemoradiotherapy at a ratio of 1:1, according to the following seven factors: gender, age, T staging, N staging, clinical staging, radiotherapy options, and chemotherapy options. Patients in the surgery group received endoscopic sinus surgery plus chemoradiotherapy, while subjects in the control group received chemoradiotherapy. The quality of life of patients before and after treatment was evaluated based on the FACT-H&N (Functional Assessment of Cancer Therapy-Head and Neck) and QLQ-H&N35 (Head and Neck Cancer Specific Module) questionnaires. In addition, overall survival and disease-free survival were compared between these two groups. The results showed overall survival was superior in the surgery group compared with the control group ( p = 0.007). However, the difference in disease-free survival between these two groups was not statistically significant ( p = 0.128). Furthermore, subgroup analysis revealed that for N0 patients, the effect of surgery combined with chemoradiotherapy on overall survival was superior to that of chemoradiotherapy ( p = 0.048); while for N1 patients, the difference in overall survival between these two groups was not statistically significant ( p = 0.065). For early nasopharyngeal carcinoma patients without lymph node metastasis, overall survival and disease-free survival in T1 patients were superior to those in T2 patients (χ2 = 4.403, p = 0.036; χ2 = 4.542, p = 0.033). At the end of treatment, the pain score was found to be significantly lower in the surgery group than in the chemoradiotherapy group ( p = 0.027). At 3 months and 1 year after treatment, dry mouth scores were significantly lower in the surgery group than in the chemoradiotherapy group ( p = 0.002, p = 0.026). These results demonstrated that the curative effect of surgery combined with chemoradiotherapy in the treatment of nasopharyngeal carcinoma was satisfactory and was particularly suitable for N0 patients.

The Safety and Immunological Effects of rAd5-EBV-LMP2 Vaccine in Nasopharyngeal Carcinoma Patients: A Phase I Clinical Trial and Two-Year Follow-Up.

Epstein-Barr virus (EBV)-encoded latent membrane protein 2 (LMP2) promotes nasopharyngeal carcinoma (NPC) progression. Previously, we reported that the dendritic cells (DCs) transfected with EBV-LMP2 recombinant serotype 5 adenoviruses (rAd5) induced anti-tumor effect by eliciting cytotoxic T lymphocytes (CTLs)-mediated immune response in vitro and the adenoviral vaccine of EBV-LMP2 (rAd5-EBV-LMP2) stimulated antigen-specific cellular immunity in mice. However, the safety and immunological effect of rAd5-EBV-LMP2 vaccine in human still remained unknown. Here we conducted a single-center, non-randomized, open-label, single-arm phase I clinical trial to clarify this unsolved issue. A total of 24 patients with regional advanced NPC were sequentially enrolled into three dose level groups (2×10(9), 2×10(10), 2×10(11) vp). The rAd5-EBV-LMP2 vaccines were intramuscularly injected for four times within 28 d (D0, D7, D14, D28). Blood samples were harvested immediately before every vaccination, one week and one month after the last vaccination (D0, D7, D14, D28, D35, D58). All the vaccine inoculation-related toxicities presented as grade I/II adverse events. The most frequent systemic adverse reactions were fatigue (33.0%, 8/24), myalgia (29.2%, 7/24) and cough (29.2%, 7/24), while the most common regional adverse reaction was tenderness in the inoculation site (54.2%, 13/24). In addition, proportion of CD(3+)CD(4+) cells in peripheral blood was significantly increased in the high dose group (2×10(11) vp). The rAd5-EBV-LMP2 vaccine was generally well-tolerated and the high dose (2×10(11) vp) is recommended to be adopted in phase II studies. The long-term outcome of rAd5-EBV-LMP2 vaccine inoculation is required to be determined in following placebo-controlled trials.

Distribution and clinical significance of circulating tumor cells in nasopharyngeal carcinoma.

OBJECTIVE: Nasopharyngeal carcinoma is one of the leading malignancies with obscure etiology. Circulating tumor cells have been showed to intimately correlate with characteristics in different kinds of cancer. But links between circulating tumor cells and nasopharyngeal carcinoma were still lacking. Therefore, we explored circulating tumor cells' distribution in nasopharyngeal carcinoma and their possible associations with nasopharyngeal carcinoma. METHODS: Firstly, we found that the positive ratio of circulating tumor cells is extremely high in four stages of nasopharyngeal carcinoma. Meanwhile, positive ratios of mesenchymal circulating tumor cells were higher in early stages of nasopharyngeal carcinoma. Apart from epithelial circulating tumor cells, total, hybrid and mesenchymal circulating tumor cells were correlated with nasopharyngeal carcinoma clinical stage. RESULTS: Our results showed that hybrid and mesenchymal circulating tumor cells were associated with nasopharyngeal carcinoma metastasis (both distant and lymph node) and smoking. Meanwhile, hybrid circulating tumor cells expressed the highest Epstein-Barr virus proteins and deoxyribonucleic acid in three types of circulating tumor cells. Moreover, we found that Epstein-Barr virus proteins viral-caspid antigen-immunoglobulin A (VCA/IgA) and early antigen-immunoglobulin A (EA/IgA), but not Epstein-Barr virus-deoxyribonucleic acid, had a closed association with nasopharyngeal carcinoma metastasis. However, Epstein-Barr virus hallmarks failed to associate with other nasopharyngeal carcinoma characteristics. Furthermore, we confirmed that matrix metalloproteinase 9 existed in circulating tumor cells and expressed most in mesenchymal circulating tumor cells. In addition, matrix metalloproteinase 9-expressed extent in hybrid circulating tumor cells is somewhat different from epithelial and mesenchymal circulating tumor cells in matrix metalloproteinase 9-positive circulating tumor cells. Nevertheless, matrix metalloproteinase 9 had no relationship with other nasopharyngeal carcinoma characteristics. Finally, our results showed that circulating tumor cells were decreased in patients after therapies. CONCLUSION: Taken together, circulating tumor cells were tightly correlated with nasopharyngeal carcinoma characteristics. In addition, Epstein-Barr virus was associated with nasopharyngeal carcinoma metastasis. Of note, decreased circulating tumor cells indicated a favorable curative effect in nasopharyngeal carcinoma patients.

[The clinical experience of transnasal endoscopic approach for skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma].

OBJECTIVE: To investigate the method of surgical treatment via trans-nasal endoscopic approach in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma. METHODS: Fifteen patients with osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma who underwent operation via trans-nasal endoscopic approach from 2008 to 2013 were retrospectively reviewed. The typical clinical manifestations included headache (NRS 6-9: 11 cases), foul odor (10 cases), epistaxis (4 cases), hearing loss (5 cases, 7 ears), tinnitus (4 cases, 5 ears). All patients underwent operation via trans-nasal endoscopic approach. During the operation, the diseased region was fully exposed, the necrotic tissue was resected, the necrotic bone was removed by high-speed electric drill, and the drainage was made unobstructed. The perioperative treatment and follow-up were carried out. RESULTS: After operation, all patients were diagnosed pathologically as osteoradionecrosis and mucosal chroinic inflammation, 1 case combined with fungal sphenoid sinusitis. Headache (9 cases) and foul odor (9 cases) resolved after operation. The follow-up was lasted 18-82 months, 13 cases were survival, 1 case lost to follow-up, 1 case died of cerebral hemorrhage. CONCLUSION: Surgical treatment via trans-nasal endoscopic approach is safe and effective in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma, and is helping to improve the survival rate and survival quality.

[Analyses of therapeutic and prognostic factors for rN3 neck recurrence of nasopharyngeal carcinoma after primary radiotherapy].

OBJECTIVE: To investigate the treatment and prognosis for rN3 neck recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy. METHODS: A total of 37 cases with rN3 neck recurrence after radiotherapy in NPC between October 2003 and August 2013 were retrospectively analyzed. Of them 19 cases presented with lymph node (LN) metastasis in supraclavicular fossa, 18 cases had metastasis LN > 6 cm, 10 cases received chemoradiotherapy, and 27 cases underwent neck dissection including modified radical neck dissection (MRND) for 9 cases, radical neck dissection (RND) for 18 cases. Six of 18 cases with RND underwent reconstructive surgery with pectoralis major flap, 12 cases received postoperative radiotherapy and 20 cases had postoperative adjuvant chemotherapy. RESULTS: Eight patients had documented recurrence or residue, 17 patients developed distant metastases, one patient showed recurrence and distant metastasis. The 5-year overall survival rate and disease-free survival rate were 27.5% and 21.6% respectively, and the median survival time was 41 months. The survival rate in surgery group was significantly higher than that in chemoradiotherapy group, and the prognosis of patients with LN > 6 cm was better than that of patients with metastasis LN to supraclavicular fossa. CONCLUSIONS: Patients with rN3 NPC are prone to metastasis, and patients with supraclavicular fossa lymph node metastasis had poor prognosis. Surgery combined with chemoradiotherapy is an effective treatment for the patients without distant metastasis.

[Dynamic observation of EB virus DNA load before and after the treatment in patients with nasopharyngeal carcinoma and its clinical significance].

OBJECTIVE: Dynamic observation of Epstein-Barr virus (EBV) DNA load before and after the treatment in patients with Nasopharyngeal carcinoma (NPC), predicting the incidence of distant metastasis and offering more personalised choice of therapies. METHOD: Fifty-four cases of patients with NPC were taken by fluorescence quantitative PCR assay of EBV DNA load before and after the treatment, all patients were followed up according to plan and carried out the progression-free survival (PFS) and overall survival (OS). RESULT: EBV DNA load in plasma of patients with NPC can partly reflect the clinical characteristics of patients; EBV DNA load in some patients with distant metastasis was higher than those patients with continuous remission when they were not started treatment (P < 0.05); For those patients whose EBV DNA copies were lower than 20,000 copies/mI before the treatment, the progression-free survival and overall survival rates were higher than those high expression patients, and the difference were statistically significant (PF < 0.01 and P < 0.05). CONCLUSION: The EBV DNA load in the plasma of NPC patients can partly predict the occurrence of distant metastases before treatment.

[Application of narrow band imaging endoscopy in early diagnosis of nasopharyngeal carcinoma].

OBJECTIVE: To investigate the use of NBI (narrow band imaging) in early the diagnosis of nasopharyngeal carcinoma. METHODS: A total of 55 cases with nasopharyngeal lesions (including 9 cases of nasopharyngeal carcinoma after treatment) were examined and diagnosed by white and NBI endoscopy between October 2011 and March 2012, and their diagnosis efficacies were evaluated based on pathological diagnosis as a gold standard. Chi-square test was used to analyze data. RESULTS: Of 55 cases, 12 cases were pathologically diagnosed as chronic mucosa inflammation and 43 as nasopharyngeal carcinoma including 6 recurrent cases, of 43 cases, 40(93.0%) were diagnosed by NBI endoscopy and 18 (41.9%) by white endoscopy. Of 12 cases with early nasopharyngeal carcinoma (5 for stage I and 7 for stage II) , 5(100.0%) for stage I, and 6(85.7%) for stage II were diagnosed by NBI endoscopy but only 1(14.3%) for stage II by white endoscopy, with a statistically significant difference (χ(2) = 10.000, P = 0.008;χ(2) = 7.143, P = 0.029). CONCLUSION: NBI endoscopy can be used in early diagnosis of nasopharyngeal carcinoma and check after treatment.

[The value of narrow band imaging laryngoscope for laryngopharyngeal reflux disease].

OBJECTIVE: To investigate the value of narrow-band imaging (NBI) laryngoscope for the diagnosis and therapy of the laryngopharyngeal reflux disease (LPRD). METHOD: Analyzed the NBI laryngoscope characteristic findings of the throats of 46 LPRD patients which confirmed the diagnosis according to the reflux symptom index (RSI) and reflux finding score (RFS) both positive and the proton pump inhibitor therapy effective. RESULT: The NBI laryngoscope findings as follows: erythema and edema between the arytenoid cartilages (71.7%), the epiglottis congestion (67.4%), pharyngeal isolation/integration erythema (65.2%), pharyngeal pebbles--like changes (65.2%), hypertrophy of the posterior commissure (52.2%), vocal cord erythema and edema (47.8%), vocal nodules or vocal polyps with erythema, or edema (39.1%), arytenoid cartilages edema and erythema (21.7%), ventricular edema, erythema and laryngeal ventricle disappeared (17.4%), granuloma (6.5%), ulcers (4.3%), false vocal cord ditch (4.3%). CONCLUSION: LPRD has characteristic findings. NBI laryngoscope is easy to operate and has a high value on the diagnosis and the treatment of the LPRD.

[A prospective study of surgery combined with concurrent radiochemotherapy in the treatment of patients with early stage nasopharyngeal carcinoma].

OBJECTIVE: To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma. METHOD: Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia. RESULT: (1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant. CONCLUSION: The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.

[Effect of p53 gene therapy on the local immunity and the efficacy of patients with nasopharyngeal carcinoma].

OBJECTIVE: To investigate the tumor regression and local immune function in nasopharyngeal carcinoma patients treated with p53 gene therapy. METHOD: The two-step immunohistochemical was done to detect the expression of tumor-infiltrating lymphocytes (TIL) T-cell receptor-CD3, CD4, CD8 and B cell receptor-CD20 in the primary tumor tissue of nasopharyngeal carcinoma. Nasal endoscopy with MRI or CT was used for evaluation of tumor size. RESULT: The expression of CD3, CD4, CD8 was significantly increased after p53 gene treatment (P < 0.05). There was no significant change in expression of CD20 after p53 gene treatment (P > 0.05). In conventional treatment group, CD3, CD4, CD8 and CD20 (P > 0.05) did not show any significant difference. In gene therapy group at 3 months after treatment, 20 patients had achieved CR, 10 PR, 1 SD, 1 PD. In conventional treatment group, 11 patients had achieved CR, 12 PR,5 SD,3 PD. The response rate between treatment group and control group (CR+PR) was different (P < 0.05). CD3 and CD4 expression was correlated with tumor regression rate (P < 0.05, P < 0.01), and CD8 expression was correlated with the CR rate (P < 0.05). CONCLUSION: T cells are the most proliferative cell of TII. in NPC patients after p53 gene therapy The local cellular immune status is positively correlated with tumor regression rate.

[The diagnosis and treatment of relapsing polychondritis (a case report)].

OBJECTIVE: To enhance the understanding of the diagnosis and treatments of relapsing polychondritis (RP). METHOD: We present a 37-years-old woman with RP, and review the literatures. RESULT: Initial presenting symptoms of the patient was auricle perichondritis. The patient was diagnosed as sudden deafness firstly. After 2 months, she consulted otolaryngologists at second time with a variety of involvement of the ear, nose, larynx or heart. She was diagnosed as relapsing polychondritis finally. CONCLUSION: RP was rare autoimmune system disease, early clinical manifestation were atypical, misdiagnosis and diagnostic errors usually occurred. Corticosteroids, immunosuppressive agents, dapsone and surgical operation could be used in these patients to control symptoms.

[Facial nerve root combing scraping for hemifacial spasm].

OBJECTIVE: To explore the effective intracranial surgical method for hemifacial spasm which can be operated more safely and easily. METHOD: Twenty-five cases of hemifacial spasm underwent intracranial facial nerve root combing scraping by improved retrosigmoid approach. The compressing vessels were found in 10 cases and could be removed easily. Both microvascular decompression and facial nerve root combing scraping were performed to reduce recurrence. The other cases with perforating artery or without any compressing vessels underwent the facial nerve root combing scraping and cutting off partially for about 1/6 to approximately 1/5 neural fibers. RESULT: Hemifacial spasms were obliterated in 22 cases (88%) after operation, obviously relieved in 2 cases (8%), invalid in 1 case (4%). Varied facial nerve paralysis was observed in 25 patients, but no hearing disturbance and other serious complication occurred. Follow-up for 2 to approximately 8 years showed there were recurrences in 2 cases (8%) and the facial nerve paralysis of 25 cases recovered in 1 to approximately 6 months after operation. CONCLUSION: The facial nerve root combing scraping is an effective and safe microsurgical procedure which has wide-ranged indication and less complication. It is very important to select suitable treatment for the patient individually during the operation to improve the efficacy and lower the risk.

[Glossopharyngeal neuroutomy by improved retrosigmoid approach].

OBJECTIVE: To explore a surgical approach to improve the operation effect of glossopharyngeal neuralgia (GPN). METHOD: In 8 cases with GPN, the improved retrosigmoid approach was adopted to access the cerebellopontine angle for exposing the jugular foramen and its adjacent tissues so as to cut off the glossopharyngeal under microscope. The sensoryrizotomy of trigemlind nerve was also performed if there was a trigeminal neuralgia. RESULT: All the symptom of pain in 8 cases with GPN disappeared after operation with no complication occurred. There was no recurrence following-up for 2 approximately 7 years. CONCLUSION: By improved retrosigmoid approach, it is easy to explore the jugular foramen and cut off the glossopharyngea for treating GDN.

[Clinical study on modified transpalatine radical operation for carcinoma of nasopharynx].

OBJECTIVE: To evaluate the method of transpalatine surgical treatment of carcinoma of nasopharynx (NPC). METHOD: The artery palatine major was protected and the resection domain of primary lesion of NPC was expanded by modified hard palatine incision. Preventive radiotherapy and routine chemotherapy was given after the operation. RESULT: Twelve patients were in our report, five of II stage and seven of III stage. In all cases, the incisions in hard palatine were healing by first intention after the operations. The patients were followed up for six months to five years. None case was found relapse or palatal fistula. They all can swallow and speech as normal. Sequelae of radiotherapy was not found. CONCLUSION: Without affecting the healing of the incision, expanding the resective domain of primary lesion of NPC is possible by modified hard palatine incision, and the occurrence of sequelae of radiotherapy can be reduced by giving preventive radiotherapy.