Clinical Outcomes of Nasopharyngeal Carcinoma Patients Treated with Adaptive Helical Tomotherapy, A 5-year Experience.

OBJECTIVES: The study aims to retrospectively review the survival and toxicity outcomes of adaptive helical tomotherapy (HT) treatment of nasopharyngeal carcinoma (NPC) patients over 5 years. METHODS: Between February 2010 and September 2017, 67 biopsy-proven non-metastatic NPC patients were analyzed. All patients except one received concurrent chemotherapy and treated with adaptive Simultaneous integrated boost- intensity-modulated radiation therapy (SIB-IMRT). The median age was 48.5 years (range, min: 11 max: 78) with male predominance (82.1% vs. 17.9%). Neck mass was the most common presenting symptom followed by hearing problems (52% and 24%). RESULTS: The mean dose with standard deviation (sd) of D50 to patients' parotid glands and cochleae were 33 ± 11 Gy; 31 ± 11 9 Gy and 37 ± 11 14 Gy; 34 ± 11 14 Gy, respectively. Locoregional progression-free survival (LRRFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) estimated at 2 and 5 years were 83% and 63%, 78.4% and 61.7%, 83% and 69%, 86% and 71%, respectively. Acute Grade 3 or higher dysphagia and mucositis observed in 28 (42%) patients who required daily iv fluid transfusion and/or hyperalimentation. None of the patients had grade 3 and higher mucous membranes and salivary gland toxicity beyond 6 months. Two patients had ≥ grade 3 late toxicity. During the median 51 months (range 2-100) follow up, thirteen patients relapsed (19.4%), six of them (8.9%) recurred locoregionally, and 7 (10.4%) of them developed distant metastasis. CONCLUSION: The present study reemphasizes that adaptive SIB-IMRT with HT is a good option for the management of NPC with comparable loco-regional control rates and low salivary gland toxicity.

Post-traumatic combined transdiaphragmatic intercostal and lumbar hernia.

Traumatic rupture of the diaphragm following blunt trauma is rare. Lumbar hernia in association with blunt trauma is even rarer. To our knowledge, the combination of these two entities has not previously been reported. We describe such a case and review the literature.