Comparison of intensity-modulated radiation therapy alone vs. intensity-modulated radiation therapy combined with chemotherapy in elderly nasopharyngeal carcinoma patients (aged >65 years).

PURPOSE: The efficacy and tolerability of adding chemotherapy to radiotherapy in the era of intensity-modulated radiation therapy (IMRT) remain controversial among older patients with nasopharyngeal carcinoma (NPC). The present study compared IMRT alone with IMRT in combination with chemotherapy in elderly NPC patients. METHODS: Between January 2011 and December 2014, 102 patients aged >65 years with NPC who received IMRT alone (IMRT group) or IMRT in combination with chemotherapy (IMRT/CT group) were enrolled. Patients from both treatment arms were pair-matched (1:1 ratio) based on six clinical factors. Differences in overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and Cox proportional hazards models, whereas the toxicity profile was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4. RESULTS: No significant differences were noted in OS (72.1% vs. 72.5%, p = 0.799), DFS (65.9% vs. 70.1%, p = 0.733), LRRFS (76.4% vs. 71.6%, p = 0.184), and DMFS (90.8% vs. 98.0%, p = 0.610) between the IMRT and IMRT/CT groups. Multivariate analyses showed that chemotherapy was not an independent factor for OS, DFS, LRRFS, and DMFS. However, the incidences of grade 3 vomiting/nausea (p = 0.000), leukopenia/neutropenia (p = 0.000), thrombocytopenia (p = 0.041), and anemia (p = 0.040) were significantly higher in the IMRT/CT group compared with the IMRT group. No grade 4 toxicities were observed. CONCLUSION: IMRT alone was similar to IMRT/CT in treating elderly NPC patients (age >65 years), with comparable survival outcomes and less grade 3 toxicities.

Preoperative Prediction of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma via Conventional and Contrast-Enhanced Ultrasound.

OBJECTIVES: To investigate the independent risk factors for cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) and establish a prediction model via conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). METHODS: A total of 275 patients with single PTC, who were admitted to our hospital from January 2016 to December 2018, were enrolled in this study. The clinical characteristics and features of the tumor on conventional US and CEUS were retrospectively analyzed. A binary logistic regression model was established, and the diagnostic efficacy of conventional US and CEUS was compared. RESULTS: The binary logistic regression analysis showed that age younger than 38 years, size of 10.0 mm or greater, solid composition, peak of the nodule interior of 28.3750 or greater, and area under the curve (AUC) of the peripheral ring of less than 3.2500 were independent risk factors of CLNM (P < .05, for all). Prediction model: Logit (p) = -4.135 + 1.040 (age) + 1.920 (size) + 1.769 (composition) + 1.230 (peak of nodule interior) + 0.812 (AUC of peripheral ring). The model positively predicted CLNM at a value of L > -0.199. The AUC, sensitivity, and negative predictive value of the receiver operating characteristic curve for the model were 0.727, 71.7%, and 75.2%, respectively, which were significantly higher than those of conventional US (Z = -2.403; P = .016; Z = -5.330; P < .001; and Z = -2.390; P = .017). The specificity of the model was 73.7%, which was lower than that of conventional US (Z = 3.508; P < .001). CONCLUSIONS: The preoperative prediction model established via conventional US and CEUS may be helpful to evaluate CLNM in patients with PTC and determine the appropriate treatment options.

Application of Contrast-Enhanced Ultrasound in the Diagnosis of Ductal Carcinoma In Situ: Analysis of 127 Cases.

OBJECTIVES: To explore the characteristics of breast ductal carcinoma in situ (DCIS) on real-time grayscale contrast-enhanced ultrasound (CEUS) imaging and the diagnostic value of CEUS in DCIS. METHODS: A total of 127 histopathologically confirmed DCIS lesions and 124 fibroadenomas (FAs; controls) were subjected to conventional ultrasound and CEUS. Next, the CEUS findings of DCIS and FA lesions, including morphologic features and quantitative parameters, were analyzed. RESULTS: Binary logistic regression was used to identify the independent risk factors from DCIS and FA lesions detected by CEUS. Contrast-enhanced ultrasound revealed significant differences between DCIS and FA. The wash-in time, enhancement mode, enhancement intensity, blood perfusion defects, peripheral high enhancement, enhancement scope, intratumoral vessels and their courses and dilatation degree, and penetrating vessels on CEUS were identified as features correlated with DCIS (P < .05). Moreover, a multivariate logistic regression analysis was developed, and the area under receiver operating characteristic curve of each index was generated, including the wash-in time, enhancement intensity, blood perfusion defects, enhancement scope, penetrating vessels, arrival time, and peak intensity (P < .05; area under the curve, >0.6). CONCLUSIONS: The contrast-enhancement patterns and DCIS parameters appeared different from FA lesions, thus suggesting that CEUS can be very useful in distinguishing DCIS from FA lesions.

Risk factors and nomogram to predict skip metastasis in papillary thyroid carcinoma.

Background: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Skip metastases of PTCs are easily misdiagnosed before surgery, and it could lead to re-operation and affect the prognosis. Although there are a few studies about nomograms for predicting central lymph node metastases (CLNM) or lateral lymph node metastases (LLNM) of PTCs, there are few studies about nomograms for skip metastases. Based on the clinical and ultrasonographic characteristics of patients with PTCs, the aim of our study was to investigate the risk factors and establish a nomogram for predicting the risk of skip metastases in PTCs. Methods: This study enrolled 218 PTCs patients with lateral cervical lymph node metastases and their data were analyzed retrospectively. According to the postoperative pathological results, the patients were divided into skip-positive group and skip-negative group. In order to establish the nomogram, univariate and multivariate analyses were used to estimate risk factors of skip metastases. The receiver operating characteristic (ROC) curve, internal calibration plot and decision curve analysis (DCA) were used to evaluate the nomogram model's efficacy. Results: There were statistical differences between skip-positive group and skip-negative group in tumor location, the maximum diameter (D) and capsule invasion (P<0.05). No statistical differences were observed in sex, age, Hashimoto's thyroiditis, multifocality, anteroposterior diameter/transverse diameter (A/T) ratio, shape, margin, microcalcification, intra-nodular vascularity and preoperative serum thyroglobulin (Tg) (P≥0.05). The risk factors of skip metastases in PTCs were D ≤10 mm, location in the upper portion and capsule invasion. The area under the curve (AUC) of nomogram was 0.877, the accuracy was 85.32%, the sensitivity was 60.98%, and the specificity was 90.96%. The calibration curve and the Hosmer-Lemeshow goodness of fit test showed that the consistency between the nomogram and the actual observation was good. The DCA showed that most PTC patients might benefit from the predictive nomogram model. Conclusions: A nomogram for predicting skip metastases in PTCs may be useful in clinical diagnosis and treatment.

Clinical and Ultrasonographic Features of Papillary Thyroid Carcinoma Located in the Isthmus.

ABSTRACT: The aim of this research was to investigate the clinical and ultrasonographic features of papillary thyroid carcinoma (PTC) in the isthmus. A total of 823 patients with 823 PTCs including 133 in the isthmus and 690 in the lateral lobe were included in our study. All patients were confirmed by postoperative pathology. The clinical and ultrasonographic characteristics were retrospectively analyzed and compared. Univariate analysis and multivariate logistic regression analysis were performed. Multifactor analyses showed that PTC in the isthmus was significantly different from PTC originating from the lateral lobe in aspect ratio, microcalcification, extrathyroid extension, lymph node metastases, and lymph node density ( P < 0.05, for all). There were no significant differences in age, sex, tumor size, margin, halo, echogenicity, and homogeneity ( P > 0.05, for all). The results indicated that the sonographic appearances of PTC in the isthmus were relatively atypical; however, it had a higher incidence of extrathyroidal extension, central lymph node metastasis, and a tendency of higher lymph node density. Therefore, more careful ultrasound evaluation should be performed for these nodules.

Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating differentiated thyroid carcinomas from benign nodules.

Objective: To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) of qualitative and quantitative parameters for differentiating differentiated thyroid cancers from benign nodules. Method: A total of 290 thyroid nodules that were pathologically confirmed were enrolled in this study. The univariate analysis was performed for the clinical characteristics and CEUS qualitative and quantitative parameters of the inside and peripheral zone of nodules, including age, gender, nodule size, intensity of enhancement, homogeneity, wash-in and wash-out patterns, margin after CEUS, ring enhancement, peak intensity, sharpness, time to peak(TP), and area under the curve(AUC), and the meaningful indicators in the single-factor analysis were further included in multivariate logistic regression analysis. Results: Multivariate analysis showed that there were significant differences in age (p=0.031), nodule size (p<0.001), heterogeneous enhancement (p<0.001), hypo-enhancement (p=0.001), unclear margin after CEUS(p=0.007), inside peak (p<0.001), and outside sharpness(p<0.001) between benign and malignant nodules. However, there were no significant differences in gender, ring enhancement, wash-in, wash-out, outside TP, outside AUC between benign and malignant thyroid nodules (P>0.05, for all). Conclusion: CEUS might be useful in the differential diagnosis of differentiated thyroid cancers and benign nodules, which could provide a certain basis for clinical treatment.

Contrast-enhanced ultrasound manifestations of renal masses undetectable on conventional ultrasound.

This study aimed to retrospectively analyze the features of contrast-enhanced ultrasound (CEUS) of renal masses that cannot be detected by conventional ultrasound (CUS). The data of 264 patients who underwent CEUS for renal lesions from January 2016 to December 2019 were retrieved. Of these, 16 patients with renal masses which were not detected by CUS were included in the final analysis. The corresponding characteristics of CEUS were evaluated, including intensity of enhancement, homogeneity, wash-in and wash-out patterns, and perilesional rim-like enhancement. Of the 16 patients, 10 patients had clear cell renal cell carcinoma (ccRCC) and 6 patients had urothelial carcinoma of the renal pelvis (UCRP). Compared with the location on non-enhanced computed tomography (CT) scan, all tumors were detected on CEUS. Most (7/10) of the ccRCCs appeared as hyperenhancement, homogeneous enhancement, synchronous-in, and no perilesional rim-like enhancement. Most (4/6) of the UCRPs appeared as isoenhancement, slow-in, fast-out, and no perilesional rim-like enhancement. CEUS may be helpful in the diagnosis and differential diagnosis of renal tumors which were not observed on CUS, and it might be an alternative method for some patients when contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) cannot be performed.

Superiority of intensity-modulated radiation therapy in nasopharyngeal carcinoma with skull-base invasion.

PURPOSE: To compare the clinical results and functional outcomes between two-dimensional conventional radiation therapy (2DRT) and intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) with skull-base invasion. METHODS: A total of 1258 patients were subclassified into two groups: mild skull-base invasion group (792; 63%) and severe skull-base invasion group (466; 37%). Patients were pair matched (1:1 ratio) using six clinical factors into 2DRT or IMRT groups. The Kaplan-Meier method and Cox regression model were performed to assess overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS). Toxicities were evaluated. RESULTS: IMRT significantly improved four-year OS compared with 2DRT (65.6% vs. 81.8%, P = 0.000), DFS (57.3% vs. 73.3%, P = 0.000) and LRRFS (76.5% vs. 87.5%, P = 0.003) in NPC with severe skull-base invasion, but similar results were observed in patients with mild skull-base invasion (P > 0.05). In patients with severe invasion, radiation therapy techniques were found to be an independent prognostic factor for OS (HR = 0.457, P = 0.000), DFS (HR = 0.547, P = 0.000) and LRRFS (HR = 0.503, P = 0.004). IMRT was associated with better OS. In subgroups analysis, IMRT group also had a better survival in OS, DFS (P < 0.05 for all rates) for patients received concurrent chemotherapy and sequential chemotherapy compared to 2DRT in the severe invasion group. The IMRT group displayed lower incidence of mucositis, xerostomia, trismus (< 1 cm) and temporal lobe necrosis than the 2DRT group. CONCLUSIONS: IMRT significantly improved patient survival compared with 2DRT in NPC patients with severe skull-base invasion, but a similar survival rate was noted in mild invasion patients. Chemotherapy can improve survival in NPC patients with severe invasion. Among the two therapies, IMRT significantly decreased therapy-related toxicity.

Gemcitabine plus cisplatin versus fluorouracil plus cisplatin as a first-line concurrent chemotherapy regimen in nasopharyngeal carcinoma: a prospective, multi-institution, randomized controlled phase II study.

BACKGROUND: The objective of this study was to evaluate the efficacy and safety of gemcitabine plus cisplatin concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma. METHOD: Patients with NPC were randomly assigned to the gemcitabine plus cisplatin (GP) group or fluorouracil plus cisplatin (PF) group. Primary end-point was disease-free survival (DFS); secondary endpoints: overall survival, distant metastasis-free survival (DMFS), locoregional relapse-free survival, and treatment-related adverse events. RESULTS: Seventy-six patients were prospectively enrolled and the median follow-up time was 41 months (9-61 months). Three-year DFS were similar between the GP and PF groups (73.7% vs. 60.5%, HR 0.66, 95% CI 0.30-1.44; P = 0.30). Distant metastasis was the most common failure form in PF compared with GP (P = 0.034). Three-year DMFS was significantly better in the GP group than PF group (89.5% vs. 71.1%, P = 0.045). Grade 3-4 gastrointestinal toxicities (vomiting and diarrhea) were significantly more common in the PF group; grade 3-4 neutropenia and thrombocytopenia were more common in the GP group. CONCLUSION: Gemcitabine plus cisplatin could be used as an alternative regimen in CCRT for nasopharyngeal carcinoma.

Chemotherapy regimens containing taxanes or fluorouracil in nasopharyngeal carcinoma: Which better?

OBJECTIVES: The efficacy of various chemotherapy regimens in nasopharyngeal carcinoma (NPC) remains under debate. We compared the efficacy and toxicity of a taxane-based regimen and regimen including fluorouracil in NPC. MATERIALS AND METHODS: Eight-hundred and six patients with stage II-IVB NPC from four institutions in China were pair-matched (1:1 ratio) to the cisplatin plus fluorouracil (PF) group or cisplatin plus taxanes (TP) group using eight clinical factors. Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and Cox regression model. Toxicities were assessed in all patients. RESULTS: Three-year DFS was significantly better in the TP group than PF group (82.5% vs. 72.7%, P=0.002), with no significant difference in OS, LRRFS or DMFS. TP led to significantly better DFS compared to PF in the subgroups advanced stage NPC, patients aged ≤45-years-old and female patients. In multivariate analysis, chemotherapy regimen was an independent prognostic factor for DFS [hazard ratio, 0.591, 95% CI 0.444-0.786, P=0.000]. Grade 3-4 leukopenia, neutropenia and anemia were significantly more common in the TP group; grade 3-4 mucositis, vomiting, vasculitis and diarrhea were more common in the PF group. CONCLUSION: Taxane-based regimens have a higher efficacy in NPC than regimens including fluorouracil, especially in patients with advanced stage, patients aged≤45-years-old and female patients.