A model to predict the risk of lethal nasopharyngeal necrosis after re-irradiation with intensity-modulated radiotherapy in nasopharyngeal carcinoma patients

Background:For patients with nasopharyngeal carcinoma(NPC) who undergo re-irradiation with intensity-modulated radiotherapy(IMRT),lethal nasopharyngeal necrosis(LNN) is a severe late adverse event.The purpose of this study was to identify risk factors for LNN and develop a model to predict LNN after radical re-irradiation with IMRT in patients with recurrent NPC.Methods:Patients who underwent radical re-irradiation with IMRT for locally recurrent NPC between March 2001 and December 2011 and who had no evidence of distant metastasis were included in this study.Clinical characteristics,including recurrent carcinoma conditions and dosimetric features,were evaluated as candidate risk factors for LNN.Logistic regression analysis was used to identify independent risk factors and construct the predictive scoring model.Results:Among 228 patients enrolled in this study,204 were at risk of developing LNN based on risk analysis.Of the 204 patients treated,31(15.2%) developed LNN.Logistic regression analysis showed that female sex(P = 0.008),necrosis before re-irradiation(P = 0.008),accumulated total prescription dose to the gross tumor volume(GTV) ≥ 145.5 Gy(P = 0.043),and recurrent tumor volume >25.38 cm3(P = 0.009) were independent risk factors for LNN.A model to predict LNN was then constructed that included these four independent risk factors.Conclusions:A model that includes sex,necrosis before re-irradiation,accumulated total prescription dose to GTV,and recurrent tumor volume can effectively predict the risk of developing LNN in NPC patients who undergo radical re-irradiation with IMRT.

顺铂、氟尿嘧啶加或不加紫杉烷的诱导化疗对局部区域晚期鼻咽癌的影响:回顾性、倾向评分匹配分析

背景与目的比较局部区域晚期鼻咽癌(nasopharyngeal carcinoma,NPC)不同诱导化疗(induction chemotherapy,IC)方案的文献中缺乏可用数据。本研究旨在评价接受紫杉烷、顺铂和5-氟尿嘧啶(taxane,cisplatin and 5?fuorouracil,TPF)或顺铂和5-氟尿嘧啶(cisplatin and 5?fuorouracil,PF)方案的IC后进行同步放化疗(concurrent chemoradiotherapy,CCRT)的局部区域晚期鼻咽癌患者的结局。方法前瞻性维护数据库中共1879例接受了IC和CCRT治疗的局部区域晚期鼻咽癌患者被纳入此观察性研究。我们采用倾向评分法比较了总生存期(overall survival,OS)、疾病特异生存期(disease-specific survival,DSS)、无远处转移生存期(distant metastasis?free survival,DMFS)和无局部区域复发生存期。结果共1256例患者接受了TPF或PF作为IC方案。多因素分析中,TPF组比PF组表现出显著更好的OS[风险比(hazard ratio,HR)=0.660;95%置信区间(confdence interval,CI):0.442–0.986;P=0.042]、DSS(HR=0.624;95%CI:0.411–0.947;P=0.027)和DMFS(HR=0.589;95%CI:0.406–0.855;P=0.005)。倾向评分匹配在每个队列中确定了294例患者,并证实了TPF组比PF组表现出显著改善的5年OS率(88.1%vs. 80.7%;P=0.042)、DSS率(88.5%vs.80.7%;P=0.021)和DMFS率(87.9%vs. 78.6%;P=0.012)。匹配前后的局部区域无复发生存率无显著差异。结论在我们的研究中,与PF方案相比,TPF方案IC结合CCRT改善了局部区域晚期鼻咽癌患者的长期生存。然而,有必要进行前瞻性随机临床试验来验证这些发现。

Occipital lymph node metastasis from nasopharyngeal carcinoma:a special case report and literature review

Cervical lymph node metastasis is common in patients with nasopharyngeal carcinoma(NPC),but occipital lymph node metastasis in NPC patients has not yet been reported.In this case report,we describe an NPC patient with occipital lymph node metastasis.The clinical presentation,diagnostic procedure,treatment,and outcome of this case were presented,with a review of the related literature.

Effect of induction chemotherapy with cisplatin, fluorouracil, with or without taxane on locoregionally advanced nasopharyngeal carcinoma: a retrospective, propensity score-matched analysis

Background:Available data in the literature comparing different induction chemotherapy(IC)regimens on locoregionally advanced nasopharyngeal carcinoma(NPC)are scarce.The purpose of the present study was to evaluate the outcomes of locoregionally advanced NPC patients who were treated with taxane,cisplatin and 5-fluorouracil(TPF)or cisplatin and 5-fluorouracil(PF)as IC followed by concurrent chemoradiotherapy(CCRT).Methods:In total,1879 patients with locoregionally advanced NPC treated with IC and CCRT from a prospectively maintained database were included in the present observational study.We compared overall survival(OS),disease-specific survival(DSS),distant metastasis-free survival(DMFS),and locoregional relapse-free survival,using the pro-pensity score method.Results:In total,1256 patients received TPF or PF as IC backbone.The TPF group showed significantly better OS(hazard ratio[HR],0.660;95%confidence interval[CI]0.442-0.986;P=0.042),DSS(HR,0.624;95%CI 0.411-0.947;P=0.027)and DMFS(HR,0.589;95%CI 0.406-0.855;P=0.005)compared with the PF group in multivariable analy-ses.Propensity score matching identified 294 patients in each cohort and confirmed that TPF was associated with significantly improved 5-year OS(88.1%vs.80.7%;P=0.042),DSS(88.5%vs.80.7%;P=0.021)and DMFS(87.9%vs.78.6%;P=0.012)rates compared with the PF group.There were no significant differences in locoregional relapse-free survival before or after matching.Conclusions:In our study,IC with the TPF regimen combined with CCRT showed improved long-term survival for the patients with locoregionally advanced NPC compared with the PF regimen.However,a prospective randomized clinical trial to validate these findings is necessary.