Screening for nasopharyngeal carcinoma in high-incidence regions——Next steps

Epstein-Barr virus(EBV)infection is a well-established risk factor in the development of nonkeratinizing and undifferentiated forms of nasopharyngeal carcinoma(NPC)common in parts of China and Southeast Asia.Early detection of NPC can significantly improve survival rates,as the 5-year survival rate for patients diagnosed at an early stage can exceed 90%after treatment.Studies have demonstrated that screening for NPC using EBV markers is an effective tool for identifying individuals with the disease.Future efforts should focus on implementing screening programs in high-incidence populations,assessing and refining screening algorithms,and exploring new,potentially more cost-effective screening methods.It is crucial to ensure that any new approaches are validated as superior or non-inferior to existing protocol before being adopted on a wider scale.The success of these screening tools in reducing NPC-related morbidity and mortality will depend on their effective implementation and ensuring access for the populations most in need of preventive interventions.This opinion piece briefly summarizes the current evidence supporting EBV-based screening for NPC detection and discusses future steps,including:1)the implementation of effective NPC screening programs,2)the evaluation of improvements in screening methodologies,and 3)the consideration of novel approaches to screening.

Observation of therapeutic effect of lamp irradiation combined with purple gromwell oil gauze on alleviating intestinal colic in patients

BACKGROUND Intestinal colic is a common complication in patients who have undergone radical surgery for colorectal cancer.Traditional Chinese medicine has advantages,including safety and stability,for the treatment of intestinal colic.Lamp irra-diation for abdominal ironing has been applied in the treatment of many gas-trointestinal diseases.Purple gromwell oil has the effects of clearing heat,cooling blood,reducing swelling,and relieving pain.RESULTS The general effective rate in the observation group was 95.00%,which was significantly higher than that in the control group(86.67%,P<0.05).Before treatment,there was no significant difference in the duration of symptoms between the groups(P>0.05).After 1,2,3,and 4 d of treatment,the duration of symptoms in both groups were decreased,and the duration in the observation group was significantly lower than that in the control group(96.54±9.57 vs 110.45±11.23,87.26±12.07 vs 104.44±11.68,80.45±16.21 vs 99.44±14.95,73.18±15.58 vs 92.17±14.20;P<0.05).After 1,3,5,and 7 d of treatment,the NRS scores in both groups were decreased,and the NRS scores in the observation group were significantly lower than those in the control group(3.56±0.41 vs 4.04±0.58,3.07±0.67 vs 3.74±1.02,2.52±0.76 vs 3.43±0.85,2.03±0.58 vs 3.03±0.82;P<0.05).There was no significant difference in the rate of adverse reaction occurrence between the groups(P>0.05).CONCLUSION The use of lamp irradiation combined with purple gromwell oil gauze in patients with intestinal colic after radical surgery for colorectal cancer can reduce symptom duration,alleviate intestinal colic,and improve treatment efficacy,and this approach is safe.It is worth promoting the use of this treatment in clinical practice.

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.

CLINICAL STUDY ON IRRADIATION COMBINED WITH TRADITIONAL CHINESE MEDICINE IN THE TREATMENT OF LARGE PRIMARY LIVER CANCER

This paper resports the response of inoperable primary liver cancer to whole liver irradiation(WLI)by movingstrip technique(MST)during the period from 1980- 1988.The results showed that WLI by MST gave good response in this malignancy.The 5-year survival after treatment was 30.83% and median survival 25.8 months.The analysis of prognostic factors indicated that the higher the midplane tissue dose(mTD),the longer the survival(P<0.001),and that the survival of those patients tumor diameter was>8 to<13 cm and/or tumor volume>50% to <75% of liver volume was longer than that of there with tumor diameter of≥13 cm and/or tumor volume≥75% of the liver volume(P<0. 001 ).Traditional Chinese medicine is an indispensable therapy during the period of WLI by MST.Both clinical and experimental studies suggest that WLI by MST can enhance the therapeutic effect.

Carbon ion irradiation-induced DNA damage evokes cell cycle arrest and apoptosis via the pRb/E2F1/c-Myc signaling pathway in p53-deficient prostate cancer PC-3 cells

Carbon ion radiotherapy has the advantages of better therapeutic effect and fewer side effects compared with those of X-rays in many kinds of tumors,including prostate cancer,and thus is an attractive treatment approach for prostate cancer.However,the biological effects and underlying mechanisms of carbon ion irradiation in prostate cancer are not yet fully understood.Therefore,this study systematically compared the effects of carbon ion irradiation with those of X-ray irradiation on DNA damage response and found that carbon ion irradiation was more effective than X-ray irradiation.Carbon ion irradiation can induce a high level of DNA double-strand break damage,reflected by the number of y-H2 A histone family member X foci,as well as by the foci lasting time and size.Moreover,carbon ion irradiation exhibited strong and long-lasting inhibitory effect on cell survival capability,induced prolonged cell cycle arrest,and increased apoptosis in PC-3 cells.As an underlying mechanism,we speculated that carbon ion irradiation-induced DNA damage evokes cell cycle arrest and apoptosis via the pRb/E2 F1/c-Myc signaling pathway to enhance the radiosensitivity of p53-deficient prostate cancer PC-3 cells.Collectively,the present study suggests that carbon ion irradiation is more efficient than X-ray irradiation and may help to understand the effects of different radiation qualities on the survival potential of p53-deficient prostate cancer cells.

Nasopharyngeal carcinoma with synchronous breast metastasis:A case report

BACKGROUND Recent reports have described cases of metachronous breast metastasis in patients with nasopharyngeal carcinoma.However,no similar cases of synchronous breast metastasis have been reported,and evidence that can be used to support the clinical diagnosis of stage IV nasopharyngeal carcinoma in patients with concurrent breast metastasis remains lacking.Therefore,additional evidence is required to elucidate the clinical characteristics of this condition and aid in the development of optimal management strategies.CASE SUMMARY We report the case of a 46-year-old woman who visited our hospital with a right breast mass as the first symptom.The first pathological biopsy report suggested triple-negative breast invasive carcinoma.Subsequent imaging revealed a nasopharyngeal mass.Further puncture biopsy of the nasopharyngeal mass,molecular pathological Epstein–Barr virus in situ hybridization,and immunohistochemistry confirmed the diagnosis of nasopharyngeal carcinoma with breast metastasis.The patient did not undergo a mastectomy and achieved complete remission after chemotherapy and radiotherapy.She continued to receive oral chemotherapy as maintenance therapy and experienced no recurrence or metastasis during the 6-month follow-up period.CONCLUSION This case report suggests that breast specialists should carefully rule out secondary breast cancers when diagnosing and treating breast masses.Furthermore,clinicians should aim to identify the pathological type of the tumor to obtain the most accurate diagnosis and prevent excessive diagnosis and treatment.

Intraoperative Open-Cavity Implant for Accelerated Partial Breast Irradiation Using High-Dose Rate Multicatheter Brachytherapy in Japanese Breast Cancer Patients: A Single-Institution Registry Study

Background: Previous research has compared the efficacies of accelerated partial breast irradiation (APBI) and wholebreast irradiation (WBI). APBI immediately after surgery may provide more benefit after intraoperative insertion of catheters. Although balloon catheter-based APBI is available in the US, it is difficult in Japanese women, who have relatively small breasts. With the applicators being implanted during tumor removal, APBI can be started immediately after surgery. The aim of this study was to assess the safety and efficacy of APBI using the intraoperative open-cavity implant technique. Method: Patients (age≥40 years) with invasive breast cancer (diameter≤3 cm) were enrolled. Before lumpectomy, the insertion of applicators and delivery doses were simulated by computed tomography (CT). After confirmation of free margins and negative sentinel nodes (SNs) using frozen section analysis, applicators were inserted. Postoperative CT-based dose distribution analysis was performed using dose-volume histograms. APBI was started on the day of surgery, delivering 32 Gy in 8 fractions over the following 5-6 days, and it covered a distance of 2 cm from tumor margins. This observational study was approved by the institutional review board of our hospital. Results: From October 2008 to July 2012, 157 women (160 lesions) were enrolled (age 55.0 years, <40:9, SN+: 25, for patients’ request). The mean number of applicators used was 6.4 (2-15) and mean planning target volume was 35.8 cm3 (6.5-137.1 cm3). All radiotherapy-related toxicities were mild. However, 12 patients (7.5%) experienced wound breakdown because of surgical site infection. Two patients developed ipsilateral breast tumor recurrence (1 marginal, 1 at a distant site). Conclusions: Despite the small number of participants and a short follow-up period, our results suggest that this technique could be helpful in establishing clinical safety and efficacy.

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer:A case report

BACKGROUND Radiation therapy(RT)for nasopharyngeal cancer can cause several complications.In rare cases,an internal carotid artery pseudoaneurysm can occur,which can be fatal.We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.CASE SUMMARY A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago(American Joint Committee on Cancer Stage T3N2M0)and received concurrent chemoradiation therapy.He subsequently relapsed and received chemotherapy.One week after the 4th cycle of chemotherapy,he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache.A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography(DSA).Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved.No pseudoaneurysm was observed on DSA after coil embolization;however,intermittent epistaxis was maintained even after coil embolization.After seven days,a diagnostic laryngoscopy was performed.Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock.In this case,epistaxis may have been a sign of pseudoaneurysm;therefore,treatment such as embolization should be performed promptly,and careful management should be undertaken after treatment.CONCLUSION This case highlights a rare,serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.

Cancer stem-like cells in Epstein-Barr virus-associated nasopharyngeal carcinoma

Although the Epstein-Barr virus(EBV) has spread to all populations in the world, EBV-associated nasopharyngeal carcinoma(NPC) is prevalent only in South China and Southeast Asia. The role of EBV in the malignant transformation of nasopharyngeal epithelium is the main focus of current researches. Radiotherapy and chemoradiotherapy have been successful in treating early stage NPC, but the recurrence rates remain high. Unfortunately, local relapse and metastasis are commonly unresponsive to conventional treatments. These recurrent and metastatic lesions are believed to arise from residual or surviving cells that have the properties of cancer stem cells. These cancer stem-like cells(CSCs) have the ability to selfrenew, differentiate, and sustain propagation. They are also chemo-resistant and can form spheres in anchorage-independent environments. This review summarizes recent researches on the CSCs in EBVassociated NPC, including the findings regarding cell surface markers, stem cell-related transcription factors, and various signaling pathways. In particular, the review focuses on the roles of EBV latent genes [latent membrane protein 1(LMP1) and latent membrane protein 2A(LMP2A)], cellular microRNAs, and adenosine triphosphate(ATP)-binding cassette chemodrug transporters in contributing to the properties of CSCs, including the epithelial-mesenchymal transition, stem-like transition, and chemo-resistance. Novel therapeutics that enhance the efficacy of radiotherapy and chemoradiotherapy and inhibitors that suppress the properties of CSCs are also discussed.

Irradiation-induced EMT is associated with activation of TGF-β and restriction of BMP signaling in esophageal cancer cells

Objective: Irradiation may enhance migration and/or invasiveness of cancer cells in vitro and in vivo, the mechanism of which may be associated with epithelial-mesenchymal transition (EMT). The present study explored the mechanisms of EMT induced by irradiation in esophageal cancer cells. Methods: Human esophageal cancer cell line EC109 was treated with increased doses of irradiation (0 Gy, 20 Gy, 40 Gy and 60 Gy). Cell morphology was observed. Expressions of E-cadherin and vimentin were determined by immunofluorescence assay or western blot. Secretion of transforming growth factor-β1 (TGF-β1) by cells was determined by enzyme-linked immunosorbent assay (ELISA), and the expressions of Smad2/3 and phosphorated Smad2 (p-Smad2) were also examined by Western blot. The mRNA expressions of BMP-4, a bone morphogenetic protein (BMP) ligand, and two secreted BMP antagonists (Chordin and Gremlin), were detected with reverse transcription-polymerase chain reaction (RT-PCR). Cell migratory capacity was evaluated. Results: Irradiation induced EMT in EC109 cells in a dose-dependent manner as evidenced by morphological changes, decreased expression of E-cadherin and increased expression of vimentin, and increased cell motility. The secretion of TGF-β1 and expression of p-Smad2 were gradually increased in an irradiation dose-dependent manner, but the Smad2/3 protein levels remained stable. The mRNA expression of BMP-4 was gradually down-regulated, but the expressions of Chordin and Gremlin were gradually up-regulated in cells treated with increased doses of irradiation. Conclusion: Irradiation can induce EMT in esophageal cancer cells in a dose-dependent manner, and the mechanism may be associated with activation of TGF-β and restriction of BMP signaling.

Quality assurance and safety of hippocampal avoidance prophylactic cranial irradiation in the multicenter randomized phase III trial(NCT01780675)

Objective:NCT01780675,a multicenter randomized phase III trial of prophylactic cranial irradiation(PCI)versus PCI with hippocampal sparing in small cell lung cancer(SCLC)investigated neurocognitive decline and safety.As part of quality assurance,we evaluated if hippocampal avoidance(HA)-PCI was performed according to the NCT01780675 trial protocol instructions,and performed a safety analysis to study the incidence and location of brain metastases for patients treated with HA-PCI.Methods:This retrospective analysis evaluated the quality of the irradiation given in the randomized controlled trial(RCT)comparing SCLC patients receiving PCI with or without hippocampal avoidance,using intensity mod-ulated radiotherapy(IMRT)or volumetric modulated arc therapy(VMAT).The dose distribution for each patient receiving HA-PCI was retrieved and analyzed to evaluate if the treatment dose constraints were met.A ques-tionnaire was sent out to all participating sites,and data on radiotherapy technique,pre-treatment dummy runs,phantom measurements and treatment electronic portal imaging device(EPID)dosimetry were collected and analyzed.As part of the safety analysis,the follow-up magnetic resonance imaging(MRI)or computerized to-mography(CT)scans on which cranial disease progression was first diagnosed were collected and matched to the radiotherapy planning dose distribution.The matched scans were reviewed to analyze the location of the brain metastases in relation to the prescribed dose.Results:A total of 168 patients were randomized in the NCT01780675 trial in 10 centers in the Netherlands and Belgium from April 2013 until March 2018.Eighty two patients receiving HA-PCI without evidence of brain metastases were analyzed.All patients were treated with 25 Gy in 10 fractions.Dummy runs and phantom measurements were performed in all institutions prior to enrolling patients into the study.The radiotherapy(RT)plans showed a median mean bilateral hippocampal dose of 8.0 Gy,range 5.4-11.4(constraint≤8.5 Gy).In six patients(7.3%)there was a protocol violation of the mean dose in one or both hippocampi.In four of these six patients(4.9%)the mean dose to both hippocampi exceeded the constraint,in 1 patient(1.2%)only the left and in 1 patient(1.2%)only the right hippocampal mean dose was violated(average median dose left and right 8.9 Gy).All patients met the trial dose constraint of V 115%PTV≤1%;however the D max PTV constraint of≤28.75 Gy was violated in 22.0%of the patients.The safety analysis showed that 14 patients(17.1%)developed cranial progression.No solitary brain metastases in the underdosed region were found.Two out of 11 patients with multiple brain metastasis developed metastasis in the underdosed region(s).Conclusions:The radiotherapy quality within the HA-PCI trial is performed according to the protocol guidelines.The dose constraints to the hippocampi are met in the vast majority of cases.In all patients,the volume of the brain for which a higher dose was accepted,is according to the trial.However,within this volume there are small areas with higher doses than advised.

CLINICAL STUDY IN ACCELERATED HYPERFRACTIONATED IRRADIATION IN THE TREATMENT OF LOCAL ADVANCED NON-SMALL CELL LUNG CANCER

Objective To evaluate the effect of accelerated hyperfractionated irradiation (AHFJ) and conventional fractionated irradiation (CFI) for local advanced non- small cell lung cancer (NSCLC). Methods The patients of AI-IFJ group were irradiated to large-field target volume by a daily fraction of 2Gy, and small-field target volume by a daily fraction of 1Gy with more than 6h interval. The total dose of large-field target volume was SOGy/25Fx/SW and of small-field target volume was 7SGy/SOFx/5W. The patients in CFI group were irradiated by a daily fraction of 2Gy to the total dose of 66Gy/33Fx/6. 6W. After 3 months of radiotherapy, the tumor response rates of complete recovery (CR), partial recovery (PR), and no change (NC) and 1- and 2- year survival rate in the two groups were observed. Results The tumor response rates of CR,PR,NC in AHFI group and CFI group were 22.9%(8/35), 60.0%(21/35), 17.1%(6/35) and 11.4% (4/35), 51.4% (18/35), 37.2% (13/35) respectively (P>0. 05). All patients were followed up 2 years or more. The 1- and 2- year survival rates in AHFI group and CFI group were 62.9% (22/35), 31 .4% (11/35) and 42.9% (15/35) , 17.1% (6/35) respectively (P< 0.05). The incidences of esophagitis and pneumonitis in AHFI group and CFI group were 34.3% (12/35), 22. 9% (8/35) and 40.0% (14/35), 17.1% (6/35)(P>0. 05). Conclusion In comparison with CFI, AHFI may increase 1- and 2- year sur-vival rate after treatment of local advanced non-small cell lung cancer, while the radio-reactions, either early or late, did not increase significantly.

Is There Any Indication for Prophylactic Brain Irradiation in the Management of Small Cell Prostate Cancer?

Small cell prostate carcinoma (SCPC) is an extremely rare pathology with an aggressive behavior, characterized by early brain metastases. We describe three cases of SCPC where brain metastases occurred despite response to chemotherapy. The benefit of prophylactic brain irradiation (PBI), as part of the management of SCPC, is discussed and compared to its indications in small cell lung cancer.

A Retrospective Study of Clinicoepidemiological Aspects of Nasopharyngeal Cancer at NCI-Cairo (2000-2010)

Aim of Work: The aim of this work was to study the clinico-epidemiological characteristics of the patients with nasopharyngeal carcinoma (NPC), analyse the prognostic factors of the disease and to analyse the results of different treatment modalities and their effect on loco-regional, distal metastatic disease control and both overall survival (OS) and disease free survival (DFS) rates. Patients and Methods: This is a retrospective study reviewing all adult nasopharyngeal carcinoma (NPC) patients who presented to the radiotherapy department—National Cancer Institute Cairo University in the period from (2000-2010). Results: In this study, it was found that the mean age was 45 years;most of the patients were of locally advanced stages. Multivariate cox proportional hazards regression identified T-stage, radiotherapy course completion & addition of chemotherapy as independent prognostic factors for local control (LC), DFS, & OS. The 5-year LC, DFS and OS rates for all studied patients were 38.2%, 33.5% & 37.2% respectively. The median DFS was 26 months and median OS was 36.5 months. Conclusion: This study matches the published data that support that radical concurrent chemoradiation is the mainstay of treatment of locally advanced NPC, & that T-stage, M-stage, prescribed dose completion, response to initial treatment are independent prognostic factors for survival. All measures should be taken to improve the local response during primary treatment as this will improve survival rates of patients with NPC.

Advance of prophylactic cranial irradiation in lung cancer

Brain metastases in patients with lung cancer are a devastating problem with profound impact on survival. Prophylactic cranial irradiation has been discussed as an option to reduce the risk of brain metastases. This report provides an extensive review of the current evidence from non-randomized and randomized trials regarding the use of prophylactic cranial irradiation in lung cancer.

The Current Status of the Delineation and Determination of the Targets and the Radiation Protocols for Nasopharyngeal Cancer with Intensity-Modulated Radiotherapy

IMRT has increased the local-regional control and decreased the complications from treating nasopharyngeal cancer （NPC）. Therefore studying IMRT is important. CT and MRI are complementary, and their joint use is currently considered to be the optimal modality to delineate the extent of the primary spread of NPC. The key problem in delineation of the neck nodes is how to translate anatomic node regions into the CT boundaries. The consensus guideline which narrowed the gap among different cancer centers is recommended in delineating the boundary of the cervical lymph node regions. The definition of the NPC GTV is clear and almost the same among the main cancer centers in their IMRT planning protocols. The suggested biological dose to the GTV is close to or more than 80 Gy; the main differences are the definitions of the CTVs and their schemes for the prescribed dose, and also the dosage to the high cervical region is different among those centers. According to their long-term follow-up results, it is suggested that, besides adding 5-10 mm margins to the primary lesions, the immediate high-risk structures （including the entire nasopharyngeal cavity, retropharyngeal space, clivus, base of the skull, pterygoid plates and muscles, parapharyngeal space, the sphenoid and partial ethmoid sinuses, the posterior third of the maxillary sinuses and the nasal cavity） should also be included with a prescription of more than 60 Gy, and the bilateral Ib, II and Va node levels should be ranked as high-risk regions and differentially prescribed for treatment with no less than 60 Gy.

Prognosis and Survival of Nasopharyngeal Cancer in Cameroon

Background: Nasopharyngeal carcinoma (NPC) is an entity belonging to up-per aerodigestive tract Cancers. NPC is more widespread in Southern China and South East Asia. In our country, it is the leading cause of head and neck cancers. Its prognosis remains bleak because of the late stage at diagnostic. Objectives: The objectives of this study were to determine the prognostic fac-tors and survival rate of patients with nasopharyngeal cancer in six reference hospitals in Cameroon. Material and Methods: It was a retrospective analytic study, conducted from January 2009 to December 2018. It was conducted in oncology, surgery and Ear Nose and Throat (ENT) units of six reference hos-pitals. Data from 114 files meeting the inclusion were collected. We have drawn survival curves and determined the different survival probabilities with the help of Kaplan-Meier Method. The different survival curves were compared using the Log-Rank Test (P < 0.05), variables that were statistically associated with the 5% cut off were introduced into the Cox regression model for multivariate analysis, thus allowing us to bring out the prognostic factors significantly associated with survival. Results: The mean age at the time of diagnosis of the 114 patients recruited was 45.30 ± 17.14 years. The predominant histological type was the UCNT (Undifferentiated Carcinoma of the NasoPharynx) representing 84.2%. According to the WHO classification, 2 patients were classified as stage I (1.8%), 33 as stage II (28.9%), 42 as stage III (36.8%), 25 as stage IV A (21.9%) and 12 as stage IV B (10.5%). At the end of the survival assessment period, 34 patients were dead and 73 patients (64%) were still alive. The median overall survival was 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44%, respectively. The prognostic factors associated with poor survival were: late consultation time of more than 12 months, N3 lymph node involvement, 3 and 4 advanced clinical stages. Conclusion: The study showed a low survival, with a median overall survival of 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44% respectively. The prognostic factors associated with poor survival were late consultation time of more than 12 months, N3 lymph Node involvement, 3 and 4 advanced clinical stages. In order to improve this survival, it is recommended that special emphasis be placed on early detection.

Optimal timing of thoracic irradiation for limited stage small cell lung cancer:Current evidence and future prospects

Lung cancer is a global health concern as the leading cause of cancer related mortality worldwide.Small cell lung cancer(SCLC)poses a formidable challenge to the treating physicians with the worst prognosis among all lung cancers.However,limited stage SCLC(LS-SCLC)has a relatively better outcome with multimodality management.Efforts have been focused on optimal integration of treatment modalities to achieve an improved therapeutic ratio for patients with LS-SCLC.While chemotherapy and thoracic radiation therapy(TRT)are primary components of initial management for LS-SCLC,there is no consensus on optimal timing of TRT.Within this context,we herein provide a concise overview of current evidence and future prospects regarding the optimal timing of thoracic irradiation for LS-SCLC in light of the literature.

The effects of low-dose splenic irradiation and radiotherapy on immune system of patients with locally advanced non-small cell lung cancer

Objective： The aim of the research was to study the effects of low-dose splenic irradiation and radiotherapy on immune system of patients with locally advanced non-small cell lung cancer （NSCLC）. Methods： Twelve cases of stage III NSCLC in Tumor Radiotherapy Center of our hospital （the Affiliated Hospital of Medical College Qingdao University, China） were collected from July 2011 to July 2012; all patients were under 75 years old with clear pathology, measurable lesions and good personal statement. They were randomly divided into combined treatment group （D1 ＋ D2） and control group （D1）. The control group （D1） only received radiotherapy to the chest; combined treatment group （D1 ＋ D2） received low-dose splenic irradiation plus conventional dose irradiation. Flow cytometry was used to detect the peripheral blood T lymphocyte immune indexes of patients before, during and after the treatment, classification by five blood cell analyzer was used to determine white blood cells, neutrophils, hemoglobin and platelet count. The radiation induced toxicity including esophagitis, pneumonia and gastrointestinal reaction was observed, as well as the dose when it happened. Results： There was no significant difference in the ratio between two groups in cells CD4＋, CD8＋ and CD4＋/CD8＋ after radiotherapy （P 〉 0.05）. There was no change in these indicators in combined treatment group after treatment （P 〉 0.05）, but it decreased in control group （P 〈 0.05）. There was no significant difference in the incidences of radiation esophagitis, pneumonia, gastrointestinal reactions and bone marrow suppression between two groups （P 〉 0.05）, but the patients in combined treatment group seemed to tolerate high dose well （P 〈 0.05）. Conclusion： Low-dose splenic irradiation combined with radiotherapy to the chest can alleviate the injury degree of acute radiation induced the toxicity of locally advanced NSCLC patients, through affect the patient＇s immune function.

High incidence of nasopharyngeal cancer: similarity for 60% of mitochondrial DNA signatures between the Bidayuhs of Borneo and the Bai-yue of Southern China

Populations in Southern China (Bai-yue) and Borneo (Bidayuh) with high incidence of nasopharyngeal cancer (NPC) share similar mitochondrial DNA signatures, supporting the hypothesis that these two populations may share the same genetic predisposition for NPC, which may have first appeared in a common ancestral reference population before the sea levels rose after the last ice age.