Long-term outcomes of a phase Ⅱ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma

Background:Salvage treatment for locally recurrent nasopharyngeal carcinoma(NPC) is complicated and relatively limited.Radiotherapy,combined with effective concomitant chemotherapy,may improve clinical treatment outcomes.We conducted a phase Ⅱ randomized controlled trial to evaluate the efficacy of intensity-modulated radiotherapy with concomitant weekly cisplatin on locally recurrent NPC.Methods:Between April 2002 and January 2008,69 patients diagnosed with non-metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group(n = 34) or radiotherapy alone group(n = 35).All patients received intensity-modulated radiotherapy.The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days(range 23-53 days).The concomitant chemotherapy schedule was cisplatin 30 mg/m^2 by intravenous infusion weekly during radiotherapy.Results:The median follow-up period of all patients was 35 months(range 2-112 months).Between concomitant chemoradiotherapy and radiotherapy groups,there was only significant difference in the 3-year and 5-year overall survival(OS) rates(68.7%vs.42.2%,P = 0.016 and 41.8%vs.27.5%,P = 0.049,respectively).Subgroup analysis showed that concomitant chemoradiotherapy significantly improved the 5-year OS rate especially for patients in stage rT3-4(33.0%vs.13.2%,P = 0.009),stages Ⅲ-Ⅳ(34.3%vs.13.2%,P = 0.006),recurrence interval >30 months(49.0%vs.20.6%,P = 0.017),and tumor volume >26 cm^3(37.6%vs.0%,P = 0.006).Conclusion:Compared with radiotherapy alone,concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC,especially those with advanced T category(rT3-4) and stage(lll-IV) diseases,recurrence intervals >30 months,and tumor volume >26 cm^3.

Dosimetry Comparison between Volumetric Modulated Arc Therapy with RapidArc and Fixed Field Dynamic IMRT for Local-Regionally Advanced Nasopharyngeal Carcinoma

Objective: A dosimetric study was performed to evaluate the performance of volumetric modulated arc radiotherapy with RapidArc on locally advanced nasopharyngeal carcinoma (NPC). Methods: The CT scan data sets of 20 patients of locally advanced NPC were selected randomly. The plans were managed using volumetric modulated arc with RapidArc and fixed nine-field coplanar dynamic intensity-modulated radiotherapy (IMRT) for these patients. The dosimetry of the planning target volumes (PTV), the organs at risk (OARs) and the healthy tissue were evaluated. The dose prescription was set to 70 Gy to the primary tumor and 60 Gy to the clinical target volumes (CTV) in 33 fractions. Each fraction applied daily, five fractions per week. The monitor unit (MU) values and the delivery time were scored to evaluate the expected treatment efficiency. Results: Both techniques had reached clinical treatment’s requirement. The mean dose (Dmean), maximum dose (Dmax) and minimum dose (Dmin) in RapidArc and fixed field IMRT for PTV were 68.4±0.6 Gy, 74.8±0.9 Gy and 56.8±1.1 Gy; and 67.6±0.6 Gy, 73.8±0.4 Gy and 57.5±0.6 Gy (P<0.05), respectively. Homogeneity index was 78.85±1.29 in RapidArc and 80.34±0.54 (P<0.05) in IMRT. The conformity index (CI: 95%) was 0.78±0.01 for both techniques (P>0.05). Compared to IMRT, RapidArc allowed a reduction of Dmean to the brain stem, mandible and optic nerves of 14.1% (P<0.05), 5.6% (P<0.05) and 12.2% (P<0.05), respectively. For the healthy tissue and the whole absorbed dose, Dmean of RapidArc was reduced by 3.6% (P<0.05), and 3.7% (P<0.05), respectively. The Dmean to the parotids, the spinal cord and the lens had no statistical difference among them. The mean MU values of RapidArc and IMRT were 550 and 1,379. The mean treatment time of RapidArc and IMRT was 165 s and 447 s. Compared to IMRT, the delivery time and the MU values of RapidArc were reduced by 63% and 60%, respectively. Conclusion: For locally advanced NPC, both RapidArc and IMRT reached the clinic requirement. The target volume coverage was similar for the different techniques. The RapidArc technique showed some improvements in OARs and other tissue sparing while using reduced MUs and delivery time.

Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy

Although many studies have investigated intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC),sample sizes in the reported studies are usually small and different in outcomes in different T and N subgroups are seldom analyzed.Herein,we evaluated the outcomes of NPC patients treated with IMRT and further explored treatment strategy to improve such outcome.We collected clinical data of 865 NPC patients treated with IMRT alone or in combination with chemotherapy,and classified all cases into the following prognostic categories according to different TNM stages:early stage group (T1-2N0-1M0),advanced local disease group (T3-4N0-1M0),advanced nodal disease group (T1-2N2-3M0),and advanced locoregional disease group (T3-4N2-3M0).The 5-year overall survival (OS),local relapse-free survival (LRFS),and distant metastases-free survival (DMFS) were 83.0%,90.4%,and 84.0%,respectively.The early disease group had the lowest treatment failure rate,with a 5-year OS of 95.6%.The advanced local disease group and advanced nodal disease group had similar failure pattern and treatment outcomes as well as similar hazard ratios for death (4.230 and 4.625,respectively).The advanced locoregional disease group had the highest incidence of relapse and death,with a 5-year DMFS and OS of 62.3% and 62.2%,respectively,and a hazard ratio for death of 10.402.Comparing with IMRT alone,IMRT in combination with chemotherapy provided no significant benefit to locoregionally advanced NPC.Our results suggest that the decision of treatment strategy for NPC patients should consider combinations of T and N stages,and that IMRT alone for early stage NPC patients can produce satisfactory results.However,for advanced local,nodal,and locoregional disease groups,a combination of chemotherapy and radiotherapy is recommended.

Volumetric modulation arc radiotherapy with flattening filter-free beams compared with conventional beams for nasopharyngeal carcinoma:a feasibility study

There is increasing interest in the clinical use of flattening filter-free(FFF) beams.In this study,we aimed to investigate the dosimetric characteristics of volumetric modulated arc radiotherapy(VMAT) with FFF beams for nasopharyngeal carcinoma(NPC).Ten NPC patients were randomly selected to undergo a RapidArc plan with either FFF beams(RA-FFF) or conventional beams(RA-C).The doses to the planning target volumes(PTVs),organs at risk(OARs),and normal tissues were compared.The technical delivery parameters for RapidArc plans were also assessed to compare the characteristics of FFF and conventional beams.Both techniques delivered adequate doses to PTVs.For PTVs,RA-C delivered lower maximum and mean doses and improved conformity and homogeneity compared with RA-FFF.Both techniques provided similar maximum doses to the optic nerves and lenses.For the brain stem,spinal cord,larynx,parotid glands,oral cavity,and skin,RA-FFF showed significant dose increases compared to RA-C.The dose to normal tissue was lower in RA-FFF.The monitor units(MUs) were(536 ± 46) MU for RA-FFF and(501± 25) MU for RA-C.The treatment duration did not significantly differbetween plans.Although both treatment plans could meet clinical needs,RA-C is dosimetrically superior to RA-FFF for NPC radiotherapy.

Long-term Therapeutic Outcome and Prognostic Factors of Patients with Nasopharyngeal Carcinoma Receiving Intensity-modulated Radiotherapy: An Analysis of 608 Patients from Low-endemic Regions of China

Objective To evaluate the long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma(NPC)from low-endemic regions of China who received definitive intensity-modulated radiation therapy(IMRT).Methods The clinical data from 608 patients with newly-diagnosed non-metastatic NPC who have received initial treatment at our cancer center from January,2008 to December,2013 were retrospectively reviewed.All patients received definitive IMRT,and 87.7%received platinum-based chemotherapy.Results The median follow-up duration was 51 months(follow-up rate,98.5%;range,10–106 months)for the entire cohort.The 5-year overall survival rate was 79.7%.The 5-year local relapse-free survival rate,regional relapse-free survival rate,distant metastasis-free survival rate and progression-free survival rate were 92.4%,93.3%,79.2%and 74.3%,respectively.A total of 153 patients had experienced treatment failure,with distant metastasis as the primary cause in 77.1%(118/153).Patients with T4 or N3 diseases had a significantly poorer prognosis than other subcategories.Stage T4 and N3 were closely associated with distant metastasis,with the metastatic rate of 29.3%and 45.5%,respectively.Conclusion IMRT provides patients with non-metastatic NPC with satisfactory long-term survival.Both T stage and N stage are important prognostic factors for NPC patients.Patients with T4 or N3 diseases have significantly increased distant metastatic rates and poor survival time.

Local definitive intensity-modulated radiation therapy recommended for patients initially diagnosed with nasopharyngeal carcinoma with distant metastasis after an effective systemic chemotherapy

Objective The aim of the study was to propose a hypothesis that local definitive intensity-modulated radiation therapy(IMRT) should be recommended for initially diagnosed metastatic nasopharyngeal carcinoma(NPC) and demonstrate its feasibility.Methods Recently published papers on local definitive radiotherapy for initially diagnosed metastatic NPC were reviewed to propose a hypothesis.Results Several studies revealed the survival benefits of adding local definitive radiotherapy to the systemic chemotherapy in patients initially diagnosed with metastatic NPC.Conclusion We suggested that local definitive IMRT should be recommended in patients initially diagnosed with NPC with distant metastasis after an effective systemic chemotherapy, which may possibly prolong their survival time and potentially treat the disease.

A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience

Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.

T cells expressing a LMP1-specific chimeric antigen receptor mediate antitumor effects against LMP1-positive nasopharyngeal carcinoma cells in vitro and in vivo

T cells modified with chimeric antigen receptor are an attractive strategy to treat Epstein-Barr virus（EBV） associated malignancies.The EBV latent membrane protein 1（LMP1） is a 66-KD integral membrane protein encoded by EBV that consists of transmembrane-spanning loops.Previously,we have identified a functional signal chain variable fragment（scFv） that specifically recognizes LMP1 through phage library screening.Here,we constructed a LMP1 specific chimeric antigen receptor containing anti-LMP1 scFv,the CD28 signalling domain,and the CD3ζchain（HELA/CAR）.We tested its functional ability to target LMP1 positive nasopharyngeal carcinoma cells.HELA/CAR cells were efficiently generated using lentivirus vector encoding the LMP1-specific chimeric antigen receptor to infect activated human CD3＋ T cells.The HELA/CAR T cells displayed LMP1 specific cytolytic action and produced IFN-γ and IL-2 in response to nasopharyngeal carcinoma cells overexpressing LMP1.To demonstrate in vivo anti-tumor activity,we tested the HELA/CAR T cells in a xenograft model using an LMP1 overexpressing tumor.Intratumoral injection of anti-LMP1 HELA/CAR-T cells significantly reduced tumor growth in vivo.These results show that targeting LMP1 using HELA/CAR cells could represent an alternative therapeutic approach for patients with EBV-positive cancers.

Treatment results and prognostic analysis of 1093 primary nasopharyngeal carcinoma: the experience of a single institution of Guangzhou in the beginning of the 21st century

Objective： To analyze the treatment results of primary nasopharyngeal carcinoma （NPC） treated in our institution in the beginning of the 21st century to identify key failures and late effects for refining future treatments. Methods： 1093 patients with primary NPC treated during December 2001 and June 2003 were retrospectively analyzed. The distribution according to the AJCC/UICC （2002 edition） staging system was stage Ⅰ in 5.8%, stage Ⅱ 40.2%, stage Ⅲ 32.7% and stage Ⅳa-b 21.3%. Four different ERT techniques were used： fluoroscopy simulation conventional radiotherapy （CR） in 74.3% of patients, computer tomography simulation conventional radiotherapy （CT-sim CR） 14.2%, three-dimensional conformal radiotherapy （3D-CRT） 6.3%, intensity modulated radiotherapy （IMRT） 5.2%. In the whole series, 46.7% of patients had additional treatment with chemotherapy. Results： The 4-year local failure-free rate （LFFR）, nodal failure-free rate, distant metastasis-free rate, progression-free survival and overall survival （OS） was 89.6%, 96.1%, 85.9%, 73.0% and 82.4%, respectively. The stage was the most important prognostic factor. The 4-year OS and LFFR of patients treated by CR, CT-sim CR, 3D-CRT and IMRT was 80.2%, 89.8%, 89.8%, 92.4% and 87.7%, 96.4%, 91.0%, 96.5%, respectively. The morbidity and degree of xerostomia and trismus were lower in the patients treated by 3D-CRT and IMRT than by CR and CT-sim CR. Conclusion： Treatment results of primary NPC in our institution have been substantially improved. Distant metastasis is the main failure. The CT simulation and conformal radiotherapy can enhance the OS and LFFR, and conformal radiotherapy can reduce the morbidity and degree of late effects.

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.

COMPARISON OF AMINOLEVULINIC ACID AND ITS METHYL ESTER MEDIATED PHOTOCYTOTOXICITY ON HUMAN NASOPHARYNGEAL CARCINOMA CELLS

Nasopharyngeal carcinoma(NPC)is a prevalent cancer in some areas of southern Asia.To explore the potential of photodynamic therapy(PDT)for the treatment of NPC,a small molecule prodrug 5-aminolevulinic acid(ALA)and its methyl ester(MAL)mediated PDT was studied in vitro.The results showed that human NPC cells were sensitive to both ALA-and MAL-mediated PDT.However,ALA was more effective than MAL,possiblly due to a higher efficiency of ALA on producing endogenous protoporphyrin(PpIX)in NPC cells.Neither ALA nor MAL caused any significant genotoxicity.The ALA-based PDT might be a useful modality in the treatment ofNPC.

Study on the effect of PET/CT-guided nasopharyngeal carcinoma target delineation on the dose received by endangered organs

Objective:To compare the differences of radiation-induced doses between 18F-FDG-PET/CT and CT/MRI-guided target delineation in nasopharyngeal carcinoma in intensity-modulated radiotherapy.Methods:A total of 31 patients with locally advanced nasopharyngeal carcinoma receiving treatment in our hospital from December 2016 to December 2017 were studied in this research,and 18F-FDG-PET/CT and CT/MRI were used to guide the target delineation to develop an intensity-modulated radiotherapy plan(experimental group and control group).The dose differences between GTV and endangered organs in the two groups were compared.Results:Comparison of primary tumor volume:PET/CT was smaller than CT/MRI,and volumes of T3 and T4 were significantly different(P<0.001).Comparison of the two delineation plans,in terms of PGTV in Dmin,Dmean,and D95,the data of experimental group was smaller than that of the control group;in Dmax,the PGTV of the experimental group was larger than that of the control group with P<0.001 considered as a significant difference.In Dmin and Dmax,doses of experimental groups of the spinal cord were lower than those of the control group,showing a significant difference(P=0.022,0.042);In Dmean,there was no difference between the two groups.In Dmax doses of an experimental group of the brainstem and parotid gland were significantly smaller than the control group(P=0.001,0.047)while there was no difference between Dmin and Dmean.There was no difference between the two groups of Dmin,Dmean,and Dmax in the doses received by chiasm and temporal lobe.Conclusion:PET/CT guided target delineation is applied in the simultaneous dose adjustment of intensity-modulated radiation therapy in patients with advanced nasopharyngeal carcinoma.In primary lesion targets shown by MRI/CT,the tumor tissue of PET/CT concentration zone was given a higher dose with relatively smaller average dose and minimum dose in the overall tumor target area.Statistics also showed that the doses received by the spinal cord,brain stem,and parotid gland were reduced with no effect on the optic chiasm and temporal lobe.In the future,more studies should probe into the long-term effects of dose changes on lesion control and endangered organs.

The role of capecitabine as maintenance therapy in de novo metastatic nasopharyngeal carcinoma:A propensity score matching study

Background:Capecitabine was previously used as a second-line or salvage therapy for metastatic nasopharyngeal carcinoma(NPC)and has shown satisfactory curative effect as maintenance therapy in other metastatic cancers.This study aimed to explore the role of capecitabine as maintenance therapy in de novo metastatic NPC patients with different plasma Epstein-Barr virus(EBV)DNA levels before treatment.Methods:We selected de novo metastatic NPC patients treated with locoregional radiotherapy(LRRT)for this retrospective study.The propensity score matching(PSM)was applied to balance potential confounders between patients who underwent capecitabine maintenance therapy and those who did not with a ratio of 1:3.Overall survival(OS)was the primary endpoint.The association between capecitabine maintenance therapy and survival was assessed using the log-rank test and a Cox proportional hazard model.Results:Among all patients eligible for this study,64 received capecitabine maintenance therapy after LRRT.After PSM,192 patients were identified in the nonmaintenance group.In the matched cohort,patients treated with capecitabine achieved a higher 3-year OS rate compared with patients in the non-maintenance group(68.5%vs.61.8%,P=0.037).Multivariate analysis demonstrated that capecitabine maintenance therapy was an independent prognostic factor.In subgroup analysis,3-year OS rate was comparable between the maintenance and non-maintenance groups in patients with high pretreatment EBV DNA levels(˃30,000 copies/mL)(54.8%vs.45.8%,P=0.835),whereas patients with low pretreatment EBV DNA levels(≤30,000 copies/mL)could benefit from capecitabine maintenance therapy in OS(90.0%vs.68.1%,P=0.003).Conclusion:Capecitabine maintenance therapy may be superior to non-maintenance therapy in prolonging OS for de novo metastatic NPC patients with pretreatment EBV DNA≤30,000 copies/mL.groups in patients with high pretreatment EBV DNA levels(˃30,000 copies/mL)(54.8%vs.45.8%,P=0.835),whereas patients with low pretreatment EBV DNA levels(≤30,000 copies/mL)could benefit from capecitabine maintenance therapy in OS(90.0%vs.68.1%,P=0.003).Conclusion:Capecitabine maintenance therapy may be superior to non-maintenance therapy in prolonging OS for de novo metastatic NPC patients with pretreatment EBV DNA≤30,000 copies/mL.

Comparison of Volumetric and Dosimetric Variations in Nasopharyngeal Carcinoma during Intensity-modulated Radiation Therapy with and without Neoadjuvant Chemotherapy

Objective Patients with nasopharyngeal carcinoma(NPC)undergoing intensity-modulated radiation therapy(IMRT)may experience significant volumetric and dosimetric variations throughout the treatment course.However,neoadjuvant chemotherapy may reduce the extent of these variations.This study was carried out to evaluate volumetric and dosimetric changes in target volumes and organs at risk(OARs)during IMRT in patients with locally advanced NPC who received concurrent chemoradiotherapy(CCRT)alone or in combination with neoadjuvant chemotherapy(NACT).Methods 35 NPC patients were recruited for this study and divided into the NACT(n=15)and CCRT(n=20)groups.Computed tomography(CT)scans were performed before neoadjuvant chemotherapy,before IMRT,before the 24 th fraction of IMRT,and after treatment.The original plan(plan 0)was based on CT images collected before IMRT.Hybrid plan 1(plan 1)and hybrid plan 2(plan 2)were generated by applying the beam configurations of plan0 to the CT scans collected before the 24 th fraction of IMRT and after treatment.Volumetric and dosimetric variations were assessed by comparing the results of plan 0 with those of plan 1 and plan 2.Results In the NACT group,compared with that in plan 0,the primary gross tumor volume(GTVnx)decreased by 33.2%±18.4%and 50.5%±12.6%in plan1 and plan 2,respectively.In the CCRT group,the corresponding reduction rates in plan 1 and plan 2 were 49.4%±8.0%and 77.8%±28.1%,respectively.The volume decrease rates in the NACT group were less than those in the CCRT group(P<0.001).In the NACT group,compared with that of plan0,the dose to 95%of the volume(D95)for the planning target volume of the primary tumor(PTVnx)decreased by 1.0%±0.7%and 0.6%±0.6%in plan 1 and plan 2,respectively.In the CCRT group,the corresponding decrease rates in plan 1 and plan 2 were 4.2%±3.8%and 6.1%±6.3%,respectively.The decrease rate of D95 for PTVnx in the NACT group was less than that in the CCRT group(P<0.001).Similar results among the plans were found in terms of D99,Dmean,V93 for PTVnxand PTVnd,and Dmeanfor the parotid glands.Conclusion Neoadjuvant chemotherapy reduces the extent of volumetric and dosimetric variations in target volumes and OARs during IMRT and,thus,helps achieve better target volume coverage,protects adjacent important structures,and minimizes unnecessary replanning during radiotherapy.

Advances of radiotherapy combined with targeted therapy for nasopharyngeal carcinoma

Nasopharyngeal carcinoma is insidious at onset,prone to lymph node metastasis,and has a high rate of locally advanced disease at initial diagnosis.Radiotherapy combined with chemotherapy is the main treatment for locally advanced nasopharyngeal carcinoma,but local recurrence and distant metastasis often lead to treatment failure,of which radioresistance caused by radiotherapy may be one of the reasons.Targeted therapy can selectively inhibit tumor proliferation and metastasis,and patients can achieve long-term survival benefits with low toxic and side effects.Targeted therapy involves a variety of tumor mechanisms,in which combination with radiotherapy may improve radioresistance and the efficacy of radiotherapy.In this review,the advantages and research progress of targeted therapy combined with radiotherapy for nasopharyngeal carcinoma were discussed.

Photodynamic therapy-mediated modulation of inflammatory cytokine production by Epstein–Barr virus-infected nasopharyngeal carcinoma cells

Nasopharyngeal carcinoma(NPC)is a malignant disease associated with Epstein–Barr virus(EBV)infection.This study aims to examine the effects of EBV infection on the production of proinflammatory cytokines in NPC cells after the Zn-BC-AM photodynamic therapy(PDT)treatment.Cells were treated with the photosensitiser Zn-BC-AM for 24 h before light irradiation.Quantitative ELISA was used to evaluate the production of cytokines.Under the same experimental condition,HK-1-EBV cells produced a higher basal level of IL-1a(1561 pg/ml),IL-1b(16.6 pg/ml)and IL-8(422.9 pg/ml)than the HK-1 cells.At the light dose of 0.25–0.5 J/cm2,Zn-BC-AM PDT-treated HK-1-EBV cells were found to produce a higher level of IL-1a and IL-1b than the HK-1 cells.The production of IL-1b appeared to be mediated via the IL-1b-converting enzyme(ICE)-independent pathway.In contrast,the production of angiogenic IL-8 was downregulated in both HK-1 and HK-1-EBV cells after Zn-BC-AM PDT.Our results suggest that Zn-BC-AM PDT might indirectly reduce tumour growth through the modulation of cytokine production.

Intensity modulated radiation therapy in elderly patients with nasopharyngeal carcinoma

Purpose To evaluate the outcomes in elderly patients with nasopharyngeal carcinoma(NPC)treated by intensity modulated radiation therapy(IMRT).Methods Patients with NPC aged≥70 years old who received intensity-modulated radiation therapy≥60 Gy were recruited into this study.The overall survival(OS),progression-free survival(PFS),cancer-specific survival(CSS),locoregional recurrence-free rate(LRFR)and distant metastasis-free rate(DMFR)were calculated using the Kaplan–Meier method.The Cox proportional hazards model was applied to perform multivariate analysis for independent prognosticators using meaningful variables from the univariate analysis.Results One hundred ninety seven patients with NPC≥70 years were recruited from the 4351 newly diagnosed NPC patients from January 2011 to December 2020.The 5-year OS,CSS,PFS,LRFR and DMFR were 59.6%,78.9%,51.3%,91.6%and 78.9%,respectively.the plasma EBV DNA was the only prognostic factor for OS,the overall staging was the only prognostic factor for CSS,and plasma EBV DNA and N category were borderline significant factor for DMFR.We did not find any prognosticator for PFS and LRFR.Conclusions The survival after IMRT for elderly patients with NPC is suboptimal.Further study stratified by comorbidity and geriatric assessment is needed.

桂滇黔地区局部晚期鼻咽癌同期放化疗联合尼妥珠单抗靶向治疗前瞻性临床研究

目的探究同期放化疗联合尼妥珠单抗靶向治疗桂滇黔交界地区局部晚期鼻咽癌患者的临床效果。方法选取2021年7月~2022年7月于右江民族医学院附属医院收治来自桂滇黔交界少数民族地区,经病理确诊的局部晚期鼻咽癌患者80例为本次研究对象,将其随机分为对照组(标准同期放化疗)和观察组(在对照组基础上联合尼妥珠单抗治疗),每组各40例。对比两组患者的肿瘤标志物水平、氧化应激指标、不良反应、并发症及近期临床疗效的变化情况。结果治疗后,两组患者的超氧化物歧化酶(superoxide dismutase,SOD)、细胞角蛋白19片段(cytokeratin 19 fragment antigen21-1,CYFRA21-1)、鳞状细胞癌相关抗原(squamous cell carcinoma associated antigen,SCCAg)、铁蛋白(serum ferritin,SF)水平明显降低,一氧化氮(NO)、丙二醛(MDA)明显升高;且观察组的SCCAg、SF、CYFRA21-1、NO、MDA水平较对照组低,SOD水平较对照组高(P<0.05)。与对照组比,观察组的客观缓解率明显上升(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。两组的并发症发生率比较,差异无统计学意义(P>0.05)。结论使用同期放化疗联合尼妥珠单抗治疗可有效改善桂滇黔交界少数民族地区局部晚期鼻咽癌患者近期生存率及临床疗效,调节肿瘤标志物及氧化应激水平,缓解病情。

血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血的血管内治疗方式、疗效及安全性。方法 回顾性分析福建医科大学附属协和医院收治的21例鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血患者的临床资料,其中8例行覆膜支架植入,6例行支架辅助弹簧圈栓塞,7例直接行载瘤动脉闭塞治疗。分析手术策略、治疗结果以及临床与影像学随访结果。结果 21例患者均成功接受血管内治疗。术后即刻止血效果均良好,瘤颈残留2例,瘤体残留1例。术后出血复发5例,其中4例再次行载瘤动脉闭塞后出血停止,1例为覆膜支架植入后发生内漏,予球囊扩张后血止,但1个月后不明原因死亡;1例覆膜支架植入术后出现昏迷,CT示蛛网膜下腔出血、脑肿胀,治疗后未好转自动出院;3例在随访中发现颈内动脉闭塞;2例术后未随访。随访的19例患者中mRS评分0分9例,1分6例,2分2例,5分1例,6分1例。结论 针对鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血,血管内治疗效果确切,安全性较高。覆膜支架短期疗效好,但也存在着动脉瘤复发、内漏等问题,载瘤动脉闭塞可能远期疗效更可靠。

八珍汤加减辅助对鼻咽癌鼻内镜下鼻咽扩大切除术后放疗患者临床疗效及免疫指标的影响

目的观察八珍汤加减辅助对鼻咽癌(NPC)鼻内镜下鼻咽扩大切除术后放疗患者临床疗效及免疫指标的影响。方法选取2022年5月至2024年1月行鼻内镜下鼻咽扩大切除术的NPC患者94例作为研究对象,随机数字表法分为对照组和观察组,每组47例。所有患者行术后放疗,对照组给予放疗后常规营养干预和不良反应处理,观察组在对照组的基础上加服八珍汤加减。比较2组临床疗效、唾液分泌功能、疼痛程度、免疫功能及生活质量,并观察不良反应。结果观察组客观缓解率82.89%(39/47)较对照组63.83%(30/47)高(P<0.05)。治疗后,观察组唾液腺分泌指数、鼻咽癌生存质量量表评分、CD3+和CD4+/CD8+水平较对照组高(P<0.05),观察组疼痛视觉模拟评分量表评分、CD8+水平较对照组低(P<0.05)。观察组血小板/白细胞减少、口腔黏膜炎发生率较对照组低(P<0.05)。结论八珍汤加减能改善NPC鼻内镜下鼻咽扩大切除术后放疗患者的放疗效果,缓解疼痛,提高唾液分泌功能,还能够调节免疫功能,减轻不良反应,起到增效减毒的作用。