Background:Postradiation nasopharyngeal necrosis(PRNN)is a severe complication after radiotherapy in patients with nasopharyngeal carcinoma(NPC),which can severely affect the quality of life and threaten the patient’...Background:Postradiation nasopharyngeal necrosis(PRNN)is a severe complication after radiotherapy in patients with nasopharyngeal carcinoma(NPC),which can severely affect the quality of life and threaten the patient’s life.Only 13.4%-28.6%of patients can be cured by traditional repeated endoscopic debridement.Here,we introduced an innovative curative-intent endoscopic surgery for PRNN patients and evaluated its clinical efficacy.Methods:Clinical data of 72 PRNN patients who underwent radical endoscopic necrectomy,followed by reconstruc-tion using a posterior pedicle nasal septum and floor mucoperiosteum flap were analyzed to determine the efficacy of this surgery.The endpoints were complete re-epithelialization of the nasopharyngeal defect,relief of headache,and overall survival(OS).Results:All surgeries were successfully performed without any severe postoperative complications or death.The median value of numeric rating scales of pain decreased from 8 before surgery to 0 after surgery(P<0.001).Fifty-one patients(70.8%)achieved complete re-epithelialization of the nasopharyngeal defect.The number of cycles of radiotherapy(odds ratio[OR],7.254;95%confidence interval[CI]1.035-50.821;P=0.046),postoperative pathological result(OR,34.087;95%CI 3.168-366.746;P=0.004),and survival status of flap(OR,261.179;95%CI 17.176-3971.599;P<0.001)were independent risk factors of re-epithelialization of the nasopharyngeal defects.Postoperative patho-logical result(hazard ratio[HR],5.018;95%CI 1.970-12.782;P=0.001)was an independent prognostic factor for OS.The 2-year OS rate of the entire cohort was 77.9%.Conclusion:Curative-intent endoscopic necrectomy followed by construction using the posterior pedicle nasal septum and floor mucoperiosteum flap is a novel,safe,and effective treatment of PRNN in patients with NPC.展开更多
Standard treatment for cervical cancer has been radiation and chemotherapy. Ionizing radiation has been associated with damage to normal tissues included in the radiation field. Post-radiation uterine cancers are char...Standard treatment for cervical cancer has been radiation and chemotherapy. Ionizing radiation has been associated with damage to normal tissues included in the radiation field. Post-radiation uterine cancers are characterized by high stage, high grade, and a preponderance of type II histologic subtypes. We report a case of type I endometrioid adenocarcinoma diagnosed 19 years after definitive chemoradiation for cervical cancer.展开更多
基金supported by the National Natural Science Foundation of China(Nos.81572912,81772895,and 81572848)Guangdong Public Welfare Research and Capacity Building Projects(2014B020212005)+5 种基金the Program of Sun Yat-Sen University for Clinical Research 5010 Program(No.201310 and No.2015011)the Major Project of Sun Yat-Sen University for the New Cross Subjectthe Special Support Program for High-level Talents in Sun Yat-Sen University Cancer Center(2015076316)the National Key Research and Development Program of China(2016YFC0905000)Guangdong Province Science and Technology Development Special Funds(Frontier and Key Technology Innovation Direction-Major Science and Technology Project,703040078088)Guangzhou Science and Technology Planning Project-Production and Research Collaborative Innovation Major Project(201604020182).
文摘Background:Postradiation nasopharyngeal necrosis(PRNN)is a severe complication after radiotherapy in patients with nasopharyngeal carcinoma(NPC),which can severely affect the quality of life and threaten the patient’s life.Only 13.4%-28.6%of patients can be cured by traditional repeated endoscopic debridement.Here,we introduced an innovative curative-intent endoscopic surgery for PRNN patients and evaluated its clinical efficacy.Methods:Clinical data of 72 PRNN patients who underwent radical endoscopic necrectomy,followed by reconstruc-tion using a posterior pedicle nasal septum and floor mucoperiosteum flap were analyzed to determine the efficacy of this surgery.The endpoints were complete re-epithelialization of the nasopharyngeal defect,relief of headache,and overall survival(OS).Results:All surgeries were successfully performed without any severe postoperative complications or death.The median value of numeric rating scales of pain decreased from 8 before surgery to 0 after surgery(P<0.001).Fifty-one patients(70.8%)achieved complete re-epithelialization of the nasopharyngeal defect.The number of cycles of radiotherapy(odds ratio[OR],7.254;95%confidence interval[CI]1.035-50.821;P=0.046),postoperative pathological result(OR,34.087;95%CI 3.168-366.746;P=0.004),and survival status of flap(OR,261.179;95%CI 17.176-3971.599;P<0.001)were independent risk factors of re-epithelialization of the nasopharyngeal defects.Postoperative patho-logical result(hazard ratio[HR],5.018;95%CI 1.970-12.782;P=0.001)was an independent prognostic factor for OS.The 2-year OS rate of the entire cohort was 77.9%.Conclusion:Curative-intent endoscopic necrectomy followed by construction using the posterior pedicle nasal septum and floor mucoperiosteum flap is a novel,safe,and effective treatment of PRNN in patients with NPC.
文摘Standard treatment for cervical cancer has been radiation and chemotherapy. Ionizing radiation has been associated with damage to normal tissues included in the radiation field. Post-radiation uterine cancers are characterized by high stage, high grade, and a preponderance of type II histologic subtypes. We report a case of type I endometrioid adenocarcinoma diagnosed 19 years after definitive chemoradiation for cervical cancer.
