-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: To evaluate the safety and efficacy of cetuximab plus intensity-modulated radiotherapy (IMRT) with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS: From June 2007 to December 2010, 33 patients with stage II (12 %), III (33 %), IVA (33 %), and IVB (21 %) NPC were treated at our hospital. Cetuximab was administered at an initial dose of 400 mg/m(2) followed by weekly doses of 250 mg/m(2). All patients completed IMRT, and a total dose of 66-70.4, 66, 60, and 54 Gy were given to the gross tumor volume, positive neck nodes, high-risk clinical target volume, and low-risk clinical target volume, respectively. Most patients (90.9 %) received platinum-based neoadjuvant, concurrent, or adjuvant chemotherapy. The efficacy and safety were evaluated retrospectively. RESULTS: With a median follow-up of 40.0 months, the 3-year progression-free survival (PFS), distant metastasis-free survival, and overall survival were 70.5 % (95 % CI 54.0-87.0 %), 83.6 % (95 % CI 70.3-96.9 %), and 90.9 % (95 % CI 81.1-100.0 %), respectively. Majority (75.8 %) of patients received ≥7 cycles of cetuximab (median 7 cycles, range 2-14 cycles). Patients who received ≥7 cycles of cetuximab showed a better 3-year PFS than those receiving <7 cycles (79.1 vs. 31.2 %, p = 0.050). During cetuximab + IMRT, stomatitis was the most common acute treatment toxicity, 23 (69.7 %) and 5 (15.2 %) patients with grade 3 and grade 4 stomatitis, respectively. Temporal lobe necrosis was observed in 7 patients. CONCLUSIONS: Cetuximab plus IMRT with or without chemotherapy for locoregionally advanced NPC is effective and tolerated. Further investigations are warranted.
Journal of Cancer Research and Clinical Oncology 03/2013; · 2.56 Impact Factor
-
Dan Ou,
Yunyan Zhang,
Xiayun He,
Yajia Gu, Chaosu Hu,
Hongmei Ying,
Guopei Zhu,
Yongru Wu,
Jian Mao,
Lei Yue,
Xigang Shen
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: We investigated the value of magnetic resonance sialography for evaluating xerostomia induced by intensity-modulated radiotherapy for nasopharyngeal carcinoma. METHODS: Fourteen patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. Salivary function was assessed by magnetic resonance sialography and subjective evaluation criteria pre-treatment, 1 week and 1 year post-radiotherapy. A magnetic resonance sialography categorical scoring system was used to compare the visibility of salivary ducts. RESULTS: The average mean dose was 38.93 Gy to the parotid glands and 59.34 Gy to the submandibular glands. Before radiotherapy, the visibility scores of both the parotid and submandibular ducts increased after secretion stimulation. The scores decreased and the response to stimulation was attenuated 1 week post-radiotherapy. For most of the parotid ducts, the visibility score improved at 1 year post-radiotherapy both at rest and under stimulation, but not for the submandibular ducts. With a median follow-up of 12.3 months, 8/12 patients had grade 1 xerostomia and 4/12 had grade 2 xerostomia. CONCLUSIONS: Magnetic resonance sialography allows non-invasive evaluation of radiation-induced ductal changes in the major salivary glands and enables reliable prediction of radiation-induced xerostomia.
International Journal of Clinical Oncology 08/2012; · 1.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: To analyze the patterns of neck and retropharyngeal lymph nodes (RPLNs) metastases with magnetic resonance imaging (MRI) in patients with sinonasal squamous cell carcinoma (SCC), and to explore the patterns of treatment failure treated with intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT). We also attempt to discuss the role of elective neck irradiation (ENI) in the treatment of cervical negative patients. MATERIALS AND METHODS: Between July 2004 and February 2011, 59 patients with histopathologically proven sinonasal SCC were treated with curative intent at our hospital. Among them, 18 (30.5%) patients had neck or RPLN lymph node involvement at diagnosis. RPLN, level Ib, and level IIa were the most common sites of initial nodal involvement. All patients received IMRT or 3D-CRT, while 19 patients further received surgical resection, and other 40 patients received cisplatin based chemotherapy. Median follow-up durations were 28months (range, 6-81months) for the entire patient population and 40months (range, 7-81months) among the surviving patients, respectively. RESULTS: The estimated 3-year local-regional control rate, distant-metastasis free survival rate, disease-free survival rate, and overall survival rate were 63.3%, 81.9%, 60.1%, and 68.9%, respectively. On multivariate analysis, old age (>60years) significantly influenced the overall survival rate(HR=9.428, p=0.000). As for the pattern of treatment failures developed in 26 patients in the follow-up time, local failure, neck recurrence, and distant metastases were seen in 18, 7, and 9 patients, respectively. Level Ib and level IIa were the most common sites of cervical nodal recurrence. None of the 11 patients who received ENI developed failure in the neck. CONCLUSION: For sinonasal SCC patients treated with IMRT or 3D-CRT, our results were generally consistent with findings of other studies, local failure still remain the predominant pattern of treatment failure. However, RPLN metastasis occurred more frequently than previously recognized through detection by MRI in our study. ENI seems to have effectively prevented regional relapse. We recommend ipsilateral level Ib and level IIa neck irradiation for T3-4 sinonasal SCC patients.
Oral Oncology 08/2012; · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the outcome of nasopharyngeal carcinoma (NPC) with retropharyngeal lymph nodes (RLNs) metastasis only and evaluate the feasibility of elective neck irradiation.
This is a retrospective study of 119 newly diagnosed non-metastatic NPC patients with RLNs metastasis only. All of them received definitive radiotherapy. Eighty nine patients received elective neck irradiation to levels II, III, VA and the rest received whole neck irradiation, including levels II-V.
The median follow-up was 36.6months. The 5-year local recurrence-free survival (LFS), nodal recurrence-free survival (NFS), distant metastasis-free survival (DMFS) and overall survival (OS) was 81.4%, 92.7%, 91.8%, and 93.6%, respectively. Four patients developed nodal relapse and only one was out-of-field relapse. No significant difference of nodal recurrence was observed between elective neck irradiation and whole neck irradiation. IMRT or three-dimensional conformal radiotherapy (3D-CRT) showed a trend of improving regional control, compared with conventional two-dimensional radiotherapy (2D-RT) (p=0.074). In 2D-RT, a higher dose (>5600cGy) to the upper neck showed a benefit of regional control(p=0.006). Multivariate analysis demonstrated that only the dose of upper neck was an independent prognostic factor of NFS.
Elective irradiation to levels II, III, VA was not inferior to whole neck irradiation for NPC patients with RLNs metastasis only. However, more evidences are needed to confirm the result. IMRT showed a trend of improving regional control. A higher dose of prophylactic radiation may be required for upper neck region in patients with RLNs metastasis.
Oral Oncology 05/2012; 48(10):1045-50. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Our aim was to evaluate the efficacy and toxicity of cisplatin, fluorouracil, and docetaxel chemotherapy plus intensity-modulated radiotherapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS: Sixty patients with locoregionally advanced NPC were enrolled. Patients received IMRT plus three courses of neoadjuvant chemotherapy and two courses of adjuvant chemotherapy consisting of docetaxel (60 mg/m(2)/day on day 1), cisplatin (25 mg/m(2)/day on days 1-3), and 5-fluorouracil (500 mg/m(2)/day on days 1-3). RESULTS: The overall response rate to neoadjuvant chemotherapy was 89 %. Three months after the completion of radiotherapy, 53 (93 %) patients achieved complete regression, 3 (5 %) achieved partial response (PR), and 1 experienced liver metastasis. However, among the 3 PR patients, 2 patients had no evidence of relapse in the follow-up. With a median follow-up of 27 months (range, 6-43), the 2-year estimated locoregional failure-free survival, distant failure-free survival, progression-free survival, and overall survival were 96.6, 93.3, 89.9, and 98.3 %, respectively. Leukopenia was the main adverse effect in chemotherapy; 14 patients experienced grade 3 or grade 4 neutropenia, and 1 patient developed febrile neutropenia. The nonhematological adverse events included alopecia, nausea, vomiting, anorexia, and diarrhea. The incidence of grade 3 acute radiotherapy-related mucositis was 28.3 %; no grade 4 acute mucositis was observed. No grade 3 or grade 4 hematological toxicity occurred during radiotherapy. None of the patients had interrupted radiotherapy. The common late adverse effects included xerostomia and hearing impairment. CONCLUSIONS: Neoadjuvant-adjuvant chemotherapy using cisplatin, fluorouracil, plus docetaxel combined with IMRT was an effective and well-tolerated alternative for advanced NPC.
International Journal of Clinical Oncology 04/2012; · 1.41 Impact Factor
-
Zhiqiang Meng,
M Kay Garcia, Chaosu Hu,
Joseph Chiang,
Mark Chambers,
David I Rosenthal,
Huiting Peng,
Caijun Wu,
Qi Zhao,
Genming Zhao,
Luming Liu,
Amy Spelman,
J Lynn Palmer,
Qi Wei,
Lorenzo Cohen
[show abstract]
[hide abstract]
ABSTRACT: Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients. Quality of life (QOL) is impaired, and available treatments are of little benefit. This trial determined the feasibility of conducting a sham-controlled trial of acupuncture and whether acupuncture could prevent xerostomia among head/neck patients undergoing radiotherapy.
A sham controlled, feasibility trial was conducted at Fudan University Shanghai Cancer Center, Shanghai, China among patients with nasopharyngeal carcinoma undergoing radiotherapy. To determine feasibility of a sham procedure, 23 patients were randomised to real acupuncture (N=11) or to sham acupuncture (N=12). Patients were treated three times/week during the course of radiotherapy. Subjective measures were the Xerostomia Questionnaire (XQ) and MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN). Objective measures were unstimulated whole salivary flow rates (UWSFR) and stimulated salivary flow rates (SSFR). Patients were followed for 1 month after radiotherapy.
XQ scores for acupuncture were significantly lower than sham controls starting in week 3 and lasted through the 1-month follow-up (all P's <0.001 except for week 3, which was 0.006), with clinically significant differences as follows: week 6 - RR 0.28 [95% confidence interval, 0.10, 0.79]; week 11 - RR 0.17 [95%CI, 0.03, 1.07]. Similar findings were seen for MDASI-HN scores and MDASI-Intrusion scores. Group differences for UWSFR and SSFR were not found.
In this small pilot study, true acupuncture given concurrently with radiotherapy significantly reduced xerostomia symptoms and improved QOL when compared with sham acupuncture. Large-scale, multi-centre, randomised and placebo-controlled trials are now needed.
European journal of cancer (Oxford, England: 1990) 01/2012; 48(11):1692-9. · 4.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Surgery is the main treatment modality for adenoid cystic carcinoma (ACC) originated from the head and neck. However, the extensive local infiltrative and perineural spread related to this malignancy often cause difficulty to achieve high tumor control. The aim of this study is to evaluate the efficacy of postoperative radiotherapy (RT) in ACC, and to identify prognostic variables associated with treatment outcomes. A retrospective review of 101 patients diagnosed with ACC in the head and neck region was performed. T stage distribution was T1, 25; T2, 35; T3, 18; and T4, 23 patients. All patients were grouped into two arms: surgery alone or combined with postoperative radiotherapy. The 5-year local-regional control (LRC), overall survival (OS) and disease-free survival (DFS) rates for all the patients were 70.5%, 91.7% and 63.2%, respectively. On univariant analysis, postoperative radiotherapy did improve the 5-year LRC and DFS compared to surgery alone (81.0% vs. 53.4%, p=0.0003 and 71.3% vs. 50.0%, p=0.0052, respectively). And patients with T1-T2 lesions achieved better treatment outcomes, whereas stage T3-T4 was associated with high local failure and poor disease-free survival. Furthermore, multivariate analysis revealed that the addition of radiotherapy and early lesions were both favorite predictors for local control and survival rates. The prognosis for ACC of the head and neck was excellent. Surgery combined with postoperative radiotherapy significantly reduced the local failure, and further improved disease-free survival. Nevertheless, the relatively high distant metastasis was an obstacle of curing the ACC patients.
Oral Oncology 12/2011; 48(5):445-9. · 2.86 Impact Factor
-
Chaosu Hu
International journal of radiation oncology, biology, physics 12/2011; 81(5):1591. · 4.59 Impact Factor
-
Zhiqiang Meng,
M Kay Garcia, Chaosu Hu,
Joseph Chiang,
Mark Chambers,
David I Rosenthal,
Huiting Peng,
Ying Zhang,
Qi Zhao,
Genming Zhao,
Luming Liu,
Amy Spelman,
J Lynn Palmer,
Qi Wei,
Lorenzo Cohen
[show abstract]
[hide abstract]
ABSTRACT: Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.
A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.
Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week 3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).
Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
Cancer 11/2011; 118(13):3337-44. · 4.77 Impact Factor
-
Archives of Oto-Rhino-Laryngology 08/2011; 269(3):1035. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To improve locoregional tumor control and survival in patients with locally advanced head and neck cancer (HNC), therapy is intensified using altered fractionation radiation therapy or concomitant chemotherapy. However, intensification of therapy has been associated with increased acute and late toxic effects. The application of advanced radiation techniques, such as 3D conformal radiation therapy and intensity-modulated radiation therapy, is expected to improve the therapeutic index of radiation therapy for HNC by limiting the dose to critical organs and possibly increasing locoregional tumor control. To date, Review articles have covered the prevention and treatment of radiation-induced xerostomia and dysphagia, but few articles have discussed the prevention of hearing loss, brain necrosis, cranial nerve palsy and osteoradionecrosis of the mandible, which are all potential complications of radiation therapy for HNC. This Review describes the efforts to prevent therapy-related complications by presenting the state of the art evidence regarding advanced radiation therapy technology as an organ-sparing approach.
Nature Reviews Clinical Oncology 07/2011; 8(11):639-48. · 11.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the efficacy and toxicity of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiation therapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC). A total of 54 patients (stage IIB: 6, stage III: 24, stage IVA-B: 24) with locoregionally advanced NPC were treated with cisplatin 25 mg/m(2) intravenously on days 1-3, and gemcitabine 1,000 mg/m(2) of 30-min intravenous infusion on days 1 and 8, every 3 weeks for two cycles as neoadjuvant chemotherapy. Two cycles of the same regimen were administered as adjuvant chemotherapy 28 days after the end of radiotherapy. The prescription doses were 66-70.4 Gy to the gross tumor volume (GTV), 66 Gy to positive neck nodes, 60 Gy to the high-risk clinical target volume and 54 Gy to the low-risk clinical target volume. The overall response rate to neoadjuvant chemotherapy was 88.6%. Toxicity was mainly grade 1/2 myelosuppression. All patients completed IMRT. The median follow-up duration was 30 months (range, 12-60 months). The 3-year locoregional control, metastasis-free rate and overall survival were 94.9%, 86.2% and 87.7%, respectively. Severe late toxicities included grade 3 trismus in one patient, grade 3 hearing impairment in one patient and cranial nerve XII palsy in one patient. No grade 4 late toxicities were observed. A combination of cisplatin plus gemcitabine chemotherapy and intensity-modulated radiotherapy for locoregionally advanced NPC is well-tolerated, convenient, effective and warrants further studies.
Archives of Oto-Rhino-Laryngology 06/2011; 269(3):1027-33. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the long term impact of concurrent chemoradiotherapy (CCRT) compared to radiotherapy (RT) alone in patients with T2N1M0 nasopharyngeal carcinoma (NPC) retrospectively. Three hundred and ninety-two patients with T2N1M0 NPC according to the AJCC 2002 stage classification system were analyzed. Among them, 211 patients were treated with RT alone and the rest of 181 patients were treated with CCRT. A planned dose of 70 Gy was delivered in 2.0 Gy per fraction over 7 weeks to the primary tumor with 6-MV photons or (60)Cobalt γ-ray. The chemotherapy regimen of cisplatin with a dose of 100mg/m(2) was delivered for 2-3 cycles. With a median follow-up of 66 months (range 2.4-117.1 months), the 5-year overall survival (OS) and disease-free survival (DFS) rates was higher in CCRT group compared to RT alone group, though they failed to reach statistical significance (80.2% vs. 76.6%, P=0.778 and 70.5% vs. 64.2%, P=0.413, respectively). A significant improvement was detected in 5-year relapse-free survival (RFS) rate in CCRT group than RT alone group (91.5% vs. 77.3%, P=0.008). Moreover, chemotherapy was the only independent prognostic factor for the 5-year RFS (P=0.007). Concurrent chemoradiotherapy appeared to improve the 5-year RFS rate for patients with T2N1M0 NPC. Large prospective, randomized clinical studies are needed to confirm its therapeutic gain.
Oral Oncology 04/2011; 47(5):408-13. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To address the characteristics and the causative factors of radiation-induced cranial nerve palsy (CNP) in nasopharyngeal carcinoma (NPC) patients with an extensive period of followed-up.
A total of 317 consecutive and nonselected patients treated with definitive external-beam radiotherapy between November 1962 and February 1995 participated in this study. The median doses to the nasopharynx and upper neck were 71 Gy (range, 55-86 Gy) and 61 Gy (range, 34-72 Gy), respectively. Conventional fractionation was used in 287 patients (90.5%). Forty-five patients (14.2%) received chemotherapy.
The median follow-up was 11.4 years (range, 5.1-38.0 years). Ninety-eight patients (30.9%) developed CNP, with a median latent period of 7.6 years (range, 0.3-34 years). Patients had a higher rate of CNP (81 cases, 25.5%) in lower-group cranial nerves compared with upper group (44 cases, 13.9%) (χ(2) = 34.444, p < 0.001). Fifty-nine cases experienced CNP in more than one cranial nerve. Twenty-two of 27 cases (68.8%) of intragroup CNP and 11 of 32 cases (40.7%) of intergroup CNP occurred synchronously (χ(2) = 4.661, p = 0.031). The cumulative incidences of CNP were 10.4%, 22.4%, 35.5%, and 44.5% at 5, 10, 15, and 20 years, respectively. Multivariate analyses revealed that CNP at diagnosis, chemotherapy, total radiation dose to the nasopharynx, and upper neck fibrosis were independent risk factors for developing radiation-induced CNP.
Radiation-induced fibrosis may play an important role in radiation-induced CNP. The incidence of CNP after definitive radiotherapy for NPC remains high after long-term follow-up and is dose and fractionation dependent.
International journal of radiation oncology, biology, physics 04/2011; 79(5):1421-7. · 4.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The current study was conducted to compare neoadjuvant chemotherapy (NACT) with concurrent chemotherapy for efficacy, toxicities and compliance of locoregionally advanced nasopharyngeal carcinoma (NPC). Eligible patients were randomized to NACT + radiotherapy (RT) + adjuvant chemotherapy (AC) arm or concurrent chemoradiotherapy(CCRT) + AC arm. Two arms received same conventional RT at a planned dose of 70 Gy. Neoadjuvant chemotherapy comprised cisplatin 90 mg/m(2) (30 mg/m(2)/day) and 5-fluorouracil 1,500 mg/m(2) (500 mg/m(2)/day) over 3 days for two 21-day cycles. The same regimen at equal dosage was administered on the 1st and 22nd days of the radiotherapy as concurrent chemotherapy. Four cycles of the same chemotherapy regimen were given to both two arms as AC. A total of 338 NPC patients were recruited. 170 patients were randomized to NACT arm and 168 patients to CCRT arm. The median duration of follow-up was 38 months. The 3-year OS and DFS rates were 95.9 versus 94.5% (P = 0.54) and 78.5 versus 82.5% (P = 0.16), respectively, in NACT and CCRT arms. An unplanned subgroup analysis according to the N-classification suggested that CCRT improves MFS in patients with N0-1 disease (80.1 vs. 94.9%, P = 0.034). Among the acute toxicities observed, the rates of grade 3/4 mucositis (52.4 vs. 35.9% P = 0.023) and vomiting (13.7 vs. 4.7% P = 0.000) were significantly higher in CCRT arm. Our preliminary results only showed an advantage of CCRT over NACT in NPC patients with limited N disease in MFS. More acute toxicities were observed in CCRT arm and a trend of better tolerance was observed in NACT arm.
Medical Oncology 01/2011; 29(1):272-8. · 2.14 Impact Factor
-
Journal of Clinical Oncology 12/2010; 29(7):e166-8. · 18.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To summarize our experience and treatment results in lymph node-negative nasopharyngeal carcinoma treated in a single institution.
From January 2000 to December 2003, 410 patients with lymph node-negative nasopharyngeal carcinoma were retrospectively analyzed. The T-stage distribution was 18.8% in T1, 54.6% in T2 (T2a, 41 patients; T2b, 183 patients), 13.2% in T3, and 13.4% in T4. All patients received radiotherapy to the nasopharynx, skull base, and upper neck drainage areas, including levels II, III, and VA. The dose was 64-74 Gy, 1. 8-2.0 Gy per fraction over 6.5-7.5 weeks to the primary tumor with (60)Co or 6-MV X-rays, and 50-56 Gy to levels II, III, and VA. Residual disease was boosted with either (192)Ir afterloading brachytherapy or small external beam fields.
The median follow-up time was 54 months (range, 3-90 months). Four patients developed neck recurrence, and only 1 patient (0.2%) experienced relapse outside the irradiation fields. The 5-year overall survival rate was 84.2%. The 5-year relapse-free survival rate, distant metastasis-free survival rate, and disease-free survival rate were 88.6%, 90.6% and 80.1%, respectively. Both univariate and multivariate analyses demonstrated that T classification was the only significant prognostic factor for predicting overall survival. The observed serious late toxicities were radiation-induced brain damage (7 cases), cranial nerve palsy (16 cases), and severe trismus (13 cases; the distance between the incisors was < or = 1 cm).
Elective levels II, III, and VA irradiation is suitable for nasopharyngeal carcinoma without neck lymph node metastasis.
International journal of radiation oncology, biology, physics 08/2010; 77(5):1397-402. · 4.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nasopharyngeal carcinoma (NPC) is rare in young patients. The aim of this study was to provide an analysis of 42 patients under 20 years of age with locoregional disease treated in a single institution.
Forty-two NPC patients aged <or=20 years (median age 16 years) represented only 2.3% of all NPC cases treated in our department between 2000 and 2003. Of these patients, 14 were stage II, 21 stage III, and seven stage IV, as diagnosed according to the 1997 American Joint Committee on Cancer (AJCC) staging system. Seventeen patients received radiotherapy alone and 25 had cisplatin-based chemotherapy additionally. The radiation dose to the primary tumour and involved nodes was 64-74 Gy.
After a median follow-up of 60 months, the 5-year locoregional control, overall survival and disease-free survival rates were 87, 79 and 73%, respectively. More than 50% of the relapses (6/11) were distant metastases. Patients with N0-1 had a lower distant metastasis rate compared with patients with N2-3, and the TNM stage grouping was found to be a marginally important prognostic factor for disease-free survival. The addition of chemotherapy failed to be of therapeutic value. Acute and chronic toxicities were limited, consisting primarily of mucositis and xerostomia.
The outcome of the present series was excellent, and matched well with other publications. A high systemic failure remains a major obstacle to cure young NPC patients. More efforts should be made to improve both survival and quality of life.
Clinical Oncology 08/2009; 21(8):617-22. · 2.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many patients with nasopharyngeal carcinoma (NPC) have marked anatomic change during intensity-modulated radiation therapy (IMRT). In this study, the magnitude of anatomic changes and its dosimetric effects were quantified. Fifteen patients with locally advanced NPC treated with IMRT had repeated computed tomography (CT) after 18 fractions. A hybrid plan was made to the anatomy of the second computed tomography scan. The dose of the original plan, hybrid plan, and new plan were compared. The mean volume of left and right parotid decreased 6.19 mL and 6.44 mL, respectively. The transverse diameters of the upper bound of odontoid process, the center of odontoid process, and the center of C2 vertebral body slices contracted with the mean contraction of 8.2 mm, 9.4 mm, and 7.6 mm. Comparing the hybrid plan with the treatment plan, the coverage of target was maintained while the maximum dose to the brain stem and spinal cord increased by 0.08 to 6.51 Gy and 0.05 to 7.8 Gy. The mean dose to left and right parotid increased by 2.97 Gy and 2.57 Gy, respectively. A new plan reduced the dose of spinal cord, brain stem, and parotids. Measurable anatomic changes occurring during the IMRT for locally advanced NPC maintained the coverage of targets but increased the dose to critical organs. Those patients might benefit from replanning.
Medical dosimetry: official journal of the American Association of Medical Dosimetrists 07/2009; 35(2):151-7. · 1.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the image registration accuracy and efficiency of CT and MRI fusion using three algorithms in nasopharyngeal carcinoma (NPC).
Twelve sets of CT and MRI scans of 12 NPC patients were fused using three image registration algorithms, respectively: Mark-and-link, Interactive, and Normalized Mutual Information (NMI). Registration accuracy was evaluated by performing statistical analysis of the coordinate differences between CT and MR anatomical landmarks along the x-, y- and z-axes. The time required to complete the registration process using three algorithms was also recorded. One-way ANOVA was used to analyze the difference of the three registration methods.
The mean time required for CT/MRI registration using the three different registration algorithms, mark-and-link, interactive, and NMI, was 6.25 min, 5.25 min, and 5.15 min, respectively. The mark-and-link method was more time consuming (F=8.74, p=0.001); however no statistical difference was found between the time required using interactive and NMI methods (p=0.77). Mean registration errors of the three methods along the x-axis were 0.66 mm, 0.70 mm, and 0.68 mm, respectively (F=0.09, p=0.91). Along the y-axis, the mean registration errors were 1.03 mm, 1.04 mm, and 1.03 mm, respectively (F=0.02, p=0.98). Along the z-axis, they were 0.58 mm, 0.64 mm, and 0.56 mm, respectively (F=0.21, p=0.81).
All three registration algorithms, mark-and-link, interactive, and NMI, can provide accurate CT/MRI registration. However the mark-and-link method was most time consuming.
Journal of Applied Clinical Medical Physics 02/2009; 10(2):2906. · 1.29 Impact Factor
