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Tian YM, Liu MZ, Zeng L, Bai L, Lin CG, Huang SM, Deng XW, Chong-Zhao, Lu TX, Han F. Long-term outcome and pattern of failure for patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Head Neck 2018; 41:1246-1252. [PMID: 30593728 DOI: 10.1002/hed.25545] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To analyze the long-term outcome and pattern of failure for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS Patients with NPC after IMRT from 2001 to 2008 were recruited (n = 865). Clinical features, laboratory data, and treatments were collected. RESULTS The 10-year local recurrence-free survival, distant metastasis-free survival, and disease-specific survival (DSS) were 92.0%, 83.4%, and 78.6%, respectively. A total of 209 patients died: 59% of whom died from distant metastasis. The 10-year DSS was higher in patients who received chemoradiotherapy than those who received IMRT alone for patients with high-risk stage III disease, while there was no survival difference for patients with stage II and low-risk stage III disease. CONCLUSIONS IMRT provides satisfactory long-term survival for patients with NPC. Distant metastasis has been the most common reason for failure. Adding chemotherapy did not improve survival in patients with stage II and low-risk stage III disease.
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Affiliation(s)
- Yun-Ming Tian
- Department of Radiation Oncology, Hui Zhou Municipal Central Hospital.,Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Ming-Zhu Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Lei Zeng
- Department of Radiation Oncology, Jiangxi Cancer Hospital
| | - Li Bai
- Department of Radiation Oncology, Hui Zhou Municipal Central Hospital
| | - Cheng-Guang Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Shao-Min Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Xiao-Wu Deng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Chong-Zhao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Tai-Xiang Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Centre.,State Key Laboratory of Oncology in South China.,Collaborative Innovation Centre for Cancer Medicine
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Zhang J, Li YQ, Guo R, Wang YQ, Zhang PP, Tang XR, Wen X, Hong XH, Lei Y, He QM, Yang XJ, Sun Y, Ma J, Liu N. Hypermethylation of SHISA3 Promotes Nasopharyngeal Carcinoma Metastasis by Reducing SGSM1 Stability. Cancer Res 2018; 79:747-759. [PMID: 30573520 DOI: 10.1158/0008-5472.can-18-1754] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/27/2018] [Accepted: 12/13/2018] [Indexed: 11/16/2022]
Abstract
Altered DNA methylation is a key feature of cancer, and aberrant methylation is important in nasopharyngeal carcinoma (NPC) development. However, the methylation mechanisms underlying metastasis of NPC remain unclear. Analyzing data from public databases and conducting our own experiments, we report here that promoter hypermethylation of SHISA3 is common and contributes to the downregulation of this gene in many types of tumors, including NPC. SHISA3 suppressed NPC cell invasion and metastasis in vitro and in vivo by impeding the E3 ubiquitin ligase tripartite motif containing 21 (TRIM21)-mediated ubiquitination and degradation small G protein signaling modulator 1 (SGSM1) and by inhibiting the MAPK pathway activation. Silencing SGSM1 abrogated the inhibitory effect of SHISA3 on NPC cell migration and invasion. This newly identified SHISA3-TRIM21-SGSM1 axis could be a novel therapeutic target in NPC. SIGNIFICANCE: These findings highlight the mechanism by which a newly identified tumor suppressor SHISA3 suppresses invasion and metastasis of nasopharyngeal carcinoma.
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Affiliation(s)
- Jian Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, P.R. China
| | - Ying-Qin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Rui Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Ya-Qin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Pan-Pan Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xin-Ran Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xin Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao-Hong Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yuan Lei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Qing-Mei He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao-Jing Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
| | - Na Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
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He Y, Zhou Q, Shen L, Zhao Y, Lei M, Wei R, Shen L, Cao S. A retrospective study of the prognostic value of MRI-derived residual tumors at the end of intensity-modulated radiotherapy in 358 patients with locally-advanced nasopharyngeal carcinoma. Radiat Oncol 2015; 10:89. [PMID: 25881159 PMCID: PMC4464998 DOI: 10.1186/s13014-015-0401-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 04/06/2015] [Indexed: 11/10/2022] Open
Abstract
Objective To retrospectively analyze the prognostic value of magnetic resonance imaging (MRI)-derived residual tumors after intensity-modulated radiation therapy (IMRT) in the patients with locally-advanced nasopharyngeal carcinoma. Methods A total of 358 patients with locally-advanced nasopharyngeal carcinoma who received IMRT were classified as having residual tumors or no residual tumor based on MRI at the end of radiotherapy. The χ2 test, log-rank test, Cox proportional hazards regression model and Kaplan-Meir survival curves were used to investigate the relationship of clinicopathological features and residual tumors and to assess the prognostic value of residual tumors. Results The 3-year overall survival (OS) rate was 73% in the residual tumor group and 90% in the no residual tumor group (HR 2.15, 95% CI 1.21-3.82,, P = 0.007); 3-year local relapse-free survival (LRFS) was 89% in the residual tumor group and 97% in the no residual tumor group (HR 4.46, 95% CI 1.61-12.38, P = 0.002); 3-year disease free survival (DFS) was 67% in the residual tumor group and 82% in the no residual tumor group (HR 2.21, 95% CI 1.40-3.48, P = 0.001). A high prescribed radiation dose (>73.92 Gy) did not increase the percentage volume of the GTVnx receiving 95% of the prescribed dose (GTVnx V95%) or improve any survival outcome. Conclusion The presence of a residual tumor after IMRT was a significant negative independent prognostic factor for OS, LRFS and DFS. Although IMRT have improved the distribution of radiotherapy doses into the tumors, residual tumors detected by MRI after IMRT are still associated with poor prognosis in patients with advanced nasopharyngeal carcinoma.
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Affiliation(s)
- Yuxiang He
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Lin Shen
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Yajie Zhao
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Mingjun Lei
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
| | - Shousong Cao
- Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, P.R. China.
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Zeng L, Tian YM, Sun XM, Huang Y, Chen CY, Han F, Liu S, Lan M, Guan Y, Deng XW, Lu TX. Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma: clinical outcomes and patterns of failure in an endemic area in China. Strahlenther Onkol 2014; 190:993-1000. [PMID: 24838409 DOI: 10.1007/s00066-014-0680-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to analyze the mode of relapse patterns and survival of 209 patients with stage IVA and IVB nasopharyngeal carcinoma (NPC). PATIENTS AND MATERIALS A total of 209 patients who underwent magnetic resonance imaging (MRI) and were subsequently histologically diagnosed with nondisseminated stage IV NPC received intensity-modulated radiotherapy (IMRT) as their primary treatment and were included in this retrospective study. RESULTS Median follow-up time was 65 months (range, 3-108 months). The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates for patients with stage IVA and stage IVB NPC were 72.7 vs. 60.0 % (p = 0.319), 62.9 vs. 51.3 % (p = 0.070), 82.9 vs. 93.1 % (p = 0.070), 82.9 vs. 82.9 % (p = 0.897), 76.4 vs. 58.5 % (p = 0.003), respectively. Age older than 44 years was found to be a statistically significant adverse independent prognostic factor for OS. Patients with advanced N status had worse OS, DFS, and DMFS rates. Patients with a primary gross tumor volume (GTV-P) ≥ 55.11 ml had worse OS, DFS, and LRRFS rates. CONCLUSION The results of treating stage IVA NPC with IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for patients with stage IVA and IVB NPC, and more effective systemic chemotherapy should be explored.
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Affiliation(s)
- Lei Zeng
- State Key Laboratory Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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T4-locally advanced nasopharyngeal carcinoma: prognostic influence of cranial nerve involvement in different radiotherapy techniques. ScientificWorldJournal 2013; 2013:439073. [PMID: 24385882 PMCID: PMC3872400 DOI: 10.1155/2013/439073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/19/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cranial nerve involvement at disease presentation of nasopharyngeal carcinoma was not uncommon. We investigated the prognosis of patients with T4-locally advanced NPC, with or without cranial nerve involvement, and compared the outcome of patients treated using different radiotherapy techniques. METHODS In this retrospective study, 83 T4-locally advanced NPC patients were diagnosed according to the seventh edition of the American Joint Committee on Cancer staging system. All patients were treated using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT). The survival rate was analyzed using the Kaplan-Meier method. RESULTS The 5-year overall, locoregional-free, and disease-free survival rates of patients treated using IMRT were 88.9%, 75.2%, and 69.2%, respectively. The outcome in these patients was significantly better than that in patients treated using 3D-CRT, with survival rates of 58.2%, 54.4%, and 47.2%, respectively. There was no significant difference in the 5-year overall, locoregional-free, and disease-free survival rates of the patients with (64.2%, 60.5%, and 53.5%, resp.) and without (76.9%, 63.6%, and 57.6%, resp.) cranial nerve involvement. CONCLUSION Locally advanced NPC patients treated using IMRT had significantly better outcomes than patients treated using 3D-CRT. Our results showed that the outcome of T4 NPC patients with or without cranial nerve involvement was not different.
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Demirci S, Kamer S, Kara G, Yildirim O, Esassolak M. Does the prognosis of nasopharyngeal cancer differ among endemic and non-endemic regions? Acta Otolaryngol 2011; 131:852-60. [PMID: 21476785 DOI: 10.3109/00016489.2011.560188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The survival rates and prognostic factors for nasopharyngeal cancer (NPC) were found to be similar to the published series from endemic regions. OBJECTIVES The purpose of this retrospective study was to evaluate treatment outcome and prognostic factors of NPC patients treated with radiotherapy or chemoradiotherapy in a non-endemic region. METHODS We analyzed clinical characteristics, treatment outcome, and prognostic factors of NPC patients in a non-endemic region, and compared our institution's results with the published literature including a similar patient population from endemic and non-endemic regions. Among 248 NPC patients, 71 (28.6%) were female and 177 (71.4%) were male with a median age of 48 years. RESULTS Within a median 59 months (range 22-178) of follow-up, local recurrence developed in 22 (8.9%), regional recurrence in 2 (0.8%), locoregional recurrence in 5 (2%), distant metastases in 21 (8.5%), and both locoregional recurrence and distant metastases in 8 (3.2%) patients. Five-year locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates were 83.7%, 73%, 78.5%, and 71.1%, respectively. In multivariate analysis for LRC, cranial nerve involvement (CNI) (p = 0.009) and tumor response (p = 0.004); for DFS, age (p = 0.003), CNI (p = 0.02), AJCC T classification (p = 0.05), and tumor response (p = 0.01); for DSS, age (p = 0.003), CNI (p = 0.04), AJCC T classification (p = 0.04), and tumor response (p = 0.01); for OS, age (p < 0.001), AJCC T classification (p = 0.005), and tumor response (p < 0.001) were significant prognostic factors.
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Affiliation(s)
- Senem Demirci
- Department of Radiation Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
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Cheng SH, Tsai SY, Horng CF, Yen KL, Jian JJ, Chan KY, Lin CY, Terng SD, Tsou MH, Chu NM, Chen HH, Chen PL, Chung YL, Hsieh CI, Tan TD, Huang AT. A prognostic scoring system for locoregional control in nasopharyngeal carcinoma following conformal radiotherapy. Int J Radiat Oncol Biol Phys 2006; 66:992-1003. [PMID: 16979832 DOI: 10.1016/j.ijrobp.2006.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Revised: 06/06/2006] [Accepted: 06/06/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE This study established a prognostic scoring system for nasopharyngeal carcinoma (NPC), which estimates the probability of locoregional (LR) control following definitive conformal radiotherapy. METHODS AND MATERIALS Patients with nondisseminated NPC at initial presentation (n = 630) were enrolled in this study. All patients had magnetic resonance imaging of the head and neck and were treated with conformal radiotherapy. Among them, 93% had concurrent chemotherapy, and 76% had postradiation chemotherapy. The extent of the primary tumor, age at diagnosis, primary tumor size, tumor and nodal classification, histology, and serum lactate dehydrogenase (LDH) level before treatment were included in the analysis for building a prognostic scoring system. The end point for this study was LR control. RESULTS The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Four factors had similarly independent prognostic effects (hazard ratio, 2.0-2.6): age >40 years, histologic WHO type I-II, serum LDH level > or =410 U/L, and involvement of two or more sites of the following anatomic structures, i.e., sphenoid floor, clivus marrow, clivus cortex, prevertebral muscles, and petrous bone. The score predicted the 5-year probability of LR control as follows: 0 (15% of the patients), 100%; 1 (42% of the patients), 93%; 2 (29% of the patients), 83%; 3 or higher (13% of the patients), 71%. CONCLUSION This scoring system is useful in the decision-making for individual patients and the design of clinical trials to improve LR control for advanced-stage NPC.
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Affiliation(s)
- Skye Hongiun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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Lu JC, Wei BQ, Chen WZ, Qian PD, Zhang YQ, Wei Q, Cha WW, Li F, Ni M. Staging of nasopharyngeal carcinoma investigated by magnetic resonance imaging. Radiother Oncol 2006; 79:21-6. [PMID: 16626827 DOI: 10.1016/j.radonc.2006.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 03/23/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the American Joint Commission on Cancer (AJCC) sixth edition staging system of nasopharyngeal carcinoma (NPC) by Magnetic Resonance Imaging (MRI). PATIENTS AND METHODS One hundred and fifty-nine non-disseminated biopsy-proven NPC patients were studied with MRI before treatment. Retrieval of MRI information enabled us to restage all patients accurately according to the sixth edition of the AJCC staging system. Splitting the respective T and N stages by the significant defining factors identified, the cancer death hazard ratios were modeled by the Cox model in SPSS 10.0 for windows (SPSS Inc, Chicago, IL). RESULTS Single site of skull base abnormality (HR = 3.91, 95% CI: 0.74-20.56) has a superior result to others involved in T3 (HR = 5.83, 95% CI: 1.24-27.29). Involvement of either anterior or posterior cranial nerves solely (HR = 6.02, 95% CI: 1.55-35.60) was not found to be as a poor prognostic indicator as others involved in T4 (HR = 7.81, 95% CI: 1.81-33.63). Less than or equal to 3 cm of N1 (HR = 4.01, 95% CI: 0.48-33.83) and N2 (HR = 4.72, 95% CI: 0.62-35.78) have a better result than >3 cm of N1 (HR = 8.09, 95% CI: 0.95-68.97) and N2 (HR = 10.58, 95% CI: 1.32-84.62), respectively. CONCLUSIONS Perhaps, it is better to down-stage single site of skull base abnormality from T3 to T2, and involvement of either anterior or posterior cranial nerves solely from T4 to T3, meanwhile, < or =3 cm of N2 down-stage to N1, >3 cm of N1 up-stage to N2.
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Affiliation(s)
- Jin-Cheng Lu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Nanjing, China.
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9
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Teo PML, Leung SF, Tung SY, Zee B, Sham JST, Lee AWM, Lau WH, Kwan WH, Leung TW, Chua D, Sze WM, Au JSK, Yu KH, O SK, Kwong D, Yau TK, Law SCK, Sze WK, Au G, Chan ATC. Dose–response relationship of nasopharyngeal carcinoma above conventional tumoricidal level: A study by the Hong Kong nasopharyngeal carcinoma study group (HKNPCSG). Radiother Oncol 2006; 79:27-33. [PMID: 16626829 DOI: 10.1016/j.radonc.2006.03.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 03/18/2006] [Accepted: 03/22/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE To define the dose-response relationship of nasopharyngeal carcinoma (NPC) above the conventional tumoricidal dose level of 66 Gy when the basic radiotherapy (RT) course was given by the 2D Ho's technique. PATIENTS AND METHODS Data from all five regional cancer centers in Hong Kong were pooled for this retrospective study. All patients (n = 2426) were treated with curative-intent RT with or without chemotherapy between 1996 and 2000 with the basic RT course using the Ho's technique. The primary endpoint was local control. The prognostic significance of dose-escalation ('boost') after 66 Gy, T-stage, N-stage, use of chemotherapy, sex and age (< or =40 years vs >40 years) was studied. Both univariate and multivariate analyses were performed. RESULTS On multivariate analysis, T-stage (P < 0.01; hazard ratio [HR], 1.58) and optimal boost (P = 0.01; HR, 0.34) were the only significant factors affecting local failure for the whole study population, and for the population of patients treated by radiotherapy alone, but not for patients who also received chemotherapy. The following were independent determinants of local failure for patient groups with different T-stages treated by radiotherapy alone: use of a boost in T1/T2a disease (P = 0.01; HR, 0.33); use of a boost (P < 0.01; HR, 0.60) and age (P = 0.01; HR, 1.02) in T3/T4 tumors. Among patients with T2b tumors treated by radiotherapy alone and given a boost, the use of a 20 Gy-boost gave a lower local failure rate than a 10 Gy-boost. There was no apparent excess mortality attributed to RT complications. CONCLUSIONS Within the context of a multi-center retrospective study, dose-escalation above 66 Gy significantly improved local control for T1/T2a and T3/4 tumors when the primary RT course was based on the 2D Ho's technique without additional chemotherapy. 'Boosting' in NPC warrants further investigation. Caution should be taken when boosting is considered because of possible increase in radiation toxicity.
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Affiliation(s)
- Peter M L Teo
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
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10
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Hsiung CY, Hunt MA, Yorke ED, Chui CS, Hu J, Xiong JP, Ling CC, Lo SK, Wang CJ, Huang EY, Amols HI. Intensity-modulated radiotherapy as the boost or salvage treatment of nasopharyngeal carcinoma: The appropriate parameters in the inverse planning and the effect of patient's anatomic factors on the planning results. Radiother Oncol 2005; 77:53-7. [PMID: 16246743 DOI: 10.1016/j.radonc.2005.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Revised: 04/18/2005] [Accepted: 04/20/2005] [Indexed: 11/17/2022]
Abstract
The current study demonstrates that the large increase in normal tissue penalty often degrades target dose uniformity without a concomitant large improvement in normal tissue dose, especially in anatomically unfavorable patients. The excessively large normal tissue penalties do not improve treatment plans for patients having unfavorable geometry.
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Affiliation(s)
- Ching-Yeh Hsiung
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung Hsien, Taiwan, ROC.
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11
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Ozyar E, Cengiz M, Gurkaynak M, Atahan IL. Trismus as a presenting symptom in nasopharyngeal carcinoma. Radiother Oncol 2005; 77:73-6. [PMID: 16154654 DOI: 10.1016/j.radonc.2005.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Revised: 06/27/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
Abstract
Trismus is a more common symptom in NPC patients with young age and an indicator of advanced primary tumour. Overall response rate after treatment was 88%. Trismus recovered in majority of patients at the end of treatment and patients with complete recovery of trismus may have a better survival.
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Affiliation(s)
- Enis Ozyar
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
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