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Aldhahri SF, Barakeh MM, Almetary RJ, Alfirm RB, Almousa HM, Alsubaie HM. Patterns of treatment failure in patients with nasopharyngeal carcinoma and salvage treatment outcome: A retrospective analysis study. Am J Otolaryngol 2023; 44:103941. [PMID: 37392726 DOI: 10.1016/j.amjoto.2023.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/13/2023] [Accepted: 06/03/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION In Saudi Arabia, head and neck cancers represent 6 % of all malignancies. 33 % of these are nasopharyngeal. Thus, we aimed to distinguish patterns of treatment failure and salvage treatment outcomes among patients with nasopharyngeal carcinoma (NPC). METHODS A retrospective review of patients treated for NPC in a tertiary care hospital. From May 2012 to January 2020, we retrospectively reviewed 175 patients that fit our inclusion criteria. Those who did not complete their treatment, started treatment in another institution, or did not complete a 3-year follow-up were excluded. In addition, the primary treatment outcome and the salvage treatment for those who failed initial treatment were collected and analyzed. RESULTS Patients were predominantly stage 4 disease. 67 % of the patients were alive without evidence of disease during their last follow-up. However, 75 % of failure occurs in the first 20 months of completing the treatment regimen. Neoadjuvant therapy and delays in referral play a significant role in treatment failure. For failed cases, concurrent salvage chemoradiotherapy showed the best survival. CONCLUSION Advanced stage 4A and T4 nasopharyngeal carcinoma should receive the maximum treatment, with a close follow-up, particularly during the first 2 years after treatment. Furthermore, the excellent outcome from salvage chemoradiotherapy and radiotherapy alone would make physicians aware of the importance of aggressive primary treatment.
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Affiliation(s)
- Saleh F Aldhahri
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Maha M Barakeh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Renad B Alfirm
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Hemail M Alsubaie
- Department of Otolaryngology-Head and Neck Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
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Clinical Characteristics and Predictive Outcomes of Recurrent Nasopharyngeal Carcinoma-A Lingering Pitfall of the Long Latency. Cancers (Basel) 2022; 14:cancers14153795. [PMID: 35954458 PMCID: PMC9367553 DOI: 10.3390/cancers14153795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose: To investigate the clinical characteristics, risk factors, and clinical outcomes of long-latent recurrence (>five years) of nasopharyngeal carcinoma (NPC). Methods: This retrospective study enrolled newly diagnosed NPC patients from the Chang Gung Research Database between January 2007 and December 2019. We analyzed the patients’ characteristics and survival outcomes after recurrence. Results: A total of 2599 NPC patients were enrolled. The overall recurrence rate was 20.5%, while 8.1% of patients had long-latent recurrence (>five years). These patients had a higher percentage of initial AJCC (The American Joint Committee on Cancer) stage I/II (60.5%, p = 0.001) and local recurrence (46.5%, p < 0.001). Unresectable rT3 and rT4 were found in 60% of patients when recurrence and 30% of local recurrence occurred in the skull base, which could not be detected by the regular endoscopy. The five-year overall survival rate of long-latent recurrence was 19.7%. Alive patients tended to be asymptomatic but have regular follow-ups with the interval less than six months. Multivariate analysis showed age and initial advanced AJCC stages were independent risk factors of death after recurrence. In contrast, patients with recurrence between two and five years, salvage surgeries, and regional recurrence had favorable survival outcomes. Conclusion: Long-latent NPC recurrence is not rare, and the survival outcome is poor. Regular follow-up for early detection of NPC recurrence is necessary even after five years of disease-free period.
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Yang ZC, Nie ZQ, Chen QY, Du CC, Luo DH, Liu LT, Guo SS, Li JB, Sun R, Liu SL, Lu ZJ, Yuan L, Lu ZX, Mai HQ, Tang LQ. Cost-Effectiveness analysis of combining plasma Epstein-Barr virus DNA testing and different surveillance imaging modalities for nasopharyngeal carcinoma patients in first remission. Oral Oncol 2022; 128:105851. [DOI: 10.1016/j.oraloncology.2022.105851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 01/07/2023]
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Wu CF, Lin L, Mao YP, Deng B, Lv JW, Zheng WH, Wen DW, Kou J, Chen FP, Yang XL, Xu SS, Ma J, Zhou GQ, Sun Y. Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA. BMC Med 2021; 19:193. [PMID: 34433440 PMCID: PMC8390246 DOI: 10.1186/s12916-021-02076-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. METHODS For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. RESULTS For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. CONCLUSIONS The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.
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Affiliation(s)
- Chen-Fei Wu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Li Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Bin Deng
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, 543002, Guangxi, People's Republic of China
| | - Jia-Wei Lv
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wei-Hong Zheng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Dan-Wan Wen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jia Kou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Fo-Ping Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xing-Li Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Si-Si Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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Paukner M, Chappell R. Window mean survival time. Stat Med 2021; 40:5521-5533. [PMID: 34258772 DOI: 10.1002/sim.9138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/05/2021] [Accepted: 06/29/2021] [Indexed: 01/05/2023]
Abstract
We propose a class of alternative estimates and tests to restricted mean survival time (RMST) which improves power in numerous survival scenarios while maintaining a level of interpretability. The industry standards for interpretable hypothesis tests in survival analysis, RMST and logrank tests (LRTs), can suffer from low power in cases where the proportional hazards assumption fails. In particular, when late differences occur between survival curves, our proposed estimate and class of tests, window mean survival time (WMST), outperforms both RMST and LRT without sacrificing interpretability, unlike weighted rank tests (WRTs). WMST has the added advantage of maintaining high power when the proportional hazards assumption is met, while WRTs do not. With testing methods often being chosen in advance of data collection, WMST can ensure adequate power without distributional assumptions and is robust to the choice of its restriction parameters. Functions for performing WMST analysis are provided in the survWM2 package in R.
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Affiliation(s)
- Mitchell Paukner
- Department of Statistics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Richard Chappell
- Department of Statistics, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Svajdova M, Sicak M, Dubinsky P, Slavik M, Slampa P, Kazda T. Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic. Cancers (Basel) 2020; 12:cancers12123510. [PMID: 33255751 PMCID: PMC7760235 DOI: 10.3390/cancers12123510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Options for the curative treatment of locally recurrent nasopharyngeal carcinoma include surgery or re-irradiation. Both approaches have been scientifically explored, yet there is no consensus on the indication or definitive preference of the above two salvage treatments. The aim of this review is to summarize the current evidence on the local treatment of recurrent nasopharyngeal carcinoma. The feasibility, safety, and efficacy of salvage surgery and radical re-irradiation are discussed. Recommendations on treatment modifications during the coronavirus disease 2019 pandemic are included as well. Abstract Recurrent nasopharyngeal carcinoma represents an extremely challenging therapeutic situation. Given the vulnerability of the already pretreated neurological structures surrounding the nasopharynx, any potential salvage retreatment option bears a significant risk of severe complications that result in high treatment-related morbidity, quality of life deterioration, and even mortality. Yet, with careful patient selection, long-term survival may be achieved after local retreatment in a subgroup of patients with local or regional relapse of nasopharyngeal cancer. Early detection of the recurrence represents the key to therapeutic success, and in the case of early stage disease, several curative treatment options can be offered to the patient, albeit with minimal support in prospective clinical data. In this article, an up-to-date review of published evidence on modern surgical and radiation therapy treatment options is summarized, including currently recommended treatment modifications of both therapeutic approaches during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Michaela Svajdova
- Department of Radiation and Clinical Oncology, Central Military Hospital—Teaching Hospital Ruzomberok, 034 01 Ruzomberok, Slovakia
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Correspondence: ; Tel.: +421-911-618-265
| | - Marian Sicak
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital—Teaching Hospital, 034 01 Ruzomberok, Slovakia;
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, 041 91 Kosice, Slovakia;
- Faculty of Health, Catholic University Ruzomberok, 034 01 Ruzomberok, Slovakia
| | - Marek Slavik
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
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Zhou GQ, Wu CF, Deng B, Gao TS, Lv JW, Lin L, Chen FP, Kou J, Zhang ZX, Huang XD, Zheng ZQ, Ma J, Liang JH, Sun Y. An optimal posttreatment surveillance strategy for cancer survivors based on an individualized risk-based approach. Nat Commun 2020; 11:3872. [PMID: 32747627 PMCID: PMC7400511 DOI: 10.1038/s41467-020-17672-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Here we adopt nasopharyngeal carcinoma as the study model to establish an approach to surveillance that balances the effectiveness of disease detection versus costs. A total of 7,043 newly-diagnosed patients are grouped according to a clinic-molecular risk grouping system. We use a random survival forest model to simulate the monthly probability of disease recurrence, and thereby establish risk-based surveillance arrangements that can maximize the efficacy of recurrence detection per visit. Markov decision-analytic models further validate that the risk-based surveillance outperforms the control strategies and is the most cost-effective. These results are confirmed in an external validation cohort. Finally, we recommend the risk-based surveillance arrangement which requires 10, 11, 13 and 14 visits for group I to IV. Our surveillance strategies might pave the way for individualized and economic surveillance for cancer survivors.
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Affiliation(s)
- Guan-Qun Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Chen-Fei Wu
- Zhongshan School of Medicine, Sun Yat-sen University, 510060, Guangzhou, China
| | - Bin Deng
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Guangzhou, 543002, Guangxi, China
| | - Tian-Sheng Gao
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Guangzhou, 543002, Guangxi, China
| | - Jia-Wei Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Li Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Fo-Ping Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Jia Kou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Zhao-Xi Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, 510060, Guangzhou, China
| | - Xiao-Dan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Zi-Qi Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Jin-Hui Liang
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Guangzhou, 543002, Guangxi, China.
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China.
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Zhou GQ, Lv JW, Tang LL, Mao YP, Guo R, Ma J, Sun Y. Evaluation of the National Comprehensive Cancer Network and European Society for Medical Oncology Nasopharyngeal Carcinoma Surveillance Guidelines. Front Oncol 2020; 10:119. [PMID: 32117766 PMCID: PMC7034102 DOI: 10.3389/fonc.2020.00119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/22/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: The National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) provide surveillance guidelines for nasopharyngeal carcinoma (NPC). We evaluated the ability of these guidelines to capture disease recurrence. Materials and methods: All 749 NPC patients were stratified for analysis by T and N stage. We evaluated the guidelines by calculating the percentage of relapses detected when following the 2018 NCCN, 2015 NCCN, and 2012 ESMO surveillance guidelines, and related surveillance costs were compared. Results: At a median follow-up of 100.8 months, 168 patients (22.4%) had experienced recurrence. Nineteen recurrences (11.3%) were detected using the 2018 NCCN, 53 (31.5%) using the 2015 NCCN and 46 (27.4%) using the ESMO guidelines. To capture 95% recurrences, surveillance would be required for 85.57 months for T1/2, 67.45 months for T3/4, 83.57 months for N0/1, and 55.80 months for N2/3 disease. In T1/2 disease, Medicare surveillance costs per patient were US$1642.66 using 2018 NCCN or ESMO and US$2179.81 using 2015 NCCN. Costs per recurrence detected were US$42,578.64, 62,088.70, and 73,329.76 using 2018 NCCN, 2015 NCCN, and ESMO, respectively. Conclusions: If strictly followed, the NCCN and ESMO guidelines will miss more than two-thirds recurrences. Improved surveillance algorithms to balance patient benefit against costs are needed.
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Affiliation(s)
- Guan-Qun Zhou
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jia-Wei Lv
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Ling-Long Tang
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yan-Ping Mao
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Rui Guo
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jun Ma
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China
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Ak S, Kiliç C, Özlügedik S. Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer. Braz J Otorhinolaryngol 2020; 87:643-648. [PMID: 31982379 PMCID: PMC9422549 DOI: 10.1016/j.bjorl.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/10/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the post- radiotherapy period is improved. Objective The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. Methods A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients’ age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. Results Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). Conclusions Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.
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Affiliation(s)
- Semih Ak
- Şanlıurfa Mehmet Akif Inan Training and Research Hospital, Department of Otorhinolaryngology, Sanlıurfa, Turkey
| | - Caner Kiliç
- University of Health Sciences Ankara Dr. Abdurrahman Yurtaslan Oncology, Department of Otorhinolaryngology, Ankara,Turkey.
| | - Samet Özlügedik
- University of Health Sciences Ankara Dr. Abdurrahman Yurtaslan Oncology, Department of Otorhinolaryngology, Ankara,Turkey
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Guo SS, Liu R, Wen YF, Liu LT, Yuan L, Li YX, Li Y, Hao WW, Peng JY, Chen DN, Tang QN, Sun XS, Guo L, Mo HY, Qian CN, Zeng MS, Bei JX, Sun SY, Chen QY, Tang LQ, Mai HQ. RETRACTED: Endogenous production of C-C motif chemokine ligand 2 by nasopharyngeal carcinoma cells drives radioresistance-associated metastasis. Cancer Lett 2020; 468:27-40. [PMID: 31604115 DOI: 10.1016/j.canlet.2019.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 01/06/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. Following the publication of the above article, the Editor was notified by a concerned reader that the authors supplied duplicated images. Specifically, overlap in Figures 1C, 4A, 4B, 4D, and 5C. These concerns were also reported at PubPeer https://pubpeer.com/publications/CAC11E726E1C3E261A1F8BB90FF173. After review, the Editor found that duplication did occur and therefore the decision was made to retract the article. After re-examination of the entire paper, raw data and lab records, the authors have found that “pictures between different experiments were carelessly mixed. We want to apologize for all the inconvenience it caused to the editorial board, and to all our peers and to all the readers of our paper.”
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Affiliation(s)
- Shan-Shan Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Rui Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Yue-Feng Wen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Radiotherapy, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, 510095, PR China
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Li Yuan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Yan-Xian Li
- Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, PR China
| | - Yang Li
- Department of Radiotherapy, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, PR China
| | - Wen-Wen Hao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Jing-Yun Peng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Dan-Ni Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Qing-Nan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Xue-Song Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Ling Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Hao-Yuan Mo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Chao-Nan Qian
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Mu-Sheng Zeng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Jin-Xin Bei
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Shu-Yang Sun
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China.
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11
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Lin Y, Ouyang Y, Lu Z, Liu Y, Chen K, Cao X. Long-Term Outcomes of Three-Dimensional High-Dose-Rate Brachytherapy for Locally Recurrent Early T-Stage Nasopharyngeal Carcinoma. Front Oncol 2019; 9:278. [PMID: 31134143 PMCID: PMC6524703 DOI: 10.3389/fonc.2019.00278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Brachytherapy (BT) is one of the techniques available for retreatment of patients with locally recurrent nasopharyng eal carcinoma (rNPC). In this study, we evaluated the treatment outcome and late toxicities of three-dimensional high-dose-rate brachytherapy (3D-HDR-BT) for patients with locally rNPC. Materials and Methods: This is a retrospective study involving 36 patients with histologically confirmed rNPC from 2004 to 2011. Of the 36 patients, 17 underwent combined-modality treatment (CMT) consisting of external beam radiotherapy (EBRT) followed by 3D-HDR-BT, while the other 19 underwent 3D-HDR-BT alone. The median dose of EBRT for the CMT group was 60 (range, 50-66) Gy, with an additional median dose of BT of 16 (range, 9-20) Gy. The median dose for the 3D-HDR-BT group was 32 (range, 20-36) Gy. The measured treatment outcomes were the 5- and 10-year locoregional recurrence-free survival (LRFS), disease-free survival (DFS), overall survival (OS), and late toxicities. Results: The median age at recurrence was 44.5 years. The median follow-up period was 70 (range, 6-142) months. The 5-year LRFS, DFS, and OS for the entire patient group were 75.4, 55.6, and 74.3%, respectively, while the 10-year LRFS, DFS, and OS for the entire patient group were 75.4, 44.2, and 53.7%, respectively. The 10-year LRFS in the CMT group was higher than that in the 3D-HDR-BT-alone group (93.8 vs. 58.8%, HR: 7.595, 95%CI: 1.233-61.826, p = 0.025). No grade 4 late radiotherapy-induced toxicities were observed. Conclusions: 3D-HDR-BT achieves favorable clinical outcomes with mild late toxicity in patients with locally rNPC.
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Affiliation(s)
- Yanzhu Lin
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yi Ouyang
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghong Liu
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kai Chen
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinping Cao
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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12
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Brunet-Garcia A, Costa-Climent MD, Pujol-Rodríguez M, Brunet-Garcia L, Faubel-Serra M. Sphenoid sinus mucocele: an unusual complication of head and neck irradiation in a North African woman. J Clin Exp Dent 2019; 11:e208-e212. [PMID: 30805127 PMCID: PMC6383900 DOI: 10.4317/jced.55161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/17/2018] [Indexed: 11/05/2022] Open
Abstract
Mucocele is a common benign lesion otherwise rarely located in the sphenoid sinus. Some complications after head and neck irradiation have been described in the literature until now. To our knowledge, this is the first report of a sphenoid sinus mucocele in a North African patient treated some years before with radiotherapy for a nasopharyngeal carcinoma (NPC). We extend the literature review about this infrequent finding, of which head and neck surgeons should be aware. Key words:Mucocele, sphenoid sinus mucocele, nasopharyngeal carcinoma, radiotherapy, North African.
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Affiliation(s)
- Aina Brunet-Garcia
- MD, Department of Otorhinolaryngology, Hospital Universitar Parc Taulí. Sabadell, Barcelona. Universitat Autònoma de Barcelona. Universitat de València. Spain
| | - Mª Dolores Costa-Climent
- MD, Department of Otorhinolaryngology, Hospital General Universitari de Castelló. Castelló de la Plana, Castelló, Spain
| | - Maria Pujol-Rodríguez
- MD, Department of Otorhinolaryngology, Hospital Universitari Vall d'Hebron. Barcelona. Spain
| | - Laia Brunet-Garcia
- MD, Department of Paediatric Cardiology, Hospital de Mataró. Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona. Universitat de Barcelona. Spain
| | - Marta Faubel-Serra
- MD, PhD. Head of Otorhinolaryngology department, Hospital General Universitari de Castelló. Castelló de la Plana, Castelló, Spain
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13
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Zhang YM, Chen MN, Gao JM, Zhou CH, Xiao JX, Sun ZY, Liao WH, Yi XP, Zee C, Chen BT. A Predictive Scoring Model for Short-Term Local Recurrent Nasopharyngeal Carcinoma Based on Magnetic Resonance Imaging. Cancer Biother Radiopharm 2018; 34:76-84. [PMID: 30585765 DOI: 10.1089/cbr.2018.2531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To predict the early identification of recurrence based on magnetic resonance imaging (MRI) in nasopharyngeal cancer (NPC) patients. METHODS The clinical and MRI data of 215 patients with local recurrent NPC were retrospectively reviewed. Logistic regression analysis was performed to distinguish the independent risk factors for the short-term (less than 24 months) local recurrence of NPC. The predictive score model was based on the regression coefficients of significant independent variables. RESULTS Residual disease in the nasopharyngeal cavity (NC), masticator space invasion (MSI), skull base bone erosion (SBBE), and MRI-detected cranial nerve invasion (MDCNI) were all significant independent risk factors for the short-term recurrence of NPC (p < 0.05). The receiver operating characteristic curve showed that the total score had a maximal AUC (area under the curve) value of 0.897, with a cutoff point of 10.50. The sensitivity and specificity were 79.4% and 80.5%, respectively. CONCLUSION Residual lesions in NC, MSI, SBBE, and MDCNI are independent risk factors in predicting the short-term recurrence of NPC. The authors' findings suggest that patients with a score of more than 10.50 points should be hypervigilant regarding the possibility of short-term recurrence.
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Affiliation(s)
- You-Ming Zhang
- 1 Department of Radiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ming-Na Chen
- 2 Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jian-Ming Gao
- 3 Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Chun-Hui Zhou
- 1 Department of Radiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jing-Xing Xiao
- 4 Department of Nuclear Medicine, Affiliated Hospital of Guangdong Medical University, ZhanJiang, People's Republic of China
| | - Zhong-Yi Sun
- 5 Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wei-Hua Liao
- 1 Department of Radiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xiao-Ping Yi
- 1 Department of Radiology, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,6 Postdoctoral Research Workstation of Pathology and Pathophysiology, Basic Medical Sciences, Xiangya Hospital, Central South University, Changsha, People's Republic of China.,7 Department of Radiology, Keck Medical Center of USC, Los Angeles, California.,8 Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California
| | - Chishing Zee
- 7 Department of Radiology, Keck Medical Center of USC, Los Angeles, California
| | - Bihong T Chen
- 8 Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California
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14
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Gao W, Wong TS, Lv KX, Zhang MJ, Tsang RKY, Chan JYW. Detection of Epstein-Barr virus (EBV)-encoded microRNAs in plasma of patients with nasopharyngeal carcinoma. Head Neck 2018; 41:780-792. [PMID: 30548946 DOI: 10.1002/hed.25544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/03/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) latently infected by Epstein-Barr virus (EBV) expresses 40 EBV BART microRNAs (miRNAs). Difference in diagnostic efficacy of these miRNAs on NPC detection was observed. Here, we performed a comprehensive evaluation on the efficacy of these miRNAs. METHODS Quantitative polymerase chain reaction was performed on plasma nucleic acid isolated from patients with NPC and noncancer donors. RESULTS For primary NPC, BART2-5P, BART6-3P, BART7-3P, BART7-5P, BART9-5P, BART11-3P, BART17-5P, and BART19-5P were significantly elevated. For recurrent NPC, plasma levels of BART2-3P, BART2-5P, BART5-3P, BART5-5P, BART6-3P, BART8-3P, BART9-5P, BART17-5P, BART19-3P, and BART20-3P were significantly increased. Area under curve (AUC) analysis showed that BART19-5P had the best performance to identify NPC which was serologically EBV DNA undetectable. For recurrent NPC, BART8-3P and BART10-3P had highest AUC value for identifying cancer in EBV DNA undetectable plasma. CONCLUSION Our data supported the use of circulating EBV miRNAs in NPC and recurrent NPC detection.
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Affiliation(s)
- Wei Gao
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, China
| | - Thian-Sze Wong
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, China
| | - Ke-Xing Lv
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Min-Juan Zhang
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, China
| | - Raymond King-Yin Tsang
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, China
| | - Jimmy Yu-Wai Chan
- Division of Head and Neck, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.,Shenzhen Institute of Research and Innovation, The University of Hong Kong, China
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15
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Zhou GQ, Wu CF, Zhang J, Mao YP, Tang LL, Chen L, Guo R, Ma J, Sun Y. Cost-Effectiveness Analysis of Routine Magnetic Resonance Imaging in the Follow-Up of Patients With Nasopharyngeal Carcinoma After Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1382-1391. [DOI: 10.1016/j.ijrobp.2018.01.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
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16
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Wen QL, He LJ, Ren PR, Chen CQ, Wu JB. Comparing Radiotherapy with or without Intracavitary Hyperthermia in the Treatment of Primary Nasopharyngeal Carcinoma: A Retrospective Analysis. TUMORI JOURNAL 2018. [DOI: 10.1177/1430.15815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Qing-Lian Wen
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou
| | - Li-Jia He
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou
| | - Pei-Rong Ren
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou
| | - Cheng-Qin Chen
- Department of Radiation Oncology, Tumor Hospital, Sun Yat-Sen School of Medical, Sun Yat-Sen University, Guangzhou, China
| | - Jing-Bo Wu
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou
- Department of Radiation Oncology, Tumor Hospital, Sun Yat-Sen School of Medical, Sun Yat-Sen University, Guangzhou, China
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17
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Leong YH, Soon YY, Lee KM, Wong LC, Tham IWK, Ho FCH. Long-term outcomes after reirradiation in nasopharyngeal carcinoma with intensity-modulated radiotherapy: A meta-analysis. Head Neck 2017; 40:622-631. [PMID: 29130584 DOI: 10.1002/hed.24993] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/26/2017] [Accepted: 09/15/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this clinical review was to summate the published data for the long-term outcomes of reirradiation with intensity-modulated radiotherapy (IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). METHODS We searched biomedical literature databases for eligible studies published from January 2005 to September 2016. Outcomes of interests were 5-year local failure-free survival, distant failure-free survival, overall survival (OS), and toxicities. Meta-analysis was performed using a random effects model. RESULTS We found 4 comparative and 8 noncomparative studies (n = 1768). Reirradiation was associated with pooled event rates of 72% (95% confidence interval [CI] 66%-78%; I2 = 84%), 85% (95% CI 82%-88%; I2 = 69%), and 41% (95% CI 36%-47%; I2 = 80%) for 5-year local failure-free survival, distant failure-free survival, and OS, respectively, with significant heterogeneity among the study results. The pooled event rate for grade 5 toxicities was 33% (95% CI 30%-35%; I2 = 0%) with minimal heterogeneity. CONCLUSION Reirradiation with IMRT for locally recurrent NPC could confer long-term disease control and survival but is associated with significant mortality.
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Affiliation(s)
- Yiat Horng Leong
- Department of Radiation Oncology, National University Cancer Institute - Singapore (NCIS), Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute - Singapore (NCIS), Singapore
| | - Khai Mun Lee
- Department of Radiation Oncology, Farrer Park Hospital, Singapore
| | - Lea Choung Wong
- Department of Radiation Oncology, National University Cancer Institute - Singapore (NCIS), Singapore
| | - Ivan Weng Keong Tham
- Department of Radiation Oncology, National University Cancer Institute - Singapore (NCIS), Singapore
| | - Francis Cho Hao Ho
- Department of Radiation Oncology, National University Cancer Institute - Singapore (NCIS), Singapore
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18
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Ghorbal L, Elloumi F, Siala W, Khabir A, Ghorbel A, Frikha M, Daoud J. Aspects anatomocliniques et thérapeutiques des récidives locales des carcinomes du nasopharynx. Cancer Radiother 2017; 21:40-44. [DOI: 10.1016/j.canrad.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/22/2016] [Accepted: 09/11/2016] [Indexed: 11/29/2022]
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19
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Emara NM, Abd El-Maksoud AA, Ibrahim E, Zeidan AM, Nouh AM. Prognostic value of claudin-4, nm23-H1, and MIB-1 in undifferentiated nasopharyngeal carcinoma. EGYPTIAN JOURNAL OF PATHOLOGY 2016; 36:149-157. [DOI: 10.1097/01.xej.0000504533.36954.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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20
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Genova P, Brunetti F, Bequignon E, Landi F, Lizzi V, Esposito F, Charpy C, Calderaro J, Azoulay D, de'Angelis N. Solitary splenic metastasis from nasopharyngeal carcinoma: a case report and systematic review of the literature. World J Surg Oncol 2016; 14:184. [PMID: 27422630 PMCID: PMC4947368 DOI: 10.1186/s12957-016-0941-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022] Open
Abstract
Background Solitary splenic metastases are a rare occurrence, and the nasopharyngeal carcinoma represents one of the most uncommon primary sources. The present study aimed to describe a rare case of a solitary single splenic metastasis from nasopharyngeal carcinoma and to assess the number of cases of isolated nasopharyngeal carcinoma metastases to the spleen reported in the literature. Main body We describe the case of a 56-year-old man with a history of nasopharyngeal carcinoma and complete remission after chemo-radiotherapy. Three months after complete remission, positron emission tomography/computed tomography scan revealed a hypermetabolic splenic lesion without increased metabolic activity in other areas. After laparoscopic splenectomy, the pathology report confirmed a single splenic metastasis from undifferentiated carcinoma of the nasopharyngeal type. The postoperative period was uneventful. We also performed a systematic review of the literature using MEDLINE and Google Scholar databases. All articles reporting cases of splenic metastases from nasopharyngeal carcinoma, with or without histologic confirmation, were evaluated. The literature search yielded 15 relevant articles, which were very heterogeneous in their aims and methods and described only 25 cases of splenic metastases from nasopharyngeal carcinoma. Conclusion The present review shows that solitary splenic metastases from nasopharyngeal carcinoma are a rare event, but it should be considered in patients presenting with splenic lesions at imaging and a history of primary or recurrent nasopharyngeal carcinoma. No evidence supports a negative impact of splenectomy in patients with solitary splenic metastasis from nasopharyngeal carcinoma.
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Affiliation(s)
- Pietro Genova
- Department of General and Oncological Surgery, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, PA, Italy.
| | - Francesco Brunetti
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Emilie Bequignon
- Department of Otorhinolaryngology and Head and Neck Surgery, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France.,INSERM U955, Créteil, France
| | - Filippo Landi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Cecile Charpy
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Julien Calderaro
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
| | - Nicola de'Angelis
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
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21
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Law BKH, King AD, Bhatia KS, Ahuja AT, Kam MKM, Ma BB, Ai QY, Mo FKF, Yuan J, Yeung DKW. Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome? AJNR Am J Neuroradiol 2016; 37:1706-12. [PMID: 27151750 DOI: 10.3174/ajnr.a4792] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Pretreatment prediction of patients with nasopharyngeal carcinoma who will fail conventional treatment would potentially allow these patients to undergo more intensive treatment or closer posttreatment monitoring. The aim of the study was to determine the ability of pretreatment DWI to predict local failure in patients with nasopharyngeal carcinoma based on long-term clinical outcome. MATERIALS AND METHODS One hundred fifty-eight patients with pretreatment DWI underwent analysis of the primary tumor to obtain the ADC mean, ADC skewness, ADC kurtosis, volume, and T-stage. Univariate and multivariate analyses using logistic regression were performed to compare the ADC parameters, volume, T-stage, and patient age in primary tumors with local failure and those with local control, by using a minimum of 5-year follow-up to confirm local control. RESULTS Local control was achieved in 131/158 (83%) patients (range, 60.3-117.7 months) and local failure occurred in 27/158 (17%) patients (range, 5.2-79.8 months). Compared with tumors with local control, those with local failure showed a significantly lower ADC skewness (ADC values with the greatest frequencies were shifted away from the lower ADC range) (P = .006) and lower ADC kurtosis (curve peak broader) (P = .024). The ADC skewness remained significant on multivariate analysis (P = .044). There was a trend toward higher tumor volumes in local failure, but the volume, together with T-stage and ADC mean, were not significantly different between the 2 groups. CONCLUSIONS Pretreatment DWI of primary tumors found that the skewness of the ADC distribution curve was a predictor of local failure in patients with nasopharyngeal carcinoma, based on long-term clinical outcome.
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Affiliation(s)
- B K H Law
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - A D King
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - K S Bhatia
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - A T Ahuja
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - M K M Kam
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - B B Ma
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - Q Y Ai
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - F K F Mo
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - J Yuan
- Medical Physics and Research Department (J.Y.), Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong S.A.R., China
| | - D K W Yeung
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
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Xu T, Su B, Wang C, Wang S, Huang H, Pan Y, Wang D, Wei W, Claret FX, Yang H. Molecular markers to assess short-term disease local recurrence in nasopharyngeal carcinoma. Oncol Rep 2015; 33:1418-26. [PMID: 25607111 PMCID: PMC4324483 DOI: 10.3892/or.2015.3739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/22/2014] [Indexed: 11/05/2022] Open
Abstract
An important challenge in nasopharyngeal carcinoma (NPC) research is to develop effective predictors of tumor recurrence following treatment to determine whether immediate adjuvant therapy is necessary. We retrospectively analyzed archived specimens collected from 45 patients with paired samples of primary NPC (pNPC) and recurrent NPC (rNPC). Clinical samples were collected from the Cancer Center Databases of the First People’s Hospital of Foshan and Shantou Central Hospital (affiliates of Sun Yat-Sen University) between 2001 and 2012. Expression levels of phosphor-Stat3 (p-Stat3), signalosome complex subunit 5 (Jab1/Csn5), Akt1, C/EBP homologous protein (CHOP), Ki-67, and apoptosis were determined by immunohistochemistry in pNPC and rNPC samples from the same patients. Differences in these markers between the short-term interval to recurrence (ITR) group (ITR <18 months) and long-term ITR group (ITR ≥18 months) were further analyzed. In Cox’s regression analysis, the ITR was significantly associated as an independent-negative prognostic factor for overall survival (hazard ratio, 0.211; 95% confidence interval, 0.053–0.841; P=0.027). p-Stat3 was increased in the short-term ITR group (ITR <18 months) and tended to be lower in the long-term ITR group (ITR ≥18 months). In the short-term ITR group, nuclear Akt expression was significantly increased in paired rNPC (P=0.028). In the long-term ITR group, the expression of nuclear Jab1/Csn5 (P=0.047) and assessment of apoptosis measured with TdT-mediated dUTP nick end-labeling (TUNEL) (P=0.003) was significantly increased in paired rNPC. The results suggest that differences between short- and long-term ITR may predict outcome in rNPC. Furthermore, the overexpression of Jab1/Csn5 and Akt may contribute to the carcinogenesis of rNPC, and Akt seems to promote the progression of short-term ITR. Intra-individual changes of Jab1/Csn5, Akt, and TUNEL may help to identify short-term ITR.
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Affiliation(s)
- Tao Xu
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Bojin Su
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Chunhua Wang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Sumei Wang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Hecheng Huang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Yunbao Pan
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Donghui Wang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
| | - Weihong Wei
- Department of Radiation Oncology, First People's Hospital of Foshan, Guangdong, Foshan 528000, P.R. China
| | - François X Claret
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Huiling Yang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong, Guangzhou 510600, P.R. China
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Wu SY, Wu YH, Yang MW, Hsueh WT, Hsiao JR, Tsai ST, Chang KY, Chang JS, Yen CJ. Comparison of concurrent chemoradiotherapy versus neoadjuvant chemotherapy followed by radiation in patients with advanced nasopharyngeal carcinoma in endemic area: experience of 128 consecutive cases with 5 year follow-up. BMC Cancer 2014; 14:787. [PMID: 25351202 PMCID: PMC4228264 DOI: 10.1186/1471-2407-14-787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Combined radiotherapy and chemotherapy is considered the standard of care for locally advanced nasopharyngeal carcinoma (LA-NPC) in Epstein-Barr virus infection endemic area. This study compared the long-term outcomes between LA-NPC patients treated with neoadjuvant chemotherapy followed by radiotherapy (NACT) and those treated with concurrent chemoradiotherapy (CCRT). Methods From 2003 to 2007, a total of 128 histopathologically proven LA-NPC patients receiving either NACT or CCRT were consecutively enrolled at the National Cheng Kung University Hospital in Taiwan. NACT consisted of 3-week cycles of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL) or weekly alternated cisplatin on day 1 and fluorouracil and leucovorin on day 8 (P-FL). CCRT comprised 3-week cycles of cisplatin (Cis 100) or 4-week cycles of cisplatin and fluorouracil (PF4). The first failure site, disease free survival (DFS), overall survival (OS), and other prognostic factors were analyzed. Results Thirty-eight patients (30%) received NACT. Median follow-up duration was 53 months. More patients with advanced nodal disease (N2-N3) (86.8% vs 67.8%, p =0.029) and advanced clinical stage (stage IVA-IVB) enrolled in the NACT group (55.2% vs 26.7%, p =0.002). For NACT, both MEPFL and P-FL had similar 5-year DFS and OS (52.9% vs 50%, p =0.860 and 73.5% vs 62.5%, p =0.342, respectively). For CCRT, both PF4 and Cis 100 had similar 5-year DFS and OS (62.8% vs 69.6%, p =0.49 and 72.9% vs 73.9%, p =0.72, respectively). Compared to CCRT, NACT had similar 5-year DFS and OS (51.5% vs 65.1%, p =0.28 and 71.7% vs 74.3%, p =0.91, respectively). Among patients who were recurrence-free in the first 2 years after treatment, those treated with NACT experienced poorer locoregional control compared to those treated with CCRT (Hazard ratio =2.57, 95% confidence interval: 1.02 to 6.47, p =0.046). Conclusions For LA-NPC, both CCRT and NACT were similarly efficacious treatment strategies in terms of long-term disease control and survival probability. Close locoregional follow-up is recommended for patients receiving NACT, because these patients are more prone to develop locoregional failure than patients receiving CCRT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chia-Jui Yen
- Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan.
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Ren H, Lim CM, Wei Goh S, Hee R, Jin Saw J, Kim J. Nasoveillance: Delivering in Vivo Surveillance for Nasopharyngeal Carcinoma1. J Med Device 2014. [DOI: 10.1115/1.4027071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hongliang Ren
- Department of Biomedical Engineering, National University Hospital, National University of Singapore, 117575, Singapore e-mail:
| | - Chwee-Ming Lim
- Department of Otolaryngology, National University Hospital, National University of Singapore, 117575, Singapore
| | - Si Wei Goh
- Department of Biomedical Engineering, National University Hospital, National University of Singapore, 117575, Singapore
| | - Rina Hee
- Department of Biomedical Engineering, National University Hospital, National University of Singapore, 117575, Singapore
| | - Jhen Jin Saw
- Department of Biomedical Engineering, National University Hospital, National University of Singapore, 117575, Singapore
| | - JaeJung Kim
- Department of Biomedical Engineering, National University Hospital, National University of Singapore, 117575, Singapore
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25
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Gao Y, Huang HQ, Bai B, Cai QC, Wang XX, Cai QQ. Treatment outcome of docetaxel, capecitabine and cisplatin regimen for patients with refractory and relapsed nasopharyngeal carcinoma who failed previous platinum-based chemotherapy. Expert Opin Pharmacother 2013; 15:163-71. [PMID: 24295173 DOI: 10.1517/14656566.2014.866652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although cisplatin combined with 5-fluorouracil is a common first-line regimen for advanced nasopharyngeal carcinoma (NPC), there are no standard regimens for refractory or relapsed patients. A study of DXD regimen [cisplatin (D), capecitabine (X) and docetaxel (D)] was conducted to evaluate the efficacy and toxicity for patients with refractory or relapsed NPC. METHODS The regimen was administered as follows: 50 mg/m(2) docetaxel and 50 mg/m(2) cisplatin on day 1 and 800 mg/m² capecitabine on days 1 - 14, repeated every 3 - 4 weeks. RESULTS Thirty patients were enrolled. The overall response and complete remission rate was 46.4 and 21.4%. Median follow-up was 24 months; median overall survival (OS) and progression-free survival (PFS) were 14.0 and 8.0 months. Five-year OS and PFS rates were 14.8 and 13.3%, respectively. Four patients achieved long-term tumor-free survival (range, 53.8 - 125.3 months). Multivariate analysis demonstrated that Epstein-Barr virus DNA status (p = 0.003) and therapeutic effect (p < 0.001) were significant independent factors for OS and PFS. The main grade 3/4 toxicities included neutropenia (26.6%), anemia (13.3%) and thrombocytopenia (10.0%). There were no chemotherapy-related deaths. CONCLUSION The DXD regimen appeared to be effective and well tolerated by patients with refractory or relapsed NPC. Further investigation is warranted.
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Affiliation(s)
- Yan Gao
- Sun Yat-sen University Cancer Center, Department of Medical Oncology , 651 Dongfeng East Road, Guangzhou, Guangdong 510060 , P. R. China +011 86 20 87343350 ;
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Cheah SK, Lau FN, Yusof MM, Phua VCE. Treatment Outcome with Brachytherapy for Recurrent Nasopharyngeal Carcinoma. Asian Pac J Cancer Prev 2013; 14:6513-8. [DOI: 10.7314/apjcp.2013.14.11.6513] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Xu T, Tang J, Gu M, Liu L, Wei W, Yang H. Recurrent nasopharyngeal carcinoma: a clinical dilemma and challenge. ACTA ACUST UNITED AC 2013; 20:e406-19. [PMID: 24155638 DOI: 10.3747/co.20.1456] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recurrent nasopharyngeal carcinoma, which represents a small proportion of head-and-neck cancers, has a unique set of patho-clinical characteristics. The management of recurrent nasopharyngeal carcinoma remains a challenging clinical problem. Traditional treatments offer limited local control and survival benefits; more seriously, they frequently induce severe late complications. Recently, novel treatment techniques and strategies-including precision radiotherapy, endoscopic surgery or transoral robotic resection, third-generation chemotherapy regimens, and targeted therapies and immunotherapy-have provided new hope for patients with recurrent nasopharyngeal carcinoma. Some of these patients can potentially be cured with modern treatments. However, a lack of adequate evidence makes it difficult for clinicians to apply these powerful techniques and strategies. Individualized management guidelines, full evaluation of quality of life in these patients, and a further understanding of the mechanisms underlying recurrence are future directions for research into recurrent nasopharyngeal carcinoma.
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Affiliation(s)
- Tao Xu
- Department of Radiation Oncology, First People's Hospital of Foshan Affiliated to Sun Yat-Sen University, Foshan, PR China. ; Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
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Imaging appearances for recurrent nasopharyngeal carcinoma and post-salvage nasopharyngectomy. Clin Radiol 2013; 68:e629-38. [PMID: 23937825 DOI: 10.1016/j.crad.2013.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/27/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a head and neck neoplasm that occurs in endemic numbers among people of southern Chinese descent. External beam radiation to the nasopharyngeal bed and primary draining lymph node echelons is the mainstay of treatment with concurrent cisplatin-based chemotherapy for more advanced disease. Detection of residual and/or recurrent NPC has important clinical implications, as salvage protocols are available. The review aims to increase awareness of the imaging features of NPC recurrences at local and distant sites using computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET). Important changes in imaging seen in patients after nasopharyngectomy are also discussed.
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Chen M, Tang LL, Sun Y, Mao YP, Li WF, Guo R, Liu LZ, Li L, Lin AH, Ma J. Treatment outcomes and feasibility of partial neck irradiation for patients with nasopharyngeal carcinoma with only retropharyngeal lymph node metastasis after intensity-modulated radiotherapy. Head Neck 2013; 36:468-73. [PMID: 23780916 DOI: 10.1002/hed.23314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to summarize the treatment outcomes and evaluate the feasibility of partial neck irradiation in patients with nasopharyngeal carcinoma (NPC) with only retropharyngeal lymph nodes (RLNs) metastasis. METHODS Between January 2003 and December 2007, 54 patients with NPC who received partial neck irradiation to levels II, III, and VA and 100 patients who received whole neck irradiation were reviewed. RESULTS The 5-year disease free survival (DFS), disease metastasis-free survival, (DMFS) local relapse-free survival (LRFS), and regional relapse-free survival (RRFS) rates were 81.8%, 87.7%, 94.8%, and 98.1%, respectively. The 5-year RRFS and DFS rates for the partial neck irradiation group and whole neck irradiation group were 98.1% versus 98.0% (p = .882), 87.0% vs 77.0% (p = .117), respectively. Partial neck irradiation was not considered a significant prognostic factor for any endpoint in univariate and multivariate analyses. CONCLUSION Partial irradiation of neck levels II, III, and VA might be acceptable for patients with NPC with only RLN metastasis.
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Affiliation(s)
- Mo Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, People's Republic of China
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Chan SC, Kuo WH, Wang HM, Chang JTC, Lin CY, Ng SH, Hsu CL, Chang KP, Liao CT, Lin YJ, Yen TC. Prognostic implications of post-therapy (18)F-FDG PET in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy. Ann Nucl Med 2013; 27:710-9. [PMID: 23715831 DOI: 10.1007/s12149-013-0736-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Reliable prognostic factors that serve as a guide to follow-up of patients with locoregionally advanced nasopharyngeal carcinoma (NPC) have not yet been identified. We sought to investigate the prognostic implications of post-therapy PET in patients with NPC treated with chemoradiotherapy. METHODS Patients with locoregionally advanced NPC (stages III and IVa-b) who had completed primary curative treatment for 3 months were eligible. All of the patients underwent (18)F-FDG PET and conventional work-up (CWU) for the assessment of treatment response. RESULTS A total of 165 patients were enrolled. Over a median follow-up of 58 months, 30 patients died and 41 had disease recurrence. The results of the 3-month post-therapy PET and total lesion glycolysis (TLG) of the primary tumor were independent predictors of overall survival. TNM tumor stage, TLG, and post-therapy PET findings were independently associated with disease-free survival (DFS). The results of post-therapy PET were more predictive of DFS than TNM tumor stage (P < 0.001 vs. P = 0.005). Among patients with stage IVa-b disease, there was a trend toward better 5-DFS rates in patients with a complete metabolic response (CMR) on PET than in those who showed a complete response in the CWU (5-year DFS = 70.7 vs. 63.1 %). Notably, the 1- and 2-year DFS rates were significantly better in the former group compared with the latter. In contrast, the results of post-therapy CWU were not a reliable predictor for DFS. CONCLUSION The results of post-therapy PET are an important independent prognostic factor in locoregionally advanced NPC. CMR on PET is associated with better DFS rates and could serve as a guidance to individualize the surveillance protocols for patients with stage IVa-b disease.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan,
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Khoo ASB, Pua KC. Diagnosis and Clinical Evaluation of Nasopharyngeal Carcinoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013. [DOI: 10.1007/978-1-4614-5947-7_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Lee AWM, Fee WE, Ng WT, Chan LK. Nasopharyngeal carcinoma: salvage of local recurrence. Oral Oncol 2012; 48:768-74. [PMID: 22425246 DOI: 10.1016/j.oraloncology.2012.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
Local control of nasopharyngeal carcinoma has substantially improved with advancing radiotherapy technology and appropriate combination with chemotherapy. However, when local recurrence occurs, this is one of the most difficult challenges. Aggressive treatment is indicated because long term salvage is achievable particularly for early recurrence, but high risk of complications is a serious concern. Treatment options include different methods of surgery and/or re-irradiation with/without chemotherapy. Available information in the literature is grossly inadequate; most reports compose of small series of highly selected patients with heterogeneous characteristics and treatment. No randomized trials have been performed to evaluate the therapeutic ratio of different treatment methods. This article reviews available treatment options, their therapeutic benefits and risks of complications; the objective is to provide information for developing treatment recommendations and suggestions for future improvement.
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Affiliation(s)
- Anne W M Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
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Li JX, Lu TX, Huang Y, Han F. Clinical characteristics of recurrent nasopharyngeal carcinoma in high-incidence area. ScientificWorldJournal 2012; 2012:719754. [PMID: 22448138 PMCID: PMC3289855 DOI: 10.1100/2012/719754] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 12/07/2011] [Indexed: 11/17/2022] Open
Abstract
Background. To describe the clinical characteristics of the patients who suffered from relapse after conventional irradiation for nasopharyngeal carcinoma (NPC). Methods. Three hundred and fifty-one consecutive patients with first-time recurrent NPC between January 1999 and July 2005 were included. The patients' clinical data were reviewed, including recurrent interval time, symptoms, signs, imaging characteristics, pathologic features, and restaging. Results. The median interval of relapse was 26.0 months. The most common symptoms in symptomatic patients were nasal bloody discharge (37.9%) and headache (31.1%). Local recurrence alone accounted for 73.5%. Most patients were restaged as stage III (23.1%) and stage IV (51.1%). Subgroup analysis suggested a significantly higher proportion of the long-latent relapses originated from early primary. A series of postreirradiation complications were more frequent in patients with longer latency at reception. Conclusions. Most recurrent nasopharyngeal carcinoma is advanced disease. Patients with different recurrent interval time show different nature behavior.
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Affiliation(s)
- Jia-Xin Li
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University, Guangzhou 510060, China
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Gao Y, Zhu G, Lu J, Ying H, Kong L, Wu Y, Hu C. Is Elective Irradiation to the Lower Neck Necessary for N0 Nasopharyngeal Carcinoma? Int J Radiat Oncol Biol Phys 2010; 77:1397-402. [DOI: 10.1016/j.ijrobp.2009.06.062] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 06/22/2009] [Accepted: 06/23/2009] [Indexed: 11/24/2022]
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Wildeman MAM, Nyst HJ, Karakullukcu B, Tan BI. Photodynamic therapy in the therapy for recurrent/persistent nasopharyngeal cancer. HEAD & NECK ONCOLOGY 2009; 1:40. [PMID: 20017928 PMCID: PMC2809049 DOI: 10.1186/1758-3284-1-40] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 12/17/2009] [Indexed: 11/10/2022]
Abstract
To determine the efficacy of Photodynamic therapy of patients with recurrent Nasopharyngeal Carcinoma we reviewed all available literature. Since the treatment options for recurrent or persistent Nasopharyngeal Carcinoma are limited, the survival rates poor and the complications severe; there is definitely a place for alternative treatment modalities with more efficacy and less morbidity. Photodynamic therapy (PDT) has the potential to be a very effective local treatment modality for recurrent or persistent nasopharyngeal cancer, without the severe side effects seen with re-irradiation. This review shows all reported results of Photodynamic therapy in the treatment for Nasopharyngeal Carcinoma.
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Affiliation(s)
- Maarten A M Wildeman
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Hara W, Loo BW, Goffinet DR, Chang SD, Adler JR, Pinto HA, Fee WE, Kaplan MJ, Fischbein NJ, Le QT. Excellent local control with stereotactic radiotherapy boost after external beam radiotherapy in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2007; 71:393-400. [PMID: 18164839 DOI: 10.1016/j.ijrobp.2007.10.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Revised: 10/04/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine long-term outcomes in patients receiving stereotactic radiotherapy (SRT) as a boost after external beam radiotherapy (EBRT) for locally advanced nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS Eight-two patients received an SRT boost after EBRT between September 1992 and July 2006. Nine patients had T1, 30 had T2, 12 had T3, and 31 had T4 tumors. Sixteen patients had Stage II, 19 had Stage III, and 47 had Stage IV disease. Patients received 66 Gy of EBRT followed by a single-fraction SRT boost of 7-15 Gy, delivered 2-6 weeks after EBRT. Seventy patients also received cisplatin-based chemotherapy delivered concurrently with and adjuvant to radiotherapy. RESULTS At a median follow-up of 40.7 months (range, 6.5-144.2 months) for living patients, there was only 1 local failure in a patient with a T4 tumor. At 5 years, the freedom from local relapse rate was 98%, freedom from nodal relapse 83%, freedom from distant metastasis 68%, freedom from any relapse 67%, and overall survival 69%. Late toxicity included radiation-related retinopathy in 3, carotid aneurysm in 1, and radiographic temporal lobe necrosis in 10 patients, of whom 2 patients were symptomatic with seizures. Of 10 patients with temporal lobe necrosis, 9 had T4 tumors. CONCLUSION Stereotactic radiotherapy boost after EBRT provides excellent local control for patients with NPC. Improved target delineation and dose homogeneity of radiation delivery for both EBRT and SRT is important to avoid long-term complications. Better systemic therapies for distant control are needed.
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Affiliation(s)
- Wendy Hara
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA
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Terlikiewicz J, Makarewicz R, Lebioda A, Kabacińska R, Biedka M. An analysis of outcomes, after re-irradiation by HDR (high-dose-rate) brachytherapy, among patients with locally recurrent nasopharyngeal carcinoma (NPC). Rep Pract Oncol Radiother 2005. [DOI: 10.1016/s1507-1367(05)71092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
NPC represents 0.2% of malignant disease in the white population but is more common in southern China, among Chinese in East Asia and the United [figure: see text] States, and in North Africa, including Saudi Arabia. NPC in these ethnic groups tends to manifest at a younger age. Undifferentiated carcinoma is the most common histopathologic type and is associated with EBV. The tumor is optimally assessed with CT and MR imaging for staging; PET scanning provides optimal assessment of recurrent tumor or small lymph node metastases. The primary tumor in the nasopharynx may be small and infiltrating, causing no or only a small mass effect in the nasopharynx. In these cases, obliteration of fat planes and loss of muscle boundaries are important diagnostic findings, which are best evaluated with MR imaging including, Gd-DTPA with fat suppression. The size of the NPC varies from 1 to 2 cm to large tumors that extend to the oropharynx, PPS, nasal cavities, paranasal sinuses, and orbits. Skull base erosion is independent of the size of the nasopharyngeal tumor and ranges from slight erosion to extensive destruction. A concomitant finding is intracranial invasion, predominantly to the basal cisterns and cavernous sinuses associated with cranial nerve palsies. Intracranial invasion should be assessed with contrast MR imaging. Lymph node metastases in the neck are present in 90% of cases and are bilateral in 50% of cases. In a small percentage of cases, extension of lymph node metastases to the mediastinum and hilar areas are encountered. Distant metastases involve the lungs, skeleton, and liver, and occasionally the choroid. They are usually present at the initial presentation [figure: see text] and increase in frequency in advanced disease and in recurrent tumors. In addition, the metastatic lymph nodes in the neck reveal no specific imaging features that would allow differentiation from other lymph node metastases. They may be discrete, often multiple, and large and bulky displaying a variable degree of necrosis and enhancement following introduction of contrast material. Local recurrence manifests commonly within the first 2 to 3 years posttherapy and is optimally evaluated by MR imaging and PET scanning.
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Affiliation(s)
- Alfred L Weber
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Ong YK, Heng DM, Chung B, Leong SS, Wee J, Fong KW, Tan T, Tan EH. Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer 2003; 39:1535-41. [PMID: 12855259 DOI: 10.1016/s0959-8049(03)00310-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The survival outcome of patients with systemic cancer differs significantly between individuals even within the same tumour type. We set out to illustrate this by analysing the factors determining survival in patients with metastatic disease from nasopharyngeal carcinoma (NPC) and to design a scoring system based on these prognostic factors. Patients referred between January 1994 and December 1999 were retrospectively analysed. Factors analysed included patient (age group, gender, performance status (BS) at diagnosis of metastases), disease (number of metastatic sites, specific metastatic sites, disease-free interval (DFI), metastases at presentation, presence of locoregional recurrence), and laboratory factors (leucocyte count, haemoglobin level, albumin level). Univariate and multivariable analyses were performed using the Cox proportion hazards model. A numerical score was derived from the regression coefficients of each independent prognostic variable. The prognostic index score (PIS) of each patient was calculated by totalling up the scores of each independent variable. Independently significant, negative prognostic factors were liver metastasis, lung metastasis, anaemia, poor PS, distant metastasis at initial diagnosis, and a DFI of <6 months. Three prognostic groups based on the PIS were obtained: (i) good risk (PIS=0-6); (ii) intermediate risk (7-10); (iii) poor risk (>or=11). The median survivals for these groups were 19.5, 10, and 5.8, months, respectively, (log rank test: P<0.0001). The variable prognosis of patients with disseminated NPC can be assessed by using easily available clinical information (patient, disease and laboratory factors). The PIS system will need to be validated on prospectively collected data of another cohort of patients.
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Affiliation(s)
- Y K Ong
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
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Law SCK, Lam WK, Ng MF, Au SK, Mak WT, Lau WH. Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy: an effective means of local salvage. Int J Radiat Oncol Biol Phys 2002; 54:1095-113. [PMID: 12419437 DOI: 10.1016/s0360-3016(02)03009-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the role of intracavitary mold brachytherapy in salvaging local failure of nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS The outcomes of 118 consecutive NPC patients with local failure treated with mold brachytherapy between 1989 and 1996 were retrospectively reviewed. Eleven patients received additional external radiotherapy. RESULTS All molds were tailor-made, and the whole procedure was performed under local anesthesia. Pharyngeal recess dissection was routinely performed to allow direct contact of the radioactive source with the pharyngeal recess, a common site of local failure. Initially, the molds were preloaded with 192Ir wires, but since 1992, the sources have been manually afterloaded; the mold has also been redesigned for better conformity, ease of insertion, and radiation safety. Using brachytherapy alone, 50-55 Gy was given for recurrence in 4-7 days; for persistence, 40 Gy was administered. The overall complete remission rate was 97%. The rates of 5-year local control, relapse-free survival, disease-specific survival, overall survival, and major complication were 85%, 68.3%, 74.8%, 61.3%, and 46.9%, respectively. Major complications included nasopharyngeal necrosis with headache, necrosis of cervical vertebrae with atlantoaxial instability, temporal lobe necrosis, and palsy of the cranial nerves. The afterloaded mold was as effective as the preloaded version, but with fewer complications. CONCLUSIONS Intracavitary mold brachytherapy was effective in salvaging NPC with early-stage local persistence or first recurrence.
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Affiliation(s)
- Stephen C K Law
- Department of Clinical Oncology, Block R, 30 Gascoigne Road, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
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Wong CS, Luk SH, Leung TW, Yuen KK, Sze WK, Tung SY. Sphenoid sinus mucocoele and cranial nerve palsies in a patient with a history of nasopharyngeal carcinoma: may mimic local recurrence. Clin Oncol (R Coll Radiol) 2002; 13:353-5. [PMID: 11716228 DOI: 10.1053/clon.2001.9288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
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Surgical options for continuing treatment of recurrent nasopharyngeal carcinoma. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200004000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lung PT. Recurrent nasopharyngeal carcinoma: the puzzles of long latency: regarding Lee AWM, et al IJROBP 44:149-156; 1999. Int J Radiat Oncol Biol Phys 1999; 45:1359. [PMID: 10613334 DOI: 10.1016/s0360-3016(99)00314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee AW. In response to Dr. P. Teo. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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