Objective To analyze the treatment results of intracavitary hyperfractionated brachytherapy for nasopharyngeal carcinoma and to determine the optimal dose of external radiation. Methods From February 1996 to June 1998, 128 patients with T1 2 nasopharyngeal carcinoma were treated with external radiotherapy followed by intracavitary brachytherapy. The majority of them had residual tumor less than 10 mm after external radiotherapy. The external radiation doses were divided into 3 groups: 56 Gy, 60 Gy and 66 Gy. Brachytherapy was delivered with 2.5 3.0 Gy per fraction, 2 fractions a day with an interval of 6 hours. The total doses ranged from 12 to 24 Gy with a median of 18 Gy. Results The disease free survival rates at 3 and 4 years for all patients were 84.2% and 74.9%, respectively. The corresponding local relapse free survival rates were 97.1% and 92.7%, respectively. The 3 year disease free survival rates and local relapse free survival rates were 83.6% and 100% for 56 Gy group, 88.4% and 90.9% for 60 Gy group, and 84.6% and 93.3% for 66 Gy group, respectively,all with differences in significant. Radiation complications were rare. Conclusions We suggest that patients with residual tumor less than 10 mm after external radiotherapy should receive intracavitary brachytherapy as a boost. The dose of external radiotherapy for T1 2 stage NPC can be decreased to 56 Gy.

Objective To study the results of external beam radiotherapy plus 192 Ir hyperfractionated high dose rate interstitial brachytherapy (HHDR-IBT) for cancer of the oral cavity and oropharynx. Methods Fourty-eight patients with cancer of the oral cavity and oropharynx were treated by external beam radiotherapy (T 1,T 2 30～50 Gy,T 3,T 4 50～60 Gy) followed by 192 Ir HHDR-IBT delivering 15～35 Gy (30～35 Gy for T 1,T 2 and 15～30 Gy for T 3,T 4 in 250～350 cGy per fraction,two fractions per day). Over 3～5 days. Results The complete response rates at 3 months were T 1100% (5/5),T 2 85%(23/27),T 3 46%(6/13),T 4 0%(0/3) and the partial reponse rates:T 2 15% (4/27), T 3 54%(7/13), T 4 100%(3/3). The 3-year survival and disease-free survival rates were 79.4% and 55.8%,respectively.Multivariate analysis showed that TNM stage and pathalogic type were prognostic factors.Conclusions Carcinoma of the oral cavity and oropharynx treated with external beam radiotherapy combined with 192 Ir hyperfractionated high dose rate interstitial brachytherapy ia able to give a good local control for T 1,T 2 lesions with good functional preservation. For T 3,T 4 lesions,this method is able to offer a high palliation.

ObjectiveTo evaluate the outcomes and toxicities of elderly nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy alone.MethodsFrom January 1995 to December 1998,95 newly diagnosed nasopharyngeai carcinoma with age ≥65 years treated in our hospital.The clinical data were analyzed retrospectively.Kaplan-Meier method was used for analysis of local-regional control survival and distant metastasis-free survival. The Logrank test was used for univariate prognostic analysis and Cox regression was used for multivariable prognostic analysis.ResultsThe follow-up rate was 98％.The 3-,5- and 8-year local-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 89％,87％,84％ and 85％,79％,79％,respectively. The most common acute toxicities were grade1-2 leukopenia (36％),skin reaction (64％) and mucositis (66％).The most frequent late toxicities were hearing impairment (8％),trismus ( 10％ ) and radiation-induced cranial neuropathy (5％).In univariate analysis,interruption of radiotherapy ( χ2 =7.45,P =0.006 ) and regional neck lymph nodes response (χ2 =4.17,P=0.041 ) was the prognostic factors for LRC,T stage (χ2 =4.16,P=0.032),N stage ( χ2 =4.66,P =0.031 ) and interruption of radiotherapy ( χ2 =9.42,P =0.002 ) was the prognostic factors for DMFS. In multivariable analysis,interruption of radiotherapy and the regional neck lymph nodes response were the prognostic factors for LRC (χ2=6.19,P=0.013 and χ2=12.16,P=0.002;respectively),N stage and radiotherapy interruption were prognostic factors for DMFS.(χ2=15.06,P =0.000 and χ2 =21.62,P =0.000 ; respectively ).ConclusionsConventional radiotherapy alone for elder NPC can produce satisfactory results with acceptable treatment-relative toxicities.Our experience showed that the early N stage,without radiotherapy interruption and good regional lymph nodes response had a good longterm prognosis.

Objective To determine the diagnostic value of diffusion weighted imaging(DWI) for primary nasopharyngeal carcinoma(NPC) and metastatic lymph nodes,and to establish the diagnostic thresh-old of apparent diffusion coefficients(ADCs). Methods Conventional MR scans and DWI scans were con-tinuously performed in 56 patients with newly diagnosed NPC and 55 healthy volunteers. All patients re-ceived primary tumor biopsy and MR image-guided cervical lymph node fine-needle biopsy. ADC and eADC values of both primary lesions and lymph nodes were calculated and compared. Results According to the pathological diagnosis,all the 56 patients had non-keratinizing carcinoma and 51 had lymph node metastasis. In the control group,75 cervical lymph nodes were found. ADC values of both primary NPC and metastatic lymph nodes were significantly lower, while eADC values were higher than those of normal controls. Setting the ADC value threshold at 0.809 ×10-3 mm2/s, the sensitivity and specificity for primary NPC detection were 80.4% and 74.5%, respectively. The negative and positive predictive values were 79.2% and 77.6% ,respectively. The accuracy was 78.4%. Setting the ADC value threshold at 0. 708×10-3 mm2/s, the sensitivity and specificity in the detection of metastatic cervical lymph nodes were 43.1% and 93.3%, respectively. The negative and positive predictive values were 70.7% and 81.5% ,respectively. The accura-cy was 73.0%. Conclusions DWI might be a new diagnostic approach in the detection of primary NPC as well as metastatic lymph nodes.

margin from CTV to PTV.

Objective To study the outcomes of nasopharyngeal carcinoma treated by late-course 3-dimentional conformal radiotherapy(3DCRT). Methods 37 primary nasopharyngeal carcinomas were involved into the CRT group. A total dose of 70 Gy to 74 Gy was delivered by using the conventional method (36 Gy) and late-course 3DCRT technique (34 ~ 38 Gy). This group was matched with a same number of patients who were treated with conventional method alone (Routing group). The treatment results and acute toxicity between the two groups were analyzed. Results The complete response (CR) rate of primary tumor was achieved 100 % in CRT group and 86 % in routing group, respectively. The CRT group had severe mucositis and peripheral neuropathy, but the difference was not statistically significant. There was no difference in the overall survival between the two groups. Conclusion Late-course 3DCRT is an effective method in the treatment of primary nasopharyngeal carcinoma.

Aim Toanalyzethekeyqualityandestablishmeth-ods for essential quality control of human recombinant ASPP2 adenovirus.Methods TheviralstructuralgeneofE2Bandtar-get gene of ASPP2 were identified by PCR;The number of virus particles was measured by UV-SDS methods;Infectious titer was determined by TCID50 assay;Target protein of ASPP2 was ob-served by Western blot assay;The biological effects of recombi-nant adenovirus on liver cancer cells were evaluated by MTT as-say;A549 cells were used to check replication of the competent adenovirus(RCA)by the observation of the cytopathic effect. Results PCRanalysisofE2BandASPP2wasinconsistent with theoretical values;Particle numbers of virus were 5. 6 × 1012 VP/mL,infectious titer was 2 ×1011 IU/mL and specific activity was 3. 5%;ASPP2 protein expression could be detected when cells were infected with virus for 24 h;Growth inhibition of liver cancer cells could be found by adding recombinant ASPP 2 adenovirus;The level of RCA was less than 1 RCA/3. 0 ×1010 VP,in line with the standards of China Food and Drug Adminis-tration(SFDA).Conclusion Thequalitycontrolmethodswere established aiming at key characters of human recombinant AS-PP2 adenovirus,which may provide foundations for its quality standard and future applications.

Objective To analyze the prognosis of advanced esophageal carcinoma treated with paclitaxel and different platinum?based chemotherapy regimens plus intensity?modulated radiotherapy ( IMRT) , and to explore an optimal chemotherapy regimen. Methods A total of 242 patients with advanced esophageal carcinoma who were admitted to our hospital and treated with paclitaxel and cisplatin ( 68 patients), nedaplatin (85 patients), lobaplatin (58 patients), or oxaliplatin (31 patients) plus IMRT from 2008 to 2014 were enrolled as subjects. The prognosis of the four groups was analyzed after 2, 3, and ≥4 cycles of chemotherapy. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. The Cox model was used for the multivariate prognostic analysis. Results The sample number of 3 years was 168 cases. In all the 242 patients, the medium survival time was 31. 1 months and the 3?year overall survival ( OS) rate was 47. 4%. There was no significant difference in the 3?year OS rate between the cispaltin, nedaplatin, lobaplatin, and oxaliplatin groups ( 46. 2% vs. 56. 4% vs. 45. 7% vs. 29. 0%, P=0. 090) . The stratified analysis showed that the cisplatin, nedaplatin, and lobaplatin groups had a significantly higher OS rate than the oxaliplatin group ( 50. 1% vs. 29. 0%, P=0. 021 ) . There was no significant difference in the 3?year OS rate between patients receiving 2, 3, and≥4 cycles of chemotherapy ( 40. 1% vs. 49. 5% vs. 50. 8%, P=0. 264) . The multivariate analysis showed that esophageal tumor volume and the maximal size of metastatic lymph node were independent prognostic factors. Conclusions Combined with IMRT, paclitaxel plus cisplatin, nedaplatin, or lobaplatin?based chemotherapy achieves improved survival rates than paclitaxel plus oxaliplatin?based chemotherapy. Esophageal tumor volume and the maximal size of metastatic lymph node are independent prognostic factors.

ObjectiveTo analyze the correlation between primary tumor volume (PTV) and prognosis of nasopharyngeal carcinoma ( NPC ) treated by intensity-modulated radiotherapy ( IMRT ).Methods330 NPC patients treated by IMRT were included.Pretreatment computerized tomography image were input into tree-dimensional treatment-planning system,in which the primary tumor volume were calculated automatically.The receiver operating characteristic curve was used to determine the best cut-off point of PTV.Within the framework of UICC 2002 T stage,The PTV was divided into four groups:V1 ＜ 10cm3,V2 10-25 cm3,V3 ＞ 25-50 cm3 and V4 ＞ 50 cm3.Kaplan-Meier and Logrank test was used to analyze the survival,Cox proportion risk regression model were used to analysis the correlation between PTV and prognosis.ResultsThe mean PTV for all NPC patients was ( 34.2 ± 27.1 ) cm3 with the range of 0.4- 153.7 cm3.The 3-year overall survival for V1,V2,V3 and V4 stage were 88.6％,90.0％,91.2％ and 74.2％,respectively (x2 =12.83,P =0.005 ).There was no significant difference among V1,V2 and V3in terms of overall survival ( x2 =1.96,P =0.376).The 3-year distant metastasis-free survival and diseasesfree survival or overall survival were decrease in PTV ＞50 cm3 and PTV≤50 cm3 (77.4％:89.9％,x2 =7.24,P=0.007and 64.5％:85.1％,x2 =13.95,P=0.000 or 74.2％:90.3％,x2 =11.76,P=0.001).Multivariate analysis revealed that PTV was a adverse prognostic factors for overall survival (x2 =0.00,P =2.580).ConclusionOur data showed that the primary tumor volume had significantly impacted on the prognosis of NPC patients treated by intensity modulated radiotherapy.

Background and purpose: Cervical nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical staging, it is also one of the main factors influencing prognosis. So this study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which may provide a basis for clinical treatment and research. Methods: From Jun. 2005 to Sep. 2007,779 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiation therapy at Fujian Provincial Cancer Hospital. Diagnostic radiologists and radiation oncoiogists together assessed the nodal distribution according to the guideline CT-hased delineation of lymph node levels. Then, Chi-sqnare test was used to analyze the correlation between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. Results: Of 779 patients, 592(76.0%) had nodal involvement. The distribution was as follows: 1 in level Ⅰ,384 in level Ⅱa, 499 in level Ⅱ_b, 184 in level Ⅲ, 33 in level Ⅳ, 67 in level V_a, 21 in level V_b, 597 in retropharynx.In these patients, a total of 1 479 postive nodes, including 973 (65.79%) extracapsular spread nodes, were detected.The rate of nodal extracapsular invasion was higher when the axial diameter increased. Leap metastasis rate was 1.0%. No significant correlation was found between T stage and nodal involvement. Conclusion: The level Ⅱ and retropharyngeal node were the most frequently involved regions, they had similar metastatic rate and were both the first echo node to metastases of nasopharyngeal carcinoma. Level Ⅰ metastasis was lower. The proportion of extracapsular spread of metastatic lymph nodes increased with axial diameter of lymph nodes-dependent. The cervical node involvement of nasopharyngeal carcinoma was spread orderly down the neck, and the incidence of skip metastasis is rare. The relationship between T stage and nodal involvement has no statistical significance.