Radiation therapy is the mainstay treatment modality of nasopharyngeal carcinoma (NPC). The treatment outcome of NPC using external beam radiotherapy has been substantially improved over the past several decades. MRI has demonstrated remarkable advantage in detecting the extent of the primary tumor, and has replaced CT scan as the primary imaging modality for both diagnosis and staging for NPC. Functional imaging may further allow more precise staging of the disease and prediction of the treatment outcome. The introduction of Cobalt-60 has substantially improved the treatment outcome for NPC as compared to that in the era of Kilo-Voltage X-ray. And intensity-modulated radiation therapy (IMRT) not only improved the prognosis after treatment as compared to conventional radiotherapy, but also improved the quality of life. In addition, concurrent chemoradiation therapy has been extensively studied and become the standard treatment for locally and/or regionally advanced NPC. However,progress in radiation biology and its clinical application was not observed. This article presented a comprehensive review of the historical evolution of the diagnostic and therapeutic technologies and techniques for the management of NPC.

Objective To investigate the feasibility of ?-knife as the only treatment or a second course radiotherapy after ?-knife radiotherapy for nasopharyngeal carcinoma(NPC).Methods From Jan.1998 to Feb.2004,2 recurrent NPC patients and 8 newly diagnosed patients with lesions in nasopharynx and skull base received ?-knife radiotherapy.Among the latter 8 newly untreatment patients,2 had poorly differentiated squamous cell carcinoma in the nasopharynx,while the other 6 patients had been misdiagnosed as nasopharyngeal tumors other than NPC,including 3 clivus chordoma and 2 caverous sinus meningioma diagnosed by MR imaging,and 1 nasopharyneal fibroangioma by direct nasopharyngoscopic examination.After ?-knife radiotherapy,all the 6 non-nasopharyngeal carcinoma patients were pathologically proved to have nasopharyngeal carcinoma.The treatment of this cohort were: 8 untreated patients with ?-knife radiotherapy first as the only treatment,2 recurrent nasopharyngeal carcinoma patients with ?-knife radiotherapy as salvage treatment.Treatment after the initial ?-knife radiotherapy for these patients were: 2 no further treatment,3 with induction chemotherapy followed by conventional radiotherapy,2 with conventional radiotherapy followed by chemotherapy,2 with conventional radiotherapy alone and 1 with chemotherapy alone.The chemotherapy regimen consisted of DDP 30?mg/m~2+5-Fu 500?mg/m~2,d1-3,3 week per cycle,totally 2-3 cycles.The radiotherapy regimen consisted of two opposing faciocervical portals or preauricular plus anterior nasal portals to a total dose of 60-70?Gy within 6-7 weeks for the primary lesion and 5060?Gy for the neck nodes with the residual primary lesion boosted with 500-750 ?cGy. Results No primary lesion of the 8 newly diagnosed patients for whom the ?-knife has been given first as the only treatment was controlled.In the 2 recurrent NPC patients,shrinkage of tumor and relief of symptoms were observed after ?-knife radiotherapy.Among 8 newly diagnosed patients,6 misdiagnosed ones received chemotherapy and radiotherapy before ?-knife radiotheryapy gave survival intervals of 6.0,2.5,2.0 and 1.0 years,while one patient who was refused of radiotherapy died of distant metastasis,and the other patient who received chemotherapy alone died of uncontrolled primary lesion.Conclusions ?-knife radiotherapy alone must not be chosen as the initial only treatment for nasopharyngeal carcinoma.For recurrent NPC,?-knife radiotherapy is indicated,preferably followed by a second course conventional radiotherapy with or without chemotherapy.Giving the green light for the radiation-induced complications of the second course conventional radiotherapy after ?-knife radiotherapy awaits further observation.

Purpose: The long term results and radiation sequelae of nasopharyngeal carcinoma treated by 60 Co external irradiation plus the high dose rate afterloading intracavity radiation (AIR) were analysed.Materials and Methods:From June 1981 to December 1988, 64 patients with nasopharyngeal cacinoma were treated by 60 Co external irradiation plus the high dose rate AIR. The AIR was given as a routine boost or for residual disease. The external irradiation dose varied from 55 to 70 Gy, whereas AIR dose ranged from 10 to 45 Gy. Results: All patients were followed up for mored than 5 years. The 5-year local control rate was 82.8%. The 5-year actuarial survival and disease free rates were 75.0%,68.8% respectively . 8 cases developed distant metastases, 6 cases recurred in the nasopharynx and/or neibouring structures and 1 case ocurred bone sarcoma of hard palate. The late radiation sequelae occured in 4 cases, 1 radiation necrosis of the bone in nasal cavity and 3 radiation perforations in hard and soft palate.Conclusion: We think that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriated reduction in external irradiation dose ,and for residual disease after primary external radiotherpy. To reduce radiation sequelae applicator should be improved.

Objective To observe the findings of 1H magnetic resonance spectroscopy ( 1H MRS) and explore its value for diagnosis of radiation induced-temporal lobe necrosis in nasopharyngeal carcinoma (NPC). Methods Thirteen patients with definite clinical diagnosis of radiation induced temporal lobe necrosis in NPC underwent 1H MRS. All 1H MRS examinations were performed on a Singa Horizont 1.5 T whole body MR system with point resolved spectroscopy (PRESS) and chemical-shift selective saturation (CHESS) (TR=2000?ms,TE=144 ?ms). The voxel (2?cm ? 2?cm ? 2?cm) was positioned in both of the lesion and the contralateral side of the temporal lobe as the control (except for bilateral lesions). 2THZ]Results The interval between radiation and the examination ranged from 32 to 172 months ( median, 42 months). Eighteen lesions were observed in 13 patients (5 patients with bilateral lesions). 1H MRS was performed on 17 lesions and 8 control temporal lobes. The mean values of NAA/ Cr in the lesions and the control temporal lobes were 1.33?0.28、1.78?0.34 respectively(t=3.22, P=0.005). Three lesions showed NAA、Cho and Cr peak absent (2 lesions with Lip peak ). Among 8 patients with the control temporal lobes 1H MRS examined, Cho/Cr decreased in 6 patients (75%). Four lesions showed Lip , Lac and MI, respectively. Conclusions The radiation-induced temporal lobe necrosis shows abnormal features on 1H MRS. Significant decrease of NAA/ Cr as well as Cho/Cr are observed in most patients. 1H MRS may play a role in the diagnosis of radiation induced temporal lobe necrosis.

Objective The changes of VGluT1-like immunoreactivity(VGluT1-LI) in the trigeminal complex of the rat in different survival time after unilateral mandibular nerve transection were examined. Methods Immunocytochemical staining method and image analysis technique were performed. Results Many VGluT1-LI were observed in the trigeminal complex of the normal rat and were mainly distributed in the terminals.A weak decrease of VGIuT1-LI in the dorsal part of principal trigeminal nucleus(Vp) could be detected at the first week after unilateral transection of mandibular nerve(P

Purpose:To compare chemoradiotherapy against radiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma.Methods:From September 1995 to July 1997,eighty-six patients with histologically proven NPC who were staged according to the Fuzhou stage classification to be N 2-3 were entered. Eighty-four patients were evaluable for tumor response and survival. The patients were randomized to receive two cycles of cisplatin (DDP) 20 mg/m 2 on Days 1-3,fluorouracil (5-Fu) 500 mg/m 2 on Days 1-3,before radical radiotherapy (RT),and three cycles of postradiotherapy chemotherapy (39 patients) or radiotherapy alone (45 patients). For chemoradiotherapy (CT-RT) group,the second cycle was given on Day 14 and the radiotherapy was given on Day 27. All patients received radical radiotherapy to the nasopharynx and neck. Radiation therapy consisted of delivering 65.1-70.3 Gy in 35-37 fractions of 1.85-1.9 Gy each over 7-7.5 weeks to the primary site with external beam 60 Co in both groups. The lymph nodes of the neck were given 56.6-65.5 Gy in 7-7.5 weeks. Boost radiotherapy was given to any residual disease. The rates of radiotherapy for boosting primary site or residual lymph nodes were not significantly different in the two arms. Results:The median follow up was 5.04 years. The 5-year actuarial survival rate (ASR) was 72.3% in CT-RT arm and 58.4% in RT arm ( P =0.154). The 5-year disease free survival rate (DFS) was 59.9% in CT-RT arm and 47.7% in RT arm ( P =0.207). The 5-year free from local failure rate (FLF) in nasopharynx was 89.5% in CT-RT arm and 81.4% in RT arm respectively ( P =0.151). The 5-year FLF in neck was 88.3% in CT-RT arm and 75.2% in RT arm respectively ( P =0.134). The 5-year free from distant metastasis rate (FDM) was 76.3% in CT-RT arm and 60.3% in RT arm ( P =0.181). The median time to first distant metastasis was 1.08 years in CT-RT arm and 0.88 year in RT arm. Although the differences did not reach statistical significance,there was some benefit from adjunctive chemotherapy to radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma. Toxicities in CT-RT arm were mainly myelosuppression and nausea and vomiting. There was no significant difference in the incidence and severity of acute mucositis between the two arms during radiotherapy. There was no treatment-related death. Conclusions:This prospective randomized trial demonstrated some benefit in DFS,FLF,FDM from adjunctive chemotherapy to radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma. But the differences were not significant. The chemoradiotherapy increased neither the incidence and severity of acute mucositis nor the late reaction.

Immunofluorescence histochemistry combined with retrograde tracing technique was employed to observe the effects of masseteric nerve transection on the expression of Trk ( tropomyosin-related kinase) receptor proteins, namely TrkA, TrkB and TrkC in the trigeminal mesencephalic nucleus ( Me5 ) of the rat. At 7 and 14 days following transection of masseteric nerve through which Fluorogold (FG) was applied to identify the Me5 neurons innervating masseter, brain sections were immunohistochemically processed to detect the three Trk isoforms in FG-labeled Me5 neurons. With the percentage of double-labeled neurons to the total number of FG-labeled neurons as the index,we demonstrated ( 1 ) a significant increase in the percentage of TrkA-immunoreactive (IR) Me5 neurons at both 7 and 14 days after nerve transection, (2) no significant, but gradual, increase in the percentage of TrkB-IR Me5 neruons with longer survival time post transection and ( 3 ) little change of TrkC expression. The current findings indicate that axotomy differently affected the expression of the individual Trk receptors and these expression patterns may reflect an adaptation of the Me5 neurons to the peripheral nerve injury.

7000?cGy). The cumulative incidence of cranial nerve Ⅸ-Ⅻ palsies increased in patients with advanced N stage. Patients in the first group of treatment field had the highest risk to progress cranial nerve Ⅸ-Ⅻ palsies, followed by the second group, and the third group had the lowest risk. Only 1 in 34 patients with brachytherapy developed cranial nerve palsy. Conclusions Our retrospective data show that the radiation-induced cranial nerve palsy is a common complication in NPC patients after radiotherapy and the incidence seems to increase with the duration of the follow-up. Factors that potentially affect the injury of cranial nerve Ⅰ-Ⅶ and Ⅸ-Ⅻ are different, because of the different anatomy. Controlling the doses to the nasopharyngeal region and using faciocervical fields may help to lower the incidence of cranial nerve palsy.

15-20 years accounted for 11%,12%,14% and 10% , respectively. 260 patients had grade 3 and 4 other injuries, including 55 skin, 79 muscles/soft tissue, 36 mucosa, 79 xerostomia and 11 trismus. Among 320 patients who suffered from caries of teeth, it involved all teeth in 192 patients. Two patients had mandible necrosis. 225 patients had decline of hearing. Among 672 ears in 336 patients,194 ears had severe deafness. The overall side reaction occurrence rate was 84.5%. Conclusions Different late side reactions do exist in nasopharyngeal carcinoma patients(84.5%) with long-term survival after radiotherapy, and some patients suffer side reactions so serious as to affect their quality of life. Cranial nerve injuries are not rare, and it may occur anytime after radiation, but it dose not stop as the patients survive along.

Objective To evaluate the limitation of image-based classification and delineation of cervical nodes proposed in 1999. Methods 259 consecutive nasopharyngeal carcinoma patients received contrast-enhanced transverse CT scan from July to November in 2003, the scanning range extended from the skull base to the inferior border of the clavicle, with thickness set at 5?mm per slice from the skull base to the oropharynx, and 1?cm per slice from the oropharynx to the clavicle. Interpretation of the images and assessment of the involved nodes distribution were performed by both radiation oncologists together with diagnostic radiologists according to 1999 image-based classification and delineation of the neck. Then we evaluated whether this classification could fully cover all the lymphatic drainage areas of the neck. Results 218 cases had nodal involvements. Nodal distributions were 0 in levelⅠA, 6 in levelⅠB, 136 in level ⅡA, 171 in level ⅡB, 78 in level Ⅲ, 20 in level Ⅳ, 33 in level VA, 27 in level VB,0 in level Ⅵ and Ⅶ, 5 in supraclavicle and 102 in retropharyngeal space, respectively. Among another 57 cases who belonged to none of the above levels, 2 cases had lesions in the preauricular area, the rest 55 medial to the border of internal carotid artery, 2?cm from inferior to the skull base to the hyoid bone. Conclusions The 1999 image-based classification of the neck nodes,being essentially rational, did not fully cover the retropharyngeal space. It would be better to shift the inferior boundary of the retropharyngeal space to the level of the hyoid bone.