The purposes of treatment of early nasopharyngeal carcinoma are to improve the survival rate and the quality of life.The combination of external beam irradiation with brachytherapy may decrease the dose of external irradiation,so the late radiation complication may be reduced.With the application of intensity modulated radiation therapy,there were more conformity and dose distribution to the target volume.It can increase the local control rate and further improve the survival rate.On the other side it can protect the surrounding normal tissue such as parotid gland,brain stem,spinal cord,etc. The incidence of xerostomia can be reduced.So the quality of life was improved.The combination of irradiation with target therapy may improve the treatment outcome in advanced nasopharyngeal carcinoma,the role in early NPC will further be investigated.

The postoperative pathological status of head and neck cancer is the determining factor for the use of radiotherapy. It is still unknown whether the interval between operation and postoperative radiotherapy has any impact on local control of the disease.However, from the radiobiological point of view, early postoperative radiotherapy is preferred, especially for patients with high-risk factors. Research has shown that concurrent chemoradiotherapy could improve the local control rate、overall survival rate and disease-free survival rate for head and cancer without surgery. Concurrent chemoradiotherapy was also recommended to the postoperative patients even though the acute toxicities might be increased significantly, but no evidence showed that it would aggravate late injuries including second primary neoplasm. The role of modern radiation technology and targeted therapy in adjuvant treatment of head and neck cancer needs to be further clarified.

Nasopharyngeal carcinoma is the commonest head and neck cancer in China and especially sensitive to both chemotherapy and radiotherapy. But radiotherapy alone has disappointing effect to local advanced cases. Nevertheless,chemoradiotherapy provides long term survival. This paper summarized the current status of the different ways of chemoradiotherapy such as induction,concurrent,adjuvant chemotherapy.

Background and purpose:Concurrent chemoradiotherapy followed by adjuvant chemotherapy have been administrated to locally advance nasopharyngeal carcinoma according to the NCCN guidelines.This study s pecifically evaluated the efficacy,toxicity and compliance of modified concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma(NPC).Methods:From Nov.2003 to Apr. 2005,67 patients with stageⅢandⅣlocally advanced nasopharyngeal carcinoma(NPC)were enrolled in this study.A total dosage of radiation,70-74 Gy,was given in 35-37 fractions in 5 fractions per week.Two cycles of chemotherapy, consisting of cisplatin 25 mg/m2?d-1 and 5-fluorouracil 300 mg/m2?d-1 were delivered simultaneously with radiotherapy on the day 1-3 during week 1 and 5.Three cycles of adjuvant chemotherapy,consisting of cisplatin 25 mg/m2?d-1 and fluorouracil 450 mg/m2?d-1,were also given,starting on day 1-3 during week 10,13 and 16.Results:The median follow-up was 20 months(ranged from 11 to 27 months).The 2-year overall survival rate and the 2-year diseasefree survival rate were 91.75%and 81.56%respectively.The 2-year overall survival rate was 96%for stageⅢand 87.65%for stageⅣ(P=0.334).The 2-year disease-free survival rate was 92.16%for stageⅢand 69.35%for stageⅣ respectively(P=0.2358).The compliance rates were 100%for radiotherapy,47 cases(70.1%)for all chemotherapy, 56 cases(83.6%)for concurrent chemotherapy and 48 cases(71.6%)for adjuvant chemotherapy.The main grade Ⅲ/Ⅳacute toxicity events during concurrent chemoradiotherapy were neutropenia in 15 patients(21.4%),vomitting and nausea in 2 patients(3%),mucositis in 56 patients(83.6%),and gradeⅢskin reaction in 10(15%),respectively. The main gradeⅢ/Ⅳacute toxicity events during adjuvant chemotherapy were neutropenia in 13 patients(19.4%), grade 3 anemia in 2 patients(1.5%)respectively.Conclusion:The primary result showed a good compliance,lower incidences of toxicity and improved early outcome of treatments for the patients with stageⅢand stageⅣ(M0)NPC. The ultimate therapeutic ratio will be updated according to longer follow-ups.

Emerging clinical evidence revealed that postoperative adjuvant chemoradiotherapy (CRT) could improve the clinical outcome for resected head and neck squamous cell carcinoma in high-risk patients. The irradiation targets and doses should be determined by the primary tumor site, clinical stage, pathology reports, and the evaluation of postoperative imaging. Adjuvant concurrent CRT with cisplatin is the current standard treatment for high-risk postoperative head and neck squamous cell carcinoma patients. However, the effect of concurrent CRT with other chemotherapeutic agents and (or) epidermal growth factor receptor (EGFR) monoclonal antibody in these patients is inconclusive. Human papillomavirus (HPV)-positive oropharyngeal cancer has the unique biological characteristics, and the indications and treatment models of postoperative adjuvant CRT for these patients are still unclear. Further study is needed.

Nearly 50% patients with head and neck cancer after radiotherapy will recurrence in the previous radiation fields.Salvage surgery is the first choice of treatment.Clinical studies have shown that a small number of patients with recurrent head and neck cancer can benefit from salvage surgery plus postoperative re-irradiation or re-irradiation with or without chemotherapy or targeted therapy,and these patients can achieved tumor control and long-term survival.However, the overall efficacy is not satisfactory, and often accompanied by severe acute and late, and even fatal treatment-related toxicity.Therefore, it is necessary to give full consideration to the condition of recurrent tumor, the first radiotherapy related factors and the patient′s related status before implementation of re-irradiation.The development of radiotherapy technology and comprehensive treatment, including the clinical application of proton and heavy ion and immune therapy, provides the possibility of improving the prognosis and reducing treatment-related toxicity for these patients.

Cerebral radiation necrosis (CRN) is a serious complication of radiotherapy for intracranial tumors and skull base tumors.Since there lacked effective therapeutic methods in the past,CRN was once considered to be progressive and irreversible.With the development of histopathology and neuroimaging,the development and progression of CRN is gradually clarified,and new therapeutic methods have been developed.In recent years,the scholars at home and abroad have tried to use bevacizumab (a humanized monoclonal antibody targeting vascular endothelial growth factor),nerve growth factor,and ganglioside in the treatment of CRN and have achieved definite therapeutic effects.In some patients,cerebral necrosis was even repaired and reversed.This article reviews the incidence,pathophysiology,treatment,and prognosis of CRN.

Objective Adenoid cystic carcinoma (ACC), a rare malignancy in head and neck region, is predominately found in the salivary glands. Our study is to retrospectively analyze the treatment outcomes and prognostic factors of ACC originated from the major salivary glands. Methods A total of 54 patients diagnosed as ACC were treated in our institution, including 24 cases originated from the parotid gland and 30 from the submandibular or sublingual gland. According to the records, 26 patients received surgery alone and 28 were treated with surgery followed by radiotherapy with a median dose of 58 Gy (range, 50 -65 Gy). Results The Follow-up rate was 94%, and 15 patients from postoperative radiotherapy group and 20 from surgery alone group were followed up more then 5 years. The 5-year overall survival rate, local-regional control rate, distant metastasis rate, and disease-free survival rate were 97%, 71%, 13% and 69%, respectively. Lung metastasis, occurred in 7 patients, was the most common distant failure. Fifteen recurrences were observed, including 13 in surgery alone group and 2 in postoperative radiotherapy group. The 5-year local-regional control and disease-free survival rates were 90% and 85% for patients treated with postoperative radiotherapy, 54% and 55% for those treated with surgery alone. Univariate and multivariate analyses showed that postoperative radiotherapy was the only prognostic factor of local-regional control and survival rates. Other parameters such as nerve involvement did not significantly influence the treatment results. Conclusions Postoperative radiotherapy can improve the prognosis of ACC originate from the major salivary glands compared with surgery alone. Distant metastasis is an obstacle in curing the disease, which indicates the value of systemic treatment.

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.

Purpose:To investigate the possibilities of three-dimensional conformal radiotherapy (3DCRT) in treating the patients with recurrent nasopharyngeal carcinoma;and planning optimization,dosimetry analysis for recurrent disease in different sites.Methods:Three patients with recurrent disease in posterior area of styloid process、cavernous sinus and with maximum volume were analysed. Comparison was made for optimized 3DCRT treatment planning with different number of beams and angles of incidences.Results:It is possible to significantly improve the dose coverage to target volume and the dose to critical organ was under the tolerance dose.Conclusions:3DCRT may be a suitable alternative to conventional therapy in patients with recurrent nasopharyngeal carcinoma.