Objective To retrospectively analyze the influence of intensity-modulated radiotherapy (IMRT) on tumor regression in primary nasopharyngeal carcinoma (NPC).Methods 272 patients with NPC received radical radiotherapy alone,196 by IMRT with a total treatment time of 6 weeks,and 76 by bilateral field conventional radiotherapy (CRT) with the total treatment timc of 7 weeks.Results By the end of radiotherapy,the primary tumor and neck lymph node residual rates of the IMRT group were 36.7％ and 44.2％,respectively,both significantly higher than those of the GRT group (21.1％ and 26.6％,x2 =6.15,3.99,P ＜ 0.05).Three months after the radiotherapy,residual lesions were observed at the nasopharynx or neck lymph nodes in 12 of the IMRT group,with a residual rate of 6.1％,not significantly different from that of the CRT group (9.2％,7/76).The 12 residual lesions of the IMRT group all vanished completely 4 -9 months after the radiotherapy.Conclusions There is an obvious difference in regressive mode between IMRT and CRT technique in NPC treatment.At the end of IMRT,the tumor residual rate is slightly increased.However,the delivered dose of gross tumor volume (GTV) is sufficient,and the boost dose should not be delivered indiscreetly.

Objective To analyze the treatment result of radiotherapy alone for patients with early stage nasopharyngeal carcinoma (NPC) and discuss the impact of T and N stages on the prognois. Methods From January 1999 to December 2001, clinical data of 362 patients with early stage (T1-2N0-1M0,92'Fuzhou staging system) NPC treated by radiotherapy alone were reviewed. Results Median follow-up time was 70 months. The 5-year overall survival (OS) rate of the whole group was 85%. The 5-year OS rates of patients with T1N0,T2N0 and T1N1 disease were 96.6% ,91.3% and 85.8% ,which were not statistically different ( χ2 = 3.83, P ＞ 0.05). The 5-year OS rate of those with T2N1 disease was 73.1%,which was sta tistically different from the former three groups ( χ2 = 30.0 ,P ＜ 0.05 ). The 5-year local-recurrence free sur vival and 5-year regional-recurrence free survival rates had no significant difference among the four groups.The 5-year distant-metastasis free survival rates of the former three, groups were 94.9% ,97.5% and 95.6% (χ2 = 0.53, P ＞0.05). The rate of patients with T2N1 disease was 81.2%, which was significantly different from the others (χ2 =26.6,P 0.05).Conclusions Radiotherapy alone for T1N0,T2N0 and T1N1 naso pharyngeal carcinoma has a satisfactory result. With more failure of distant metastasis, patients with T2N1 disease has obviously poorer outcome than the others. Patients who have high risk of distant metastasis may need combined treatment instead of radiotherapy alone in the future study.

Objective To analyze the local control rate and the desimetric patterns of local recurrence in nasopharyngeal carcinoma(NPC)patients having been treated with standardized conventional radiotherapy and to evaluate the delineation of rational target volume.Methods From Jan.2000 to Dec.2000,476 patients with untreated NPC were treated by standardized conventional radiotherapy alone at the Sun Yat-sen University Cancer Center.The radiation ports were designed on a X-ray simulator.The nasopharyngeal lesion demonstrated by CT scan and the subclinical spread regions adjacent to the nasopharynx were defined as the target volume.Kaplan- Meier method was used to calculate the cumulative local recurrence rate.For patients with locad recurrence,the primary and recurrent local tumor volumes(V_(nx),V_(recur))were delineated with three-dimensional treatment planning system(3DTPS),and the dataset of radiation ports and delivered prescription dose to the 3DTPS were transferred according to the first treatment.The dose of radiation received by V_(recur)was calculated and analyzed with dose- volume histogram(DVH).Local recurrence was classified as:1.“in-port”with 95% or mere of the recurrence volume((recur)_V_(95))was within the 95% isedase;2.“marginal”with 20% to95% of _(recur)V_(95)within the 95% isedese; 3.“outside”with only less than 20% of _(recur)_V_(95)within the 95% isodose curve.Results With the median follow- up of 42.5 months(range 8～54 months),52 patients developed local recurrence.The 1-,2-,3 and 4-year cumulative local failure rate was 0.6%,3.9%,8.7% and 11.5%,respectively.Among the 42 local recurrent patients who could be analyzed by 3DTPS,52% were in-port,40% were marginal and 7% were outside.For most of the marginal recurrence and all the outside recurrence patients,the main reason of recurrence were related to the unreasonable design of the radiation port and inaccuracy in the interpretation image findings.Conclusions The outcome of better local control rate and the dosimetric pattern of local recurrence show that the target volume is reasonable for NPC in Sun Yat-sen University Cancer Center.Enhancing the capability of correct interpretation of images,accurate design of the radiation pouts and making most useful molecular or functional imaging techniques to escalate the local radiation dose are promising ways to improve the local control further and better.

Objective To investigate the neuroimaging features in mitochondrial encephalomyopatbies with lactic acidosis and stroke-like episodes(MELAS).Methods Twenty-two clinically diagnosed patients who came from department of neurology,Huashan hospital in October 2003 to July 2006 were analyzed for CT,MRI,MRI contrast,MRA and MRS.Results In all 22 patients,the neuroimaging results of 21 were positive.There were 9 patients lying in hemisphere,12 in both cerebral hemispheres,including occipital,parietal,temporal and frontal lobe.The abnormal areas showed low signal intensity on T_1-weighted MRI,high signal intensity on T_2-weighted MRI and fluid attenuated inversion recovery(FLAIR)images.The lesions of 12/16 patients on MR contrasted images were enhanced.The lesions of one patient showed malacoma-like changes,one showed Fahr syndrome' s change and another showed high signal intensity on MR contrasted images.Conclusion Although the neuroimaging features of MELAS are complicated,the specific ones could help to make the diagnosis.

Background: Salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC) is complicated and relatively limited. Radiotherapy, combined with effective concomitant chemotherapy, may improve clinical treatment out?comes. We conducted a phase II randomized controlled trial to evaluate the efcacy of intensity?modulated radio?therapy with concomitant weekly cisplatin on locally recurrent NPC. Methods: Between April 2002 and January 2008, 69 patients diagnosed with non?metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group (n = 34) or radiotherapy alone group(n= 35). All patients received intensity?modulated radiotherapy. The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days (range 23–53 days). The concomitant chemotherapy schedule was cisplatin 30 mg/m2 by intravenous infusion weekly during radiotherapy. Results: The median follow?up period of all patients was 35 months (range 2–112 months). Between concomitant chemoradiotherapy and radiotherapy groups, there was only significant difference in the 3?year and 5?year overall survival (OS) rates (68.7% vs. 42.2%, P = 0.016 and 41.8% vs. 27.5%, P = 0.049, respectively). Subgroup analysis showedthat concomitant chemoradiotherapy significantly improved the 5?year OS rate especially for patients in stage rT3–4 (33.0% vs. 13.2%, P = 0.009), stages III–IV (34.3% vs. 13.2%, P = 0.006), recurrence interval >30 months (49.0% vs. 20.6%,P= 0.017), and tumor volume >26 cm3 (37.6% vs. 0%, P = 0.006). Conclusion: Compared with radiotherapy alone, concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC, especially those with advanced T category (rT3–4) and stage (III–IV) diseases, recurrence intervals >30 months, and tumor volume >26 cm3.

OBJECTIVETo study the anticancer activity of the Clematis manshrica saponins in vivo.

METHODAnticancer activities were tested in mice with experimental tumor (S180, HepA and P388) in vivo.

RESULTThe Clematis manshrica saponins showed a significant anticancer activities on Sarcoma-180, HepA and P388 implanted in mice. In S180 sarcoma, the average tumor inhibition rates were 42.78%, 52.06% and 58.25% (P < 0.05-0.01) respectively; The mean inhibition rates were 37.44%, 52.05% and 59.36% (P < 0.05-0.001) in Hep A tumor separately; while in P388 tumor, the mean inhibition rates were 34.50%, 46.78% and 54.39% (P < 0.05-0.01), respectively.

CONCLUSIONThe results indicate that Clematis manshrica has obvious antitumor effects against various transplanted tumor in mice.

Animals ; Antineoplastic Agents, Phytogenic ; administration & dosage ; isolation & purification ; pharmacology ; Cell Line, Tumor ; Clematis ; chemistry ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Female ; Leukemia P388 ; pathology ; Liver Neoplasms ; pathology ; Male ; Mice ; Neoplasm Transplantation ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Random Allocation ; Saponins ; administration & dosage ; isolation & purification ; pharmacology ; Sarcoma 180 ; pathology

OBJECTIVETo assess the necessity of routine prophylactic irradiation at the level Ib for nasopharyngeal carcinoma (NPC).

METHODSNewly diagnosed NPC patients between January, 2001 and June, 2005 were enrolled in this study. The nodal distribution in each region was calculated from the data of transversal contrast enhance CT or magnetic resonance scan of the head and neck.

RESULTSCervical node involvement was found in 75.1% of the 338 patients enrolled. The rates of involvement at levels Ib, IIa, IIb, III, IV, Va, Vb and in the supra-clavicular region were 0.9%, 49.1%, 60.7%, 26.0%, 5.9%, 9.5%, 3.8% and 0.9%, respectively. Skip metastasis occurred only in 2.4% of the cases. The high risk region (defined by a probable risk>5%) of nodal metastases was (1) the ipsilateral levels III, IV, Va, and Vb in case of level II involvement, (2) the ipsilateral levels II, IV, Va, and Vb in case of level III involvement, (3) the ipsilateral levels II, III, Va, Vb and the supra-clavicular region in case of level IV involvement, (4) the ipsilateral levels II, III, IV, Vb and the supra-clavicular region in case of level Va involvement, (5) the ipsilateral levels II, III, IV, Vb, and the supra-clavicular region in case of level Vb involvement, (6) the contralateral levels II, III, and Va in case of unilateral cervical node involvement.

CONCLUSIONNodal involvement in NPC patients rarely occurs at the level Ib, which is not a high risk region whatever the regions may be to have lymph node metastasis and therefore does not need routine prophylactic irradiation.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lymphatic Metastasis ; pathology ; radiotherapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Neck ; Neoplasm Staging ; Tomography, X-Ray Computed ; Young Adult

Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Membrane Transport Proteins ; genetics ; Middle Aged ; Mutation ; genetics ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Spastic Paraplegia, Hereditary ; genetics ; Young Adult

Objective To observe the influence of calium and phosphate ion concentration from calcium phosphate cement leaching liquor on osteoblast by using newborn rats calvarial organ culture model in vitro,and to provide an objective model for the research on calcium phosphate cement degradation and osteoconduction.Methods Neonatal rat calvarial were treated with three types of media separately:BGJb media(blank control group),BGJb media + leaching liquoron of leaching 6 hours(experimental group 1),BGJb media + leaching liquoron of leaching 14 days(experimental group 2).Proliferation of osteoblast was determined by methyl thiazolyl tetrazolium (MTT).Differentiation of osteoblast was evaluated by the following assays:alkaline phosphatase (ALP) assay,and the real-time reverse transcription PCR.Results In experimental group 1,the proliferation(the A value were 0.563 ± 0.047,0.932 ± 0.065,1.325 ± 0.139,1.395 ±0.108 in 3,5,7,9 days respectively),the ALP activity[(5.111 ±0.440),(8.380 ±0.505),(10.124 ± 0.625) U/g prot in 3,7,10 days respectively) and osteocalcin expression of osteoblast (the 2-ΔΔct value were 4.41 ±0.52,21.24 ±2.17,31.84 ±3.51 in 3,7,10 days respectively) inside cultured calvarial were enhanced over time,while in experimental group 2,the activities of osteoblast revealed an inhibiting profile in 5,7,9 days,and the ALP activity and osteocalcin expression of osteoblast decreased compared to the blank control group in 7,10 days.Conclusions Calvarial organ culture method can be used as the research model for understanding the degradation of calcium phosphate bone cement.

Background:The TNM staging system is far from perfect in predicting the survival of individual cancer patients because only the gross anatomy is considered. The survival rates of the patients who have the same TNM stage disease vary across a wide spectrum. This study aimed to develop a nomogram that incorporates other clinicopatho-logic factors for predicting the overall survival (OS) of non-metastatic nasopharyngeal carcinoma (NPC) patients after curative treatments. Methods:We retrospectively collected the clinical data of 1520 NPC patients who were diagnosed histologically between November 2000 and September 2003. The clinical data of a separate cohort of 464 patients who received intensity-modulated radiation therapy (IMRT) between 2001 and 2010 were also retrieved to examine the extensibil-ity of the model. Cox regression analysis was used to identify the prognostic factors for building the nomogram. The predictive accuracy and discriminative ability were measured using the concordance index (c-index). Results:We identiifed and incorporated 12 independent clinical factors into the nomogram. The calibration curves showed that the prediction of OS was in good agreement with the actual observation in the internal validation set and IMRT cohort. The c-index of the nomogram was statistically higher than that of the 7th edition TNM staging sys-tem for predicting the survival in both the primary cohort (0.69 vs. 0.62) and the IMRT cohort (0.67 vs. 0.63). Conclusion:We developed and validated a novel nomogram that outperformed the TNM staging system in predict-ing the OS of non-metastatic NPC patients who underwent curative therapy.