Objective This paper summarize peri-operative nursing of minimally invasive surgery on osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma.Methods 47 cases of osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma were operated via nasal endoscope from March 2006 to March 2013.Focused peri-operative psychological support and adequate medical care were given to patients.Strengthened nasal nasopharyngeal cavity nursing,the observation and nursing of complications were carried out after operation and health guidance pre-discharge was given.Results The operations of 47 cases were successful and no major complication of intra-operation and post-operation occurred.Headache and foul odor relieved after operation.The follow-up continued for 3 to 84 months,46 cases were survived,1 case died of nasopharyngeal massive bleeding.Conclusions Effective peri-operative nursing of minimally invasive surgery on osteoradionecrosis of skull base after radiotherapy could ensure patients' cooperation and the smooth implementation of surgery and improve the quality of life.

Objective To investigate the expression level and the significances of prognosis by miR-451a in nasopharyngeal carcinoma (NPC) in Guangxi. Methods The expressions of miR-451a in 89 cases of nasopharyngeal carcinoma were detected by real time RT-PCR. The relation among the expression level , the clinicopathologic features of NPC and its prognosis were analyzed. Results The expression of miR-451a were found in all of nasopharyngeal carcinoma. The expression level of miR-451a in nasopharyngeal carcinoma was negative correlated to overall survival and disease free survival (P = 0.01,P = 0.04). Conclusions miR-451a may play a key role in detection of nasopharyngeal carcinoma with poor prognosis.

OBJECTIVE: To investigate the tumor regression and local immune function in nasopharyngeal carcinoma patients treated with p53 gene therapy. METHOD: The two-step immunohistochemical was done to detect the expression of tumor-infiltrating lymphocytes (TIL) T-cell receptor-CD3, CD4, CD8 and B cell receptor-CD20 in the primary tumor tissue of nasopharyngeal carcinoma. Nasal endoscopy with MRI or CT was used for evaluation of tumor size. RESULT: The expression of CD3, CD4, CD8 was significantly increased after p53 gene treatment (P < 0.05). There was no significant change in expression of CD20 after p53 gene treatment (P > 0.05). In conventional treatment group, CD3, CD4, CD8 and CD20 (P > 0.05) did not show any significant difference. In gene therapy group at 3 months after treatment, 20 patients had achieved CR, 10 PR, 1 SD, 1 PD. In conventional treatment group, 11 patients had achieved CR, 12 PR,5 SD,3 PD. The response rate between treatment group and control group (CR+PR) was different (P < 0.05). CD3 and CD4 expression was correlated with tumor regression rate (P < 0.05, P < 0.01), and CD8 expression was correlated with the CR rate (P < 0.05). CONCLUSION T cells are the most proliferative cell of TII. in NPC patients after p53 gene therapy The local cellular immune status is positively correlated with tumor regression rate.
Adult ; Aged ; CD4-Positive T-Lymphocytes ; immunology ; Carcinoma ; Female ; Genes, p53 ; Genetic Therapy ; Humans ; Lymphocyte Count ; Lymphocytes, Tumor-Infiltrating ; immunology ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; immunology ; pathology ; therapy

OBJECTIVE: To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma. METHOD: Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia. RESULT: (1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant. CONCLUSION The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.
Aged ; Carcinoma ; Chemoradiotherapy ; Combined Modality Therapy ; methods ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; mortality ; pathology ; surgery ; therapy ; Nasopharynx ; radiation effects ; Neoplasm Staging ; Prospective Studies ; Radiotherapy Dosage ; Survival Rate ; Xerostomia ; epidemiology ; etiology

OBJECTIVE: To study the histomorphology at the nasal mucosa in the nasopharyngeal carcinoma (NPC) patients postradiotherapy. METHOD: Forty-seven specimens from the nasal mucosa of NPC patients postradiotherapy were observed under light microscope. The changes of the mucosal histomorphology include cells and cilia in epithelium, basal layer, glandular and glandular cells in lamina propria. Six specimens were observed under electron microscope, including the changes of the cilia and ciliated columnar epithelial cells in epithelium. RESULT: The histomorphology of the 47 specimens were normal before radiotherapy. In the 47 specimens, six specimens had no changes but 41 specimens were found various changes postradiotherapy. The mucosal changes of epithelium and cilia desquamating, basal layer thickening, decrease of the serous glands and increase of the mucous glands in lamina propria were observed under light microscope. We found the cilia structural abnormalities and the abnormal phenomena of the epithelium under scanning electron microscope (SEM) and transmission electron microscope (TEM) respectively. CONCLUSION We found that the various extent of destruction of the nasal mucosa may be the pathological basis of complicating nasal or sinusitis in NPC patients postradiotherapy.
Adult ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; Female ; Humans ; Male ; Middle Aged ; Nasal Mucosa ; pathology ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; Treatment Outcome

Objective To investigate the use of NBI (narrow band imaging) in early the diagnosis of nasopharyngeal carcinoma.Methods A total of 55 cases with nasopharyngeal lesions (including 9 cases of nasopharyngeal carcinoma after treatment) were examined and diagnosed by white and NBI endoscopy between October 2011 and March 2012,and their diagnosis efficacies were evaluated based on pathological diagnosis as a gold standard.Chi-square test was used to analyze data.Results Of 55 cases,12 cases were pathologically diagnosed as chronic mucosa inflammation and 43 as nasopharyngeal carcinoma including 6 recurrent cases,of 43 cases,40(93.0％) were diagnosed by NBI endoscopy and 18 (41.9％) by white endoscopy.Of 12 cases with early nasopharyngeal carcinoma (5 for stage Ⅰ and 7 for stage Ⅱ),5(100.0％) for stage Ⅰ,and 6 (85.7％) for stage Ⅱ were diagnosed by NBI endoscopy but only 1(14.3％) for stage Ⅱ by white endoscopy,with a statistically significant difference (x2 =10.000,P =0.008 ;x2 =7.143,P =0.029).Conclusion NBI endoscopy can be used in early diagnosis of nasopharyngeal carcinoma and check after treatment.

OBJECTIVETo investigate the method of surgical treatment via trans-nasal endoscopic approach in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma.

METHODSFifteen patients with osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma who underwent operation via trans-nasal endoscopic approach from 2008 to 2013 were retrospectively reviewed. The typical clinical manifestations included headache (NRS 6-9: 11 cases), foul odor (10 cases), epistaxis (4 cases), hearing loss (5 cases, 7 ears), tinnitus (4 cases, 5 ears). All patients underwent operation via trans-nasal endoscopic approach. During the operation, the diseased region was fully exposed, the necrotic tissue was resected, the necrotic bone was removed by high-speed electric drill, and the drainage was made unobstructed. The perioperative treatment and follow-up were carried out.

RESULTSAfter operation, all patients were diagnosed pathologically as osteoradionecrosis and mucosal chroinic inflammation, 1 case combined with fungal sphenoid sinusitis. Headache (9 cases) and foul odor (9 cases) resolved after operation. The follow-up was lasted 18-82 months, 13 cases were survival, 1 case lost to follow-up, 1 case died of cerebral hemorrhage.

CONCLUSIONSurgical treatment via trans-nasal endoscopic approach is safe and effective in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma, and is helping to improve the survival rate and survival quality.

Carcinoma ; Endoscopy ; Humans ; Nasopharyngeal Neoplasms ; radiotherapy ; Osteoradionecrosis ; surgery ; Retrospective Studies ; Skull Base ; surgery ; Survival Rate

OBJECTIVETo evaluate the efficacies of different treatments for recurrent cervical lymph nodes and the factors contributing to prognosis in patients with nasopharyngeal carcinoma after radiotherapy.

METHODSClinical data of 79 patients with nasopharyngeal carcinoma after radiotherapy were retrospectively analyzed, and all cases were diagnosed as having recurrent cervical lymph nodes by pathological examination. The factors including sex, age, the interval between completion of radiotherapy and recurrence, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor in the neck were analyzed for prognosis. Kaplan-Meier curves, Log-rank test and Cox's proportional hazards regression mode were used in the statistical analysis.

RESULTSThe median recurrence time was 26 months, and the 1- , 3- and 5-year overall survival rates were 77.9%, 53.4% and 39.7%. Cox's proportional hazards regression mode analysis indicated that age, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor were significantly prognostic factors.

CONCLUSIONSNeck dissection is superior to re-radiotherapy in treatment of recurrent cervical lymph nodes in nasopharyngeal carcinoma after radiotherapy. The patients younger than 45 years old, in early rN stage and for recurrence in the center region of primary tumor have a better prognosis.

Carcinoma ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; pathology ; Nasopharyngeal Neoplasms ; radiotherapy ; Neck ; Neck Dissection ; Neoplasm Recurrence, Local ; surgery ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Objective: To evaluate the diagnostic value and feasibility of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma (NPC). Methods: One thousand three hundred and sixty-four NPC patients who had completed NPC treatment were enrolled. All patients were followed-up with imaging, serological examination of EB virus and nasopharyngeal endoscopy(WL and NBI mode), in which (1) both white light (WL) and NBI modes were done; (2) positive endoscopic patients were given nasopharyngeal biopsy; (3) using histologic finding as criterion standard, the sensitivity, specificity, accuracy and Yonden′s index of two modes were compared. Kappa index was used to evaluate the consistency between the two modes and pathological results respectively; (4) the positive rates of WL and NBI in patients with early recurrent (stage Ⅰ+ Ⅱ) were compared. Results: A total of 265 cases were suspected as having recurrent lesions by endoscopy in WL mode and 68 cases of them were pathologically diagnosed as having NPC; and 82 cases were suspected as having recurrent lesions by endoscopy in NBI mode and 74 cases of them were pathologically diagnosed as having NPC. The sensitivity, specificity, accuracy and Yonden′s index of WL mode were 91.89%, 0, 25.09% and -0.0811, respectively, with a kappa of -0.045; the sensitivity, specificity, accuracy and Yonden′s index of NBI mode were 100.00%, 95.94%, 97.05% and 0.9594, respectively. Conclusion NBI has higher sensitivity, specificity, early diagnosis rate and Yonden′s index than WL.