Objective： A prospective randomized trial was performed to evaluate the contribution of neoadjuvant chemotherapy in the patients with locoregionally advanced nasopharyngeal carcinoma. Methods： The patients with locoregionally advanced nasopharyngeal carcinoma were treated with either radiotherapy alone (RT group) or neoadjuvant chemotherapy plus radiotherapy (CT/RT group). Neoadjuvant chemotherapy consisting of 2-3 cycles of cisplatin (20 mg/m2 on Day 1 to Day 5), bleomycin (7 mg/m2 on Day 1 and Day 5), and 5-FU (500 mg/m2 on Day 1 to Day 5) followed by radiotherapy was given to CT/RT group. All patients were treated in a uniform definitive-intent radiation therapy in two groups. Results： From 1992 to 1993, 457 patients were enrolled and 440 patients (221 in RT group, 219 in CT/RT group) were assessable. The 5-year overall survival (OS) rates were 62％ for CT/RT group and 55％ for RT group (P=0.1335)； The 5-year relapse free survival rate was 48％ versus 58％ , respectively (P=0.0539). The 5-year free local recurrence (FLR) rate was 82％ for CT/RT group, 74％ for RT group (P=0.0412). There was no significant difference in free distant metastasis (FDM) between two treatment groups (CT/RT group, 79％ ; RT group, 75％ ; P=0.4177). Subgroup analyses showed that neoadjuvant chemotherapy improved local control in patients with T3-4 disease, and had no effect in preventing distant metastases in patients with N2-3 disease. Conclusion： Despite improving FLR and RFS, neoadjuvant chemotherapy and radiatherapy failed to gain other survival benefit or reduce distant metastases in patients with locoregionally advanced nasopharyngeal carcinoma. The indication for neoadjuvant chemotherapy is proposed.

OBJECTIVETo investigate the therapeutic effect of scalp flaps pedicled with superficial temporal vessel and hair removal for reconstruction of facial skin defects.

METHODSFrom Jan. 2010 to Dec. 2011, 6 cases with large facial skin defects were treated with scalp flaps pedicled with superficial temporal vessel and hair removal. At the first stage, the skin expanders were implanted subcutaneously at the homolateral side according to the defect size. After the expansion was finished, the expanded flaps pedicled with superficial temporal vessel were used to reconstruct the facial skin defects at the second stage. 2 weeks after operation, hair removal was performed to remove the hair on flaps. 4-6 treatments were needed.

RESULTSSeven flaps in 6 cases were survived completely. The wounds at donor sites were closed directly. The effect of hair removal was reliable. The patients were followed up for 6 months to 1 year. The flap color, texture and thickness had a good match with surrounding skin tissue.

CONCLUSIONSIt is a good option to reconstruct facial skin defects with scalp flaps pedicled with superficial temporal vessel and hair removal.

Adolescent ; Face ; surgery ; Hair Removal ; Humans ; Reconstructive Surgical Procedures ; Scalp ; transplantation ; Surgical Flaps ; blood supply ; transplantation

BACKGROUND AND OBJECTIVEWe previously reported that C-KIT overexpression and mutation exist in biopsy samples of nasopharyngeal carcinoma (NPC). Yet whether Imatinib had an inhibitory effect on the proliferation of NPC in vitro was still unknown. So, this study examined whether sensitivities to Imatinib of other cell lines are different and whether C-KIT expression and mutations exist, to analyze the correlations between them.

METHODSThe expression of C-KIT in NPC cell lines, including CNE-1, CNE-2, Hone-1, C-666, SUNE-1, 5-8F, and nasopharyngeal epithelial (NPE) cell line NP-69, were detected by Western blot. Direct sequencing of polymerase chain reaction (PCR) products was performed to analyze the sequences of C-KIT from the above-mentioned cell lines. Inhibitory effects on proliferation by Imatinib on these cell lines were determined by CCK-8 assay. Pearson product moment correlation and t test were used to analyze the correlation betweeen C-KIT overexpression, C-KIT gene mutation, and the inhibitory effect of Imatinib.

RESULTSCompared with NPE cell line NP-69, NPC cell lines CNE-1, CNE-2, Hone-1, C-666, SUNE-1, and 5-8F had significantly higher levels of C-KIT expression. Heterozygous IVS17+78T>C were found in CNE-1, CNE-2, Hone-1, and NP-69 cell lines, homozygous IVS17+78T>C was found in C-666, and no mutation was found in SUNE-1 or 5-8F. Imatinib had a dose-dependent inhibitory effect on proliferation for CNE-1, CNE-2, Hone-1, C-666, SUNE-1, and 5-8F. No significant correlation between the inhibitory effects of Imatinib, C-KIT overexpression, or C-KIT mutation was found.

CONCLUSIONC-KIT overexpression and intron mutation were found in NPC cell lines and Imatinib had a dose-dependent inhibitory effect on proliferation for NPC cell lines, yet no significant correlation between C-KIT overexpression, C-KIT mutation, or the inhibitory effect of Imatinib was found.

Antineoplastic Agents ; pharmacology ; Benzamides ; Carcinoma, Squamous Cell ; genetics ; metabolism ; pathology ; virology ; Cell Line ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Dose-Response Relationship, Drug ; Epithelial Cells ; cytology ; metabolism ; Herpesvirus 4, Human ; isolation & purification ; Heterozygote ; Homozygote ; Humans ; Imatinib Mesylate ; Introns ; Mutation ; Nasopharyngeal Neoplasms ; genetics ; metabolism ; pathology ; virology ; Nasopharynx ; cytology ; Piperazines ; pharmacology ; Proto-Oncogene Proteins c-kit ; genetics ; metabolism ; Pyrimidines ; pharmacology

Objective： The current study was designed to investigate the diagnosis and the treatment of osteoradionecrosis of the skull base (ORN) in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods： All patients (n=12) diagnosed as nasopharyneal carcinoma and osteoradionecrosis of the skull base were studied retrospectively with their clinical manifestations, diagnoses, therapies and prognoses. Results： ORN was found with characteristic CT and endoscopic findings, they were never seen in the patients with NPC relapse. The latent periods of ORN in the patients after primary radiotherapy were 3 - 15 years, while the periods were 7 months - 2 years in the patients after reirradiation. Six patients with local ORN were operated, 1 patients was died of exhaustion; Six patients with extensive ORN were treated using conservative methods, 3 patients were died of severe nasopharyngeal bleeding, while one were died of exhaustion. Conclusion： The ORN of the skull base after radiotherapy could be diagnosed by CT and endoscopic findings. The patients with extensive ORN or radiation induced cranial neuropathy were associated with poor prognosis. The most common causes of death were severe nasopharyngeal bleeding and exhaustion.

Objective：The fifth edition of the International Union Against Cancer (UICC) staging manual defines new rules for classifying nasopharyngeal carcinoma (NPC). The study was conducted to assess the effectiveness of the manual to predict the prognosis for Chinese patient populations. Methods：From August 1992 to December 1993, a total of 621 consecutively admitted patients with nondisseminated NPC were treated with definitive-intent radiation therapy alone. A computer database containing all information for staging was formed on presentation. The extent of disease of each patient was restaged according to the 1997 UICC system. Results：The 1997 UICC system creates subgroups (Stages Ⅰ -Ⅳ ) that are assigned to 38 (6.1％ ), 270 (43.5％ ), 156 (25.1％ ), and 157 (25.3％ ) patients, respectively. The incidence of parapharyngeal extension was 74.1％ (460/621). Of these patients (460) with parapharyngeal extension, 310 (67.4％ ) patients were classified as T2 disease, The 5-year Overall survival(OS) rates were 89％ , 70％ , 53％ , and 37％ for Stages Ⅰ -Ⅳ , respectively. The 1997 UICC system showed highly significant differences between the overall stages for both OS and relapse-free survival(RFS). The 1997 UICC T-classifications showed significant correlation with local failure, and N classification was accurate in predicting freedom from distant metastasis(FDM). Conclusion：The 1997 UICC staging system for NPC is prognostically useful for Chinese patient populations. However, an uneven patient number distribution was noted. Subdivision of parapharyngeal extension should be included in future revisions of the staging system.

Establishing Epstein-Barr virus(EBV)-specific cytolytic T lymphocytes(EBV-CTLs) from peripheral blood mononuclear cells(PBMCs) for adoptive immunotherapy has been reported in EBV-associated malignancies including Hodgkin's lymphoma and nasopharyngeal carcinoma(NPC). In the current study, we performed ex vivo expansion of tumor-infiltrating lymphocytes(TILs) obtained from NPC biopsy specimens with a rapid expansion protocol using anti-CD3 monoclonal antibody(OKT3), recombinant human interleukin(IL)-2, and irradiated PBMCs from healthy donors to initiate the growth of TILs. Young TIL cultures comprised of more than 90% of CD3+ T cells, a variable percentage of CD3+CD8+ and CD3+CD4+ T cells, and less than 10% of CD3-CD16+ natural killer cells, a similar phenotype of EBV-CTL cultures from PBMCs. Interestingly, TIL cultures secreted high levels of the Th1 cytokines, interferon gamma (IFNγ) and tumor necrosis factor-alpha (TNF-α), and low levels of the Th2 cytokines, IL-4 and IL-10. Moreover, young TILs could recognize autologous EBV-transformed B lymphoblast cell lines, but not autologous EBV-negative blast cells or allogeneic EBV-negative tumor cells. Taken together, these data suggest that ex vivo expansion of TILs from NPC biopsy tissue is an appealing alternative method to establish T cell-based immunotherapy for NPC.
Biopsy ; CD3 Complex ; analysis ; CD4 Antigens ; analysis ; CD8 Antigens ; analysis ; Cells, Cultured ; Herpesvirus 4, Human ; immunology ; Humans ; Immunotherapy, Adoptive ; Interferon-gamma ; metabolism ; Interleukin-10 ; metabolism ; Interleukin-2 ; pharmacology ; Interleukin-4 ; metabolism ; Lymphocytes, Tumor-Infiltrating ; immunology ; virology ; Monocytes ; pathology ; Muromonab-CD3 ; pharmacology ; Nasopharyngeal Neoplasms ; immunology ; pathology ; therapy ; virology ; Receptors, IgG ; analysis ; T-Lymphocytes, Cytotoxic ; immunology ; virology ; Tumor Necrosis Factor-alpha ; metabolism

Objective To observe the changes of cervical sagittal parameters of digital radiography(DR)at bilateral oblique position of cervical spine in patients with neck type cervical spondylopathy(NTCS)after cervical rotation and lifting manipulations,and to evaluate the clinical significance of cervical sagittal parameters in assessing the efficacy of NTCS by combining the pain score of visual analogue scale(VAS).Methods A retrospective analysis was carried out in 36 NTCS patients admitted to the outpatient clinic of the Tuina Department of Foshan Hospital of Traditional Chinese Medicine from November 2020 to May 2021.According to the treatment method,the patients were divided into the trial group and the control group,with 18 patients in each group.The trial group was treated with cervical rotation and lifting manipulations,and the control group was treated with cervical vertebra traction.The two groups were treated once every other day for 2 continuous weeks.The changes of VAS pain score and sagittal parameters of DR such as sagittal vertical axis of cervical vertebra 2-7(C2-7 SVA),the T1 slope(T1S),neck tilt(NT),and thoracic inlet angle(TIA)in the two groups were observed before and after treatment.Spearman correlation analysis was used to explore the correlation between VAS scores of pain level and cervical sagittal parameters.Results(1)Before treatment,there was no statistically significant difference in the VAS pain scores between the two groups(P＞0.05).After treatment,the VAS pain scores in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the scores in the trial group was significantly superior to that in the control group(P＜0.01).(2)Before treatment,there was no statistically significant difference in the values of cervical sagittal parameters of C2-7 SVA,T1S,NT,and TIA between the two groups(P＞0.05).After treatment,the C2-7 SVA,T1S,and TIA of the trial group were significantly improved compared with those before treatment(P＜0.05),but the improvement of NT was not obvious(P＞0.05);the cervical sagittal parameters of the control group were not significantly improved compared with those before treatment(P＞0.05).The intergroup comparison showed that the improvement of C2-7 SVA,T1S,and TIA in the trial group was significantly superior to that in the control group(P＜0.05 or P＜0.01),while the difference in NT between the two groups after treatment was not statistically significant(P＞0.05).(3)The results of Spearman correlation analysis showed that before treatment,VAS pain score had no correlation with C2-7 SVA,T1S,NT,and TIA(P＞0.05),C2-7 SVA was negatively correlated with NT(r=-0.502,P＜0.05),and T1S was positively correlated with NT(r=0.601,P＜0.05).After treatment,VAS pain score was negatively correlated with C2-7 SVA(r=-0.362,P＜0.05)and positively correlated with TIA(r=0.476,P＜0.05),C2-7 SVA was positively correlated with NT(r=0.928,P＜0.05),and T1S was positively correlated with TIA(r=0.623,P＜0.05).Conclusion Both cervical rotation and lifting manipulations and cervical traction can relieve the pain and adjust cervical sagittal parameters in the patients with NTCS,but cervical rotation and lifting manipulations are more effective in treating NTCS.And there may be a correlation between the VAS scores of pain level and cervical sagittal parameters in patients with NTCS.

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (NPC); however, it is not known whether locoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of locoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing locoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations (P < 0.05). Both locoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival (OS). The mortality risk was similar in the group undergoing locoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio (HR) = 0.9, P = 0.529]; this risk was 60% lower than that of the group undergoing supportive treatment (HR = 0.4, P = 0.004) and 130% higher than that of the group undergoing both systemic chemotherapy and locoregional radiotherapy (HR = 2.3, P < 0.001). In conclusion, locoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Lung Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Palliative Care ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Survival Rate ; Young Adult

Neoadjuvant chemotherapy plus radiotherapy is the most common treatment regimen for advanced nasopharyngeal carcinoma (NPC). Whether chronomodulated infusion of chemotherapy can reduce its toxicity is unclear. This study aimed to evaluate the toxic and therapeutic effects of sinusoidal chronomodulated infusion versus flat intermittent infusion of cisplatin (DDP) and 5-fluorouracil (5-FU) followed by radiotherapy in patients with locoregionally advanced NPC. Patients with biopsy-diagnosed untreated stages III and IV NPC (according to the 2002 UICC staging system) were randomized to undergo 2 cycles of sinusoidal chronomodulated infusion (Arm A) or flat intermittent constant rate infusion (Arm B) of DDP and 5-FU followed by radical radiotherapy. Using a "MELODIE" multi-channel programmed pump, the patients were given 12-hour continuous infusions of DDP (20 mg/m2) and 5-FU (750 mg/m2) for 5 days, repeated every 3 weeks for 2 cycles. DDP was administered from 10:00 am to 10:00 pm, and 5-FU was administered from 10:00 pm to 10:00 am each day. Chronomodulated infusion was performed in Arm A, with the peak deliveries of 5-FU at 4:00 am and DDP at 4:00 pm. The patients in Arm B underwent a constant rate of infusion. Radiotherapy was initiated in the fifth week, and both arms were treated with the same radiotherapy techniques and dose fractions. Between June 2004 and June 2006, 125 patients were registered, and 124 were eligible for analysis of response and toxicity. The major toxicity observed during neoadjuvant chemotherapy was neutropenia. The incidence of acute toxicity was similar in both arms. During radiotherapy, the incidence of stomatitis was significantly lower in Arm A than in Arm B (38.1% vs. 59.0%, P = 0.020). No significant differences were observed for other toxicities. The 1-, 3-, and 5-year overall survival rates were 88.9%, 82.4%, and 74.8% for Arm A and 91.8%, 90.2%, and 82.1% for Arm B. The 1-, 3-, and 5-year progression-free survival rates were 91.7%, 88.1%, and 85.2% for Arm A and 100%, 94.5%, and 86.9% for Arm B. The 1-, 3-, and 5-year distant metastasis-free survival rates were 82.5%, 79.1%, and 79.1% for Arm A and 90.2%, 85.2%, and 81.7% for Arm B. Chronochemotherapy significantly reduced stomatitis but was not superior to standard chemotherapy in terms of hematologic toxicities and therapeutic response.
Adult ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma ; Cisplatin ; administration & dosage ; Disease-Free Survival ; Dose Fractionation ; Drug Chronotherapy ; Female ; Fluorouracil ; administration & dosage ; Humans ; Induction Chemotherapy ; adverse effects ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Staging ; Neutropenia ; chemically induced ; Radiotherapy, High-Energy ; Stomatitis ; etiology ; Survival Rate ; Young Adult

Postradiation nasopharyngeal necrosis is an important late effect of radiotherapy that affects prognosis in patients with nasopharyngeal carcinoma. In the present study, we reviewed the clinical and imaging features of 67 patients with pathologically diagnosed postradiation nasopharyngeal necrosis who were treated at Sun Yat-sen University Cancer Center between June 2006 and January 2010. Their clinical manifestations, endoscopic findings, and imaging features were analyzed. Early nasopharyngeal necrosis was limited to a local site in the nasopharyngeal region, and the tissue defect was not obvious, whereas deep parapharyngeal ulcer or signs of osteoradionecrosis in the basilar region was observed in serious cases. Those with osteoradionecrosis and/or exposed carotid artery had a high mortality. In conclusion, Postradiation nasopharyngeal necrosis has characteristic magnetic resonance imaging appearances, which associate well with clinical findings, but pathologic examination is essential to make the diagnosis.
Adult ; Aged ; Carcinoma ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Nasopharynx ; pathology ; radiation effects ; Necrosis ; Osteoradionecrosis ; diagnosis ; etiology ; Radiation Injuries ; diagnosis ; etiology ; Radiotherapy, Intensity-Modulated ; adverse effects