Objective To study the CT and MRI features of meningiomas at special locations.Methods CT and MRI findings of meningiomas at special locations (lateral ventricle,diaphragma sellae,frontal sinus) in 11 cases confirmed by pathology were analyzed retrospectively.8 patients were evaluated with MRI,3 patients were evaluated with CT.Results 11 cases were all singular lesion.The lesions were at lateral ventricle in 4, at diaphragma sellae in 4,at frontal sinus in 3.Of total 11 cases,8 cases showed isointensity or slight hypointensity signal on T 1WI ,tumors had isointensity or slight hyperintensity signal or slight hypointensity signal on T 2WI,homogeneous or inhomogeneous enhancement were found on Gd-DTPA enhanced MRI scanning.3 cases were showed homogeneous density or slight highly density on plain CT scanning.Pathological diagnosis was as follows:fibroblastic type in 4,angioblastic type in 3,syncytial type in 1,psammomatous type in 3.There were 9 cases were misdiagnosed before operation.Conclusion It is a fact that improving the imaging correct diagnostic rate of meningioma at special locations will play an important role in deciding correct operative route of entry and increasing cure rate.

Objective To observe the clinical manifestation and pathological immunohistochemical features of intraspinal extramedullary peripheral primitive neuroeetodermal tumour (PNET). Methods From Apr. 1996 to Aug. 2007, totally 5 patients with intraspinal extramedullary peripheral PNET were treated, including 3 male and 2 female, aging from 11 to 48 years. The primary site was cervical vertebral in 2 (C5-C7 and C5-T1 ) and thoracic vertebral in 4( T4-T6, T6-T8 ,T4-T5 and C5-T1 ). The clinical manifestation was paresis of limbs in 5 and incontinence in 4. All the patients were pathologically diagnosed Results All of the three patients who had CD99 staining expressed CD99 ( + ). All the 5 patients received surgery followed by radiotherapy and 4 received postoperative chemotherapy. The most common treatment failure was local recurrence. The overall survival time of the 5 patients was 4.8year,2.5year,2. 1ycar, 1.6year and 0.8 year respectively. Conclusions Intraspinal extramedullary peripheral PNET is highly malignant tumor.Patients have very poor survival and local control New treatment protocol should be studied to improve the local disease control and increase remission rate. To distinguish central PNET from peripheral PNET has crucial significance since different entities have different treatment protocol and prognosis.

Objective To detect the clinical features and prognostic factors of nasal cavity malignancy with breast metastasis.Methods 846 Patients with nasal cavity malignancy from January 1999 to December 2011 were enrolled,the clinical and pathological features,clinical diagnostic methods and prognostic factors for breast metastasis patients were analyzed.Results Six female cases (median age 25) were diagnosed with breast metastasis,including 3 rhabdomyosarcoma and 3 olfactory neuroblastoma; consisting 0.7％ of the total 846 cases of primary nasal malignancy group.The metastasis were more likely to be multiple breast lesions with/without metastasis in other site.For the primary tumor,five patients received 66-72 Gy/30-33f of radical radiotherapy,one patient with rest rhabdomyosarcoma received 58 Gy of palliative radiation since breast metastasis was found after 14 Gy of radiation and breast mass resection were performed right after.For the breast metastasis,five of 6 patients received breast surgery,one patients with olfactory neuroblastoma received 6 cycles cyclophosphamide + adriamycin + vincristine chemotherapy.Median survival was 12.7 months.Conclusions For nasal cavity malignancy,breast metastasis more likely occur in younger female patients.Ultrasound may provide useful information in evaluating breast metastasis.Cases combined with metastasis except breast have unfavorable prognosis.

Objective To evaluate the outcome of Stage Ⅱ nasopharyngeal carcinoma(NPC) trea-ted by conventional fractionation radiotherapy. Methods From January 1990 to May 1999,216 patients with untreated stage Ⅱ NPC were irradiated by 6 MV photons and 9-12 MeV electrons with linear accelera-tor. Of 26 patients with residual lesions after 70 Gy irradiation, 18 received intracavitary brachytherapy and 8 received stereotactic irradiation boost. Results The 10-year overall survival (OS) of patients with T2 N0 M0, T1N1M0 and T2N1M0 disease were 90%, 80% and 75.2% (χ2 = 3.26, P =0. 200), respectively. The corresponding disease-free survival(DFS) and distant metastasis-free survival(DMFS) were 79% ,60% and 62.6% (χ2 = 5.87, P = 0.053) ;90% ,74% and 68.0% (χ2 = 7.09, P = 0. 030), respectively. In uni-variate analysis, T stage had no impact on OS, DFS or DMFS (χ2 = 0.44, P = 0. 500 ; χ2 = 0.44, P = 0.500 ; χ2 = 0.25, P = 0. 610), while N stage significantly influenced DFS and DM FS (χ2 = 5.86, P = 0. 015 ; χ2 = 5.31 ,P = 0. 021). Multivariate analysis showed that N stage was an independent prognostic factor for DFS and DMFS(χ2=5.03,P=0.025;χ2=6.47,P=0.01). Conclusions Stage Ⅱ NPCwithposifivelymph node treated by radiotherapy alone is inadequate. In order to improve DFS and DMS, combined chemo-radio-therapy should be considered.

Objective To investigate the clinical features,treatment outcome and prognosis of pa tients with nasopharyngeal adenoid cystic carcinoma(ACC).Methods From March 1963 to August 2002, 33 patients with ACC were retrospectively reviewed.Among them,13 received multimedality therapy(S + R in 9 and R +S in 4) and the remaining 20 received radiotherapy alone.The interval between the first visit and clinical diagnosis was 12 months(1.0-36.4 months).The misdiagnosis rate was 55% (18/33),with the most common error of otitis media.The clinical symptoms of ACC were similar to those of squamous carcino ma in nasopharynx,though the cervical lymph node metastasis was rare(12%) and cranial nerve invasion was common (58%). ResultsAfter a median follow-up of 60.8 months (5.0-245.2 months),the 5-and 10-year overall survival rates,free-disease survival rates,local regional control rates and metastasis-free sur vival rates were 66% and 29% ,41% and 27% ,61% and 40% ,62% and 62% ,respectively.Among the 20 patients(61%) with recurrence,15 had local regional failure(13 in situ and 2 in cervical lymph node) ,and 9 had distant metastasis(5 in the lung,2 in the lung and bone,1 in the liver and I in the bone).Univariate analysis showed that clinical stage was a prognostic factor(Ⅰ + II vs Ⅲ + Ⅳ,P = 0.009),while treatment modality(radiotherapy alone vs multimodality therapy) was not. ConclusionsNasopharyngeal ACC is a locally aggressive disease with a long course.Either radiotherapy alone or muhimodality therapy(S + R/R + S) is effective in the treatment.

Objective To evaluate the efficacy of intensity-madulated radiotherapy(IMRT) as the primary treatment in nasopharyngeal carcinoma (NPC). Methods Between November 2001 and March 2006,147 newly diagnosed NPC patients were treated with IMRT. The disease was Stage I in 3 patients, Stage Ⅱ in 35,Stage Ⅲ in 67 and Stage Ⅳ in 42. For T1-2 disease,the prescription dose was 70 Gy to the gross tumor volume( GTVnx) and positive neck nodes ,60 Gy to the planning target volume I, and 50-56 Gy to the clinically negative neck. For T3-4 disease,the prescription dose was 74-78 Gy to GTVnx. The local control rate(LC),overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated by Kaplan-Meier method. Results The 3-year LC, OS, DFS and DMFS of the whole group were 93.2% ,93.5% ,72.6% and 74.4% ,respectively. T stage was a significant predictor of LC and OS. For patients with T1-2 and T3-4 disease,the LC was 100% and 86.9% (P=0.007) and OS was 95.5% and 91.3% (P=0.030), respectively. N stage was a significant predictor of OS, DFS and DMFS(P=0.03,0.004 and 0.0004,respectively). The grade Ⅰ+ Ⅱ and Ⅲ acute toxieities of parotid were 96.6% and 1.4%. The rate of grade Ⅱ xerostomia at 3-month, 6-month, 1-year and 2-year after radiotherapy were 43.0%, 12.0% ,4.9% and 3.2%. Conclusions The treatment results are promising according to our target definition and dose prescription protocol for nasopharyngeal carcinoma.

Objective To study the dynamic change of anatomy and dosimetry distribution and its influence during intensity modulated radiation therapy(IMRT) for nasopharyngeal carcinoma(NPC). Methods From June 2006 to August 2007,12 patients with stage Ⅲ-Ⅳ NPC receiving initial IMRT concurrently combined with chemotherapy were included in the study. The target volumes and,involving organs were contoured on the first set of spiral CT images. When IMRT planning was finished,a second CT scans was acquired to rectify the treatment center. Weekly spiral CT images acquired during the treatment period according to the same treatment center were fused with the first CT images. In order to determine the best time of replanning, modified plan target volume( PTV1 ) and normal organs( parotids and outline) were contoured on the fusion interface by a single physician. Changes of each structure throughout treatment period were measured by a system software. Then the dose distributions were computed and evaluated for replanning CT using the same beams arrangement in the original plan. Cumulative dose was estimated compared with the original plan. Results The volume of outlines and parotids decreased gradually, and the change came to peak in the fifth week. So the fifth and first week CT scans were selected as research objectives. No significant changes in maximal and mean dose was observed in the brainstem, spinal cord or mandible. Despite volume changes,D99 and D95 of the PTV1 did not change siguificantly(P＞0.05). D95 of the bilateral parotids increased significantly ( PL = 0.03,PR = 0.01 ). Conclusions During IMRT for NPC, the volume of PTV1, the outlines and parotids decrease,and the change come to peak in the fifth week. Comparing to the first treatment plan, the dose parameters of the parotids increase significantly in the second plan based on the fifth week CT,but those of the brainstem,cord,mandible and PTV1 change slightly.

Objective To evaluate the treatment results of the patients with nasopharyngeal mucoe-pidermoid carcinoma (MEC), and explore an appropriate treatment method. Methods Eleven patients with pathologically confirmed nasopharyngeal MEC were included in this study. The number of patients with pathologically well-, medium-and poorly-differentiated tumor were 1, 2 and 7, respectively. Radiotherapy (RT) alone and surgery (S) alone were given to 1 patient each. Combined modality treatment was RT + S in 6 patients and S + RT in 3 patients. Results After a median follow-up of 41.5 months (range, 8 to 153 months), one patient died of heart disease and one was lost follow-up. The remaining 9 patients were alive, including 6 with disease-free and 3 with residual tumors. None of them had cervical lymphatic spread or dis-tant metastasis. Conclusions Nasopharyngeal MEC progresses slowly and has good prognosis, which should be followed up for a long time. Primary surgery followed by radiotherapy is recommended.

To investigate the potential risk factors for parotid gland failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods The clinical data of 1096 NPC patients who underwent IMRT in our hospital from January 2005 to December 2012 were analyzed retrospectively.Among these patients, 13 patients experienced parotid gland recurrence, and the recurrence in 12 patients was analyzed.A case-control study was performed with the side of the parotid gland with recurrence as the case group and the side of the parotid gland without recurrence as the control group.The association of parotid gland failure with the extent of tumor invasion, IMRT dose distribution, and local recurrence was analyzed.The differences between groups were analyzed with χ2 test or Fisher′s the exact probability test.Results Among the 12 patients, 11 had stage III-IV primary NPC;after definitive IMRT, 9 had local tumor residues.The median time of parotid gland recurrence was 16(8-43) months.Of all the patients who experienced recurrence, 8 had recurrence in the superficial lobe of the parotid gland, 1 in the deep lobe, and 3 in both superficial and deep lobes.Recurrence was in the same side of primary tumor (P<0.001).Compared with the controls, the side of the parotid gland with recurrence had higher rate of cervical puncture/surgery (P=0.025).Parotid gland recurrence was often complicated by ipsilateral lymph node recurrence (67% vs.8%, P=0.003), as well as the tendency of ipsilateral primary lesion recurrence (42%vs.8%;P=0.059).Conclusions For NPC patients, the recurrence rate in the parotid gland is very low. Parotid gland recurrence may be related to locally advanced NPC, residues after treatment, the history of cervical puncture/surgery, and locoregional recurrence.The low radiotherapy dose in the parotid gland caused by IMRT may be an important reason for parotid gland recurrence.

Objective To analyze the treatment outcomes of patients with primary sphenoid sinus malignancies. Methods Sixteen patients with primary sphenoid sinus malignancies admitted to our hospital from 2000 to 2013 were analyzed retrospectively. No patients were newly diagnosed with cervical lymph node metastasis. One patient had stageⅣA disease, while fifteen had stageⅣB disease. Eleven patients received surgery followed by radiotherapy, one surgery alone, three radiotherapy alone, and one chemotherapy alone. All surgeries were cytoreductive . The median dose of radiotherapy was 69. 96 Gy ( 56.00?80. 56 Gy ) . Results The 3?year local control ( LC) , distant metastasis?free survival ( DMFS) , disease?free survival ( DFS) , and disease?specific survival ( DSS) rates were 67%, 69%, 44%, and 58%, respectively, in all patients, and 67%, 55%, 30%, and 41%, respectively, in patients treated with cytoreductive surgery followed by radiotherapy. All orbital contents and skull base were preserved. In all patients, the local recurrence, distant metastasis, and lymph node recurrence rates were 25%, 37%, and 6%, respectively. There were no independent predictors for the LC and DSS rates based on the prognostic analysis. Conclusions With the orbital contents and skull base preserved, the cytoreductive surgery followed by radiotherapy yields satisfactory outcomes and a low lymph node recurrence rate in the treatment of sphenoid sinus malignancies. The prophylactic irradiation of cervical lymph nodes is not recommended in clinical practice.