PURPOSE: This study is to evaluate the xerostomia following 3-dimensional conformal radiation therapy (3D CRT) in nasopharynx cancer patients using the xerostomia questionnaire score (XQS). MATERIALS AND METHODS: Questionnaire study was done on 51 patients with nasopharynx cancer who received 3D CRT from Dec. 2000 to Aug. 2005. 3D CRT technique is based on "serial shrinking field" concept by 3 times of computed tomography (CT) simulation. Total target dose to the primary tumor was 72 Gy with 1.8 Gy daily fractions. Xerostomia was assessed with 4-questions XQS, and the associations between XQS and time elapsed after RT, age, sex, stage, concurrent chemotherapy, and parotid dose were analyzed. RESULTS: Concurrent chemotherapy was given to 40 patients and RT alone was given to 11 patients. The median time elapsed after 3D CRT was 20 (1~58) months and the mean XQS of all 51 patients was 8.4+/-1.9 (6~14). XQS continuously and significantly decreased over time after 3D CRT (x(2)=-0.484, p<0.05). There was no significant difference in XQS according to sex, age, and stag. However, XQS of concurrent chemotherapy patients was significantly higher than RT alone patients (p=0.001). XQS of patients receiving total mean parotid dose > or=35 Gy was significantly higher than <35 Gy (p=0.05). CONCLUSION: Decreasing tendency of XQS over time after 3D CRT was observed. Concurrent chemotherapy and total mean parotid dose > or=35 Gy were suggested to adversely affect radiation-induced xerostomia.
Drug Therapy ; Humans ; Nasopharyngeal Neoplasms* ; Surveys and Questionnaires ; Radiotherapy, Conformal* ; Xerostomia*

We reported two patients with nasopharyngeal adenocarcinoma resected by using the exclusively endoscopic approach. Case reports and a review of the world literature concerning nasopharyngeal adenocarcinoma. The tumors were resected successfully via the exclusively endoscopic approach and no conversions to the conventional approach were necessary. The two patients were followed up for 26 and 18 months respectively, and no recurrence was noted without postoperative chemotherapy or radiotherapy. To the best of our knowledge, this is the first report of endoscopic resection of nasopharyngeal adenocarcinoma. Our experience revealed that not only for the early recurrent nasopharyngeal carcinoma, the exclusively endoscopic nasopharyngectomy can be expanded for the resection of selected nasopharyngeal adenocarcinoma.
Adenocarcinoma* ; Drug Therapy ; Endoscopes ; Humans ; Nasopharyngeal Neoplasms ; Radiotherapy ; Recurrence

Concurrent chemoradiation therapy (CCRT) has played the most important and central role in the definitive therapy for the patients with locoregionally advanced stage nasopharynx cancer. The addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to CCRT have been widely accepted with the rationale of improving distant control in the clinical practices. This review article investigated the role of IC and AC based on 11 recent meta-analysis publications, and found that the clinical benefits obtained by the additional IC or AC to CCRT, at the cost of the increased risks of more frequent and more severe side effects, seemed not big enough. More intervention is not always better, however, less seems frequently good enough. The author would speculate that ‘less is more’ and would advocate CCRT alone as the current standard.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Drug Therapy ; Humans ; Induction Chemotherapy ; Nasopharyngeal Neoplasms

Chemotherapy is one of main treatments for nasopharyngeal carcinoma (NPC) except radiation therapy. Improving and optimizing chemotherapeutic regimen are helpful to improve the therapeutic effects and reduce side effects. At present, concurrent chemoradiotherapy still is the standard treatment for advanced nasopharyngeal carcinoma. Induced chemotherapy has been shown superiority, but the effect of adjuvant chemotherapy needs further study. This paper analyzed the superior and inferior, effect and side effect of all kinds of chemotherapeutic methods or scheme including induced chemotherapy, concurrent chemotherapy, adjuvant chemotherapy and palliative chemotherapy and introduced simply the mechanism and clinical effect of new drugs of anticancer. It was hoped to offer some reference for the selection of chemotherapy for NPC.
Antineoplastic Combined Chemotherapy Protocols ; Carcinoma ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy

Between January 1971 and December 1987, 113 patients with nasopharyngeal cancer (NPC) were treated by radiation therapy with or without chemotherapy in the department of Radiation Oncology, Yonsei University Hospital. There were 19 patients under thirty years of age. The histology was undifferentiated carcinoma in 68% of the younger patients as compared to 47% of the older patients. Sex, stage, initial symptoms and treatment modalities differed little from those of older patients. In younger patients, the initial complete response rate was 79% as compared to older patients with 54%, distant metastases were more common and the overall five year survival rate was not significantly different between the two age groups (33.7% for the young vs. 37.4% for the old). The five year survival rates for stage III and IV were 60.0% and 24.5%, respectively. Histologic subtype was not correlated with survival. The best survival was found only in patients who obtained a complete clearance of disease after radiation therapy. Adjuvant chemotherapy is suggested as an important target for further study.
Carcinoma ; Chemotherapy, Adjuvant ; Drug Therapy ; Humans ; Nasopharyngeal Neoplasms* ; Neoplasm Metastasis ; Radiation Oncology ; Survival Rate

PURPOSE: This study is to report experience with Fractionated Stereotactic Radiation Therapy (FSRT) for locally recurrent nasopharynx cancer after curative conventional radiation therapy. MATERIALS AND METHODS: Three patients with locally recurrent and symptomatic nasopharynx cancer were given FSRT as reirradiation method between the period of September of 1995 and August of 1996. For two patients, application of FSRT is their third radiation therapy directed to the nasopharynx. Two patients were given low dose chemotherapy as radiation sensitizer concurrently with FSRT. Authors used 3-dimensional coordinate system by individually made, relocatable Gill-Thomas-Cosman (GTC) stereotactic frame and multiple non-coplanar arc therapy dose planning was done using XKnife-3. Total of 45 Gy/18 fractions or 50 Gy/20 fractions were given. RESULTS: Authors observed satisfactory symptomatic improvement and remarkable objective tumor size decrease by follow-up MR images taken 1 month post-FSRT in all three patients, while no neurologic side effect attributable to reirradiation was noticed. Two died at 7 and 9 months with loco-regional and distant seeding outside FSRT field, while one patient is living for 4 month. CONCLUSION: Authors experienced satisfactory therapeutic effectiveness and safety of FSRT as reirradiation method for locally recurrent nasopharynx cancer. Development of more effective systemic chemotherapeutic regimen is desired for distant metastasis.
Drug Therapy ; Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms* ; Nasopharynx* ; Neoplasm Metastasis

PURPOSE: To evaluate the relationship between treatment failure and COX-2 expression in nasopharyngeal cancer patients treated with chemotherapy and radiotherapy. MATERIALS AND METHODS: The subjects of this study were 22 nasopharyngeal cancer patients. The patients were treated with neoadjuvant chemotherapy, followed by radiotherapy, or with radiotherapy alone. The formalin- fixed, paraffin- embedded tissues of 11 patients who developed a locoregional recurrence (n=7) or distant metastasis (n=4) were compared with those of 11 disease free patients. Prognostic factors, including histological type, stage, radiation dose and chemotherapy, were well balanced between the two groups. The COX-2 expression was determined immunohistochemically. RESULTS: COX-2 expression was stronger in the patients with a locoregional recurrence or distant metastasis than in those free of disease. The COX-2 distribution scores of the control group were as follows: 0 in 7, 1 in 2 and 2 in 2 patients. In the recurrence group, the scores were as follows; 0 in 3, 1 in 1, 2 in 2 and 3 in 5 patients. COX-2 expression was shown to have a statistically significant influence on the treatment failure by the Mann-Whitney U test (p=0.024) and Mantel-Haenszel Chi-Square test (p=0.018). It also significantly influenced the treatment failure when an analysis was performed within patients with a undifferentiated histology (p=0.039 by the Mann- Whitney U test, p=0.037 by the Mantel-Haenszel Chi- Square test). CONCLUSION: COX-2 expression is believed to be one of the important factors associated with a locoregional recurrence or distant metastasis.
Cyclooxygenase 2 ; Drug Therapy ; Humans ; Nasopharyngeal Neoplasms* ; Neoplasm Metastasis ; Prostaglandin-Endoperoxide Synthases* ; Radiotherapy ; Recurrence ; Treatment Failure

Thirty-one patients with previously untreated and locally advanced nasopharyngeal caner were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam St. Mary's Hospital. 23/31 were evaluable for recurrence and survival. There were 8 patients for stageIII , and 15 patients for stageIV. Eleven patients were treated with radical radiation therapy alone (am I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (am II). The two arms were comparable in patients characteristics of 11 radiotherapy patients, complete response was 55% (6/11) and partial response 45% (5/11). Among 12 patients after induction chemotherapy, complete response was 25% (3/12) and partial response 75% (9/12). After subsequent radiotherapy, complete response was increased to 83% (10/12) and partial response was 17% (2/12). Treatment failure was 36% (local recurrence; 3/11, and regional recurrence; 1/11) in arm l and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm II. There was no significant difference in survival between am I and arm II (p>.05). The toxicities of treatment were acceptable. More controlled clinical trails must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer.
Arm ; Drug Therapy ; Humans ; Induction Chemotherapy ; Nasopharyngeal Neoplasms ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Treatment Failure

p style=text-align: justify;strongOBJECTIVE:/strong To describe an unusual presentation of undifferentiated nasopharyngeal malignancy with immunohistochemical features of both diffuse B-cell lymphoma and undifferentiated carcinomastrong./strongbr /br /strongMETHODS:/strongbr /strongDesign:/strong Case Reportbr /strongSetting/strong: Tertiary Private University Hospital br /strongPatient:/strong Onebr /br /strongRESULTS:/strong A 49-year-old female whose initial nasopharyngeal biopsy interpretation was diffuse large B-cell lymphoma underwent three cycles of Rituximab, Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisone (R-CHOP). Post-chemotherapy Computed Tomography (CT) scan of the nasopharynx revealed no change in tumor size or appearance. Repeat nasopharyngeal (NP) biopsy findings suggested an epithelial tumor lineage or post-chemotherapy reactive mucosal epithelial cells. No residual lymphoma was noted and immunostaining was positive for cytokeratin. The patient underwent 35 fractions of radiotherapy. Re-evaluation by Magnetic Resonance Imaging (MRI) with contrast after four months showed significant tumor shrinkage. Repeat NP biopsy revealed necrotic tissues with foci of high-grade squamous cell carcinoma. Two months after the biopsy, repeat MRI with contrast of the nasopharynx and neck showed increase in the bulk of the nasopharyngeal tumor with inferior extension to the level of the orophaynx and possible contralateral involvement. A nasopharyngectomy via left maxillary swing was performed and the final histopathology was undifferentiated carcinoma.br /br /strongCONCLUSION:/strong Undifferentiated malignancies of the nasopharynx may contain lymphoma or carcinoma and rarely, both lineages in coexistence. In such cases, the possibility of a collision tumor should be considered. Immunohistochemical distinction is important for treatment and prognostication./p
Human ; Female ; Middle Aged ; NASOPHARYNGEAL NEOPLASMS-drug therapy ; NASOPHARYNX ; LYMPHOMA ; CARCINOMA ; Cyclophosphamide ; Vincristine ; Prednisone

OBJECTIVETo investigate the role of sho-saiko-to compound (SSTC) on the growth of the well-differentiated squamous cell line 1 of nasopharyngeal carcinoma (CNE-1) and well-differentiated CNE-2 in tumor-bearing nude mouse, and try to supply scientific data for its clinical development.

METHODSSTC were prepared by concentration gradients, and the effect of SSTC on the growth and proliferation of the CNE-1 and CNE-2 were investigated by MT assay and soft-agar colony formation test. After setting up the subcutaneous tumor-bearing nude mouse model at the right lower back (0.2 mL CNE-2 cell suspension, 5 x 10(5)/mL), we randomly divided forty mice into 5 groups and gave high, middle and low concentration groups of SSTC (0.5, 0.25, 0.125 g X mL(-1) by intragastric administration. Positive and negative groups were set up for comparison. After constant administration for 15 days, the volume and weight of the tumor were measured for inhibition rate, so as to investigate the role of SSTC on the CNE-2 bearing tumor.

RESULTIn vitro, compared with negative control, SSTC at different gradient concentrations were cultured with the CNE-1 and CNE-2 for 24 h, 48 h and 72 h. It showed that the growth and proliferation of both cell lines were inhibited to some extent. The inhibition rate was increased as the concentration and culture time increasing. Both MTT assay and soft-agar colony formation test showed that the 50% inhibiting concentration (IC50) was about 2.5 g X L(-1). In vivo, compared with negative control, the SSTC could slow down the tumor growth in the SSTC treated groups. The tumor growth of the negative control group (0.76 +/- 0.28) g, (962.88 +/- 245.96) mm3 and the low concentration group of SSTC (0.88 +/- 0.40) g, (1239.66 +/- 421.93) mm3 were obviously faster than those of the high, middle concentration group of SSTC (0.22 +/- 0.14) g, (239.31 +/- 137.07) mm3; (0.20 +/- 0.16) g, (263.42 +/- 166.57) mm3 and CTX positive control group (0.20 +/- 0.10) g, (246.72 +/- 194.6) mm3 (P<0.05).

CONCLUSIONSSTC could efficiently inhibit the growth and proliferation of CNE-1 and CNE-2 in vitro, and slow down the tumor growth of the CNE-2 bearing nude mice. It may be a new compound of Chinese medicine for nasopharyngeal carcinoma therapy.

Animals ; Carcinoma ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; Female ; Humans ; Male ; Mice ; Mice, Nude ; Nasopharyngeal Neoplasms ; drug therapy ; Transplantation, Heterologous