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

PURPOSE: To evaluate the prognosis of nasopharyngeal carcinoma (NPC) patients who developed bone-only metastasis after primary treatment and the stratification of these patients into different risk groups based on independent prognostic factors. MATERIALS AND METHODS: Eighty NPC patients who developed bone-only metastasis after definitive radiotherapy from October 2005 to December 2010 were enrolled. All these patients received palliative treatment for bone metastasis, including chemotherapy and/or radiotherapy. Clinical features, treatment modality, and laboratory parameters were examined with univariate and multivariate analyses. RESULTS: The median follow-up time was 15.5 months (range, 2-67 months) for the whole cohort. The median overall metastatic survival (OMS) time and the 2-year estimate OMS rate were 26.5 months and 52%, respectively. Multivariate analysis indicated that patients with short metastases-free interval, multiple bone metastases sites, high serum lactic dehydrogenase levels, and treated with radiotherapy or chemotherapy alone had significantly worse outcomes. Patients were stratified into three different risk groups based on the number of adverse factors present. The OMS curves of the three groups were all significantly different (p<0.001). CONCLUSION: Severl prognostic factors were found to be associated with worse outcomes. According to the number of adverse factors present, bone-only metastasis patients can be stratified into three risk groups with significantly different prognoses. Such grouping may help in improving the design of clinical trials and in guiding individualized treatment for NPC patients with bone-only metastasis.
Adolescent ; Adult ; Aged ; Bone Neoplasms/mortality/*secondary/therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Nasopharyngeal Neoplasms/mortality/*pathology/therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo analyze the prognostic factors affecting long-term result in pediatric or adolescent nasopharyngeal carcinoma.

METHODSFrom January 1984 to December 1998, 117 cases of pediatric and adolescent nasopharyngeal carcinoma proven by pathology were treated by radiotherapy and/or chemotherapy. Their data were retrospectively analyzed. Of the 117 patients, 35 received chemotherapy before radiotherapy, 36 were treated with continuous radiotherapy and the other 81 with split-course radiotherapy. A dose of 56 - 80 Gy/6 - 13 weeks (66.32 +/- 4.72 Gy) was given in the nasopharynx and 47 - 73 Gy/5 - 13 weeks (57.90 +/- 5.80 Gy) in the neck. The survival rates were assessed by Kaplan-Meier analysis and the survival curves compared by Log-rank test. The multivariate analysis was conducted by Cox model.

RESULTSThe 1-, 3- and 5-year overall survival rate was 86.3%, 66.6% and 56.4%, respectively; and disease-free survival rate at 1, 3 and 5 years was 71.8%, 53.9% and 50.4%, respectively. A monovariate analysis showed that the age (P = 0.0015), mode of biopsy (P = 0.0234), N stage (P = 0.0001), mode of irradiation (P = 0.0027), chemotherapy (P = 0.0056) and short-term result (P = 0.0000) were the significant prognostic factors. The multivariate analysis demonstrated that the age (P = 0.027), N stage (P = 0.048), mode of irradiation (P = 0.009) and short-term result (P = 0.000) were the factors influencing prognosis of nasopharyngeal carcinoma in childhood and adolescence. Radiation-induced brain injuries were observed in 17 patients including brain stem injury in 1 (0.9%), temporal brain lobes in 3 (2.6%) and cranial nerves in 13 (11.1%).

CONCLUSIONThe mode of irradiation, N stage and short-term result are the significantly influencing factors of prognosis in pediatric and adolescent nasopharyngeal carcinoma. Radiation-induced brain injuries during radiotherapy should not be overlooked.

Adolescent ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; pathology ; radiotherapy ; Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Nasopharyngeal Neoplasms ; drug therapy ; mortality ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Radiation Injuries ; etiology ; Radiotherapy, High-Energy ; adverse effects ; Retrospective Studies ; Survival Rate

OBJECTIVE: The purpose of this study is to investigate the effective of alternating Chemo-radiotherapy for locally Advanced Nasopharyngeal Carcinoma. METHOD: Retrospective analysis 106 cases of patients with locally advanced nasopharyngeal carcinoma between November 2005 and March 2007. All patients received cisplatin-based chemotherapy but 15 patients received radiotherapy(RT) alone. Inducing chemotherapy (IC) + RT + adju-vant chemotherapy (AC) regimen in 36 patients, IC+RT regimen was delivered in 25 patients and AC + RT regimen in 30 patients. 61 patients received 1 to 2 cycles of inducing chemotherapy and 66 patients received 3 to 6 cycles of adjuvant chemotherapy after radiotherapy. Chemotherapy started on the first day after the end of the induction chemotherapy, adjuvant chemotherapy begun after radiotherapy for a week. All patients were treated by radiotherapy using 60 Co r-ray, the nasophyarynx primary site was given a total does of 68 -74 Gy. The lymph nodes of the neck was given 60 to 70 Gy. The prophylactic irradiation does of the neck was 48-50 Gy. RESCULT: The median follow up time was 51 months. A total of 58 patients died, the overall survival rate was 45% in whole groups. The 5-year overall survival rates were 33%, 63%, 60% and 50% in RT, IC + RT + AC, IC + RT and RT+AC group, respectively. The 5-year disease-free survival rates were 13%, 56%, 48% and 40% in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The 5-year relapse-free survival rates were 13%, 53%, 48% and 50% in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The 5-year metastasis-free survival rates were 6%, 50%, 44% and 47% in RT, IC + RT + AC, IC+ RT and RT + AC group, respectively. There was significant difference in all groups (P < 0.05). The median time to relapses were 22 months, 29 months, 28 months and 25 months in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The median time to first distant metastasis were 10 months, 19 months, 15 months and 12 months in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. There was no significant difference in all groups (P > 0.05). IC + RT + AC group had heavier acute toxicity effects than other groups, but it did not affect the treatment process, all patients could be tolerated. CONCLUSION This retrospective study has demonstrated that alternating Chemo-radiotherapy and early radiotherapy not only can improve the survival rate for locally Advanced Nasopharyngeal Carcinoma, but also have slight toxicities and side reaction, all patients may tolerated.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma ; Chemotherapy, Adjuvant ; adverse effects ; Cisplatin ; administration & dosage ; Disease-Free Survival ; Female ; Humans ; Induction Chemotherapy ; adverse effects ; Male ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy ; mortality ; pathology ; radiotherapy ; Neoplasm Staging ; Radiotherapy Dosage ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo evaluate the efficacy and safety of gemcitabine combined with ifosfamide (GI regimen)in patients with recurrent or metastatic nasopharyngeal carcinoma after failure of platinum-based chemotherapy.

METHODSThe clinical data of 27 nasopharyngeal carcinoma patients, who received GI regimen between April 2005 and March 2014 after failure of prior platinum-based chemotherapy, were retrospectively reviewed,and relevant prognostic factors were explored.

RESULTSAll patients were evaluable for efficacy and toxicity. No patient achieved complete response (CR). Partial response (PR) was achieved in ten patients, stable disease (SD) in thirteen patients, progressive disease (PD) in four patients, with a response rate of 37.0% and an overall disease control rate (PR+SD) of 85.2%. For ten PR patients, the median duration of response was 5.5 months. The median progression-free survival of the whole group was 6.7 months, and the Kaplan-Meier estimate of median overall survival was 17.4 months. The 1-year survival rate was 72.6%. Toxicity was mainly hematological: Grade III or IV anemia, neutropenia and thrombocytopenia were found in 3.7%, 37.0% and 18.5% of all patients, respectively. Univariate and multivariate analyses indicated that dose intensity of gemcitabine was a significant prognostic factor for PFS, whereas salvage treatment after failure of GI regimen was a significant prognostic factor for OS.

CONCLUSIONSGemcitabine and ifosfamide combination is effective and well tolerated by patients with advanced nasopharyngeal carcinoma pretreated with platinum-based chemotherapy. Further clinical study is warranted.

Anemia ; chemically induced ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Disease-Free Survival ; Humans ; Ifosfamide ; administration & dosage ; adverse effects ; Induction Chemotherapy ; Kaplan-Meier Estimate ; Nasopharyngeal Neoplasms ; drug therapy ; mortality ; pathology ; Neutropenia ; chemically induced ; Platinum ; therapeutic use ; Remission Induction ; Salvage Therapy ; Survival Rate ; Thrombocytopenia ; chemically induced ; Treatment Failure