This is to report the results of 3-dimensional (3D) high dose re-irradiation (re-RT) for patients with locally recurrent nasopharyngeal cancer. Between May 1995 and Dec. 2000, 21 patients with locally recurrent cancer of the nasopharynx received high dose 3D re-RT at Samsung Medical Center. The median 55 (45 - 70) Gy was applied by daily fractions of 2.5 Gy or 3.0 Gy. The median survival period, the rates of local control, overall survival and disease-free survival at 5 years, of all patients, were 21 months, 71.8%, 32.3%, and 21.2% respectively. The number of patients who experienced treatment failures at any site was 14 (67.0%) : eight patients (38.1%) experienced distant hematogenous metastases; five patients (23.8%) experienced recurrences within the current re-RT treatment volume; and seven patients (33.0%) had recurrences outside this volume. Five patients (23.8%) experienced severe late radiation-induced complications of RTOG grade IV or V, and these were brainstem necrosis (2), temporal lobe necrosis (1), mucosal necrosis (1), and massive epistaxis (1). For locally recurrent nasopharyngeal cancer patients, high dose 3D re-RT could lead to improved results when compared with the historic data by conventional re-RT techniques. Further treatment refinements, that would be necessary, may include optimization in patient selection, improvement in target localization and patient immobilization, and the addition of systemic agents, either as a radiation sensitizer or a radiation protector.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/*radiotherapy/secondary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Human ; Male ; Middle Aged ; Nasopharyngeal Neoplasms/mortality/pathology/*radiotherapy ; Neoplasm Recurrence, Local/mortality/*radiotherapy ; Radiation Dosage ; *Radiotherapy, Conformal ; Survival Analysis

OBJECTIVETo investigate the clinical characteristics of second primary tumor of tongue after nasopharyngeal carcinoma (NPC) radiotherapy and the prognostic factors of patients.

METHODSFifty-three cases with second primary tumor of tongue after NPC radiotherapy, presenting to Cancer Centre, Sun Yat-sen University from Jan. 1st 1975 to Dec. 31st 2000 were analyzed retrospectively with regard to mortality and survival rate (Kaplan-Meier method); A multivariate analysis was performed in these patients with Cox proportional hazard model.

RESULTSForty of 53 patients died. Among them,37 died of second primary tumor of tongue, 2 of recurrence of NPC, 1 of perioperative period. The overall 5-year and 10-year survival rate of 51 patients receiving therapy were 41.64% and 35.69% respectively. The subsites of tumor were: tip 0, margin 26 (49.06%), ventral lateral 8 (15.09%) and dorsal aspect 19 (35.85%). Eighteen cases had recurrence of second primary tumor of tongue (33.96%) ; Six (11.32%) cases had clinical lymph node metastasis from second primary tumor of tongue and 3 (5.66%) had pathological lymph node metastasis; The univariate analysis showed the major prognostic factors influencing survival of these patients were tumor size, clinical TNM stage at presentation; Using multivariate analysis, risk factors that independently influence survival were clinical and pathological stage and the interval between two tumors.

CONCLUSIONSThe clinical and pathological stage and the interval between two tumors are the prognostic factors for second primary tumor of tongue after NPC radiotherapy.

Adult ; Aged ; Carcinoma ; mortality ; pathology ; radiotherapy ; Carcinoma, Squamous Cell ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; mortality ; pathology ; radiotherapy ; Neoplasms, Second Primary ; Prognosis ; Retrospective Studies ; Survival Rate ; Tongue Neoplasms

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

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

OBJECTIVE: To retrospectively analyze the long-term curative effects and prognostic factors of 137 cases of NPC patients treated with intensity modulated radiation therapy. METHOD: The three-dimensional conformal intensity modulated radiation therapy adopted for the design plan of 137 cases of newly diagnosed and no distant metastatic NPC patients. Evaluation of short-term clinical efficacy was made according to the efficacy evaluation criteria of WHO solid tumor one month after radiotherapy. During the 2 years after radiotherapy, re-examinations were made every 3 months. Two years later, re-examinations were made every 6 to 12 months, and the routine examinations included clinical body check, nasopharyngoscope, CT, B Chao, MRI, chest X-ray, bone scan, so as to understand the condition of cavum nasopharyngeum, cervical lymph nodes and cranial nerves. Life table method was adopted to calculate the overall survival rate, Kaplan-Meier method was used to calculate relapse-free survival rate, distant metasis-free survival rate and disease-free survival rate. Log-rank test was used for univariate analysis of 14 clinical factors which may exert influences on prognosis. Multivariate analysis was performed with the Cox regression model, P < 0.05 is of statistical significance. RESULT: (1) Of the 137 cases, the overall survival rates of 1-year, 3-year and 5-year were 98.5%, 90.3%, 74.6% respectively, relapse-free survival rates were 97.0%, 81.9%, 66.7% respectively; distant metasis-free survival rates were 96.3%, 80.5%, 56.0% respectively; disease free survival rates were 95.6%, 76.9%, 43.8% respectively. (2) Univariate analysis revealed that the influences of T-staging,N-staging, 92 Fuzhou clinical staging, combined chemotherapy, skull base bone destruction, injury of cranial nerve, retropharyngeal lymph node metastasis, residual disease, total time of IMRT on prognosis were of no statistical significance(with all the P values lower than 0.05) The influences of gender, nationality, age, pathological type and anemia or on prognosis were of no statistical significance(with all the P values higher than 0.05). (3) T-staging, skull base bone destruction, injury of cranial nerve, retropharyngeal lymph node metastasis, N-staging, combined chemotherapy, residual disease, total time of IMRT, and anemia were drawn into Cox model, and the results showed that N-staging, combined chemotherapy, injury of cranial nerve, residual disease, and total time of IMRT were independent factors that affect prognosis (with all P values lower than 0.05). CONCLUSION IMRT obviously has advantages than conventional radiotheraphy in treating NPC patients. N-staging, injury of cranial nerve, combined chemotherapy, residual disease, and total time of IMRT are the main factors that affect prognosis.
Adult ; Aged ; Carcinoma ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; mortality ; radiotherapy ; Neoplasm Recurrence, Local ; Prognosis ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Skull Base ; pathology ; Survival Rate