Objective To observe the clinical effects of radiotherapy and/or chemotherapy in the treatment of nasal and Waldeyer ring natural killer (NK)/T cell lymphoma and to analyze the prognostic factors.Methods Between January 20,2000 and December 21,2010,109 patients with nasal NK/T cell lymphoma and 21 patients with Waldeyer ring NK/T cell lymphoma were admitted to our hospital; the diagnosis was confirmed by immunohistochemistry.According to the Ann Arbor staging system,116 patients were classified as stage Ⅰ E,and 14 as stage Ⅱ E.Thirty patients received radiotherapy alone;2 patients received chemotherapy alone; 98 patients received radiochemotherapy.Results The follow-up rate was 100％.Seventy-eight patients were followed up for at least 5 years.The complete remission (CR) rate was 89.2％ in all patients.The CR rates of stage Ⅰ E patients and stage Ⅱ E patients were 88.8％ and 92.9％,respectively (x2 =0.02,P =0.837).The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86％ and 96％,respectively (x2 =1.44,P =0.230).The five-year overall survival (OS) rate and disease-free survival (DFS) rate of all patients were 58.0％ and 57.2％,respectively.The five-year OS rates of stage Ⅰ E patients and stage Ⅱ E patients were 60.6％ and 36.3％,respectively (x2 =0.25,P =0.615) ;the five-year DFS rates of stage Ⅰ E patients and stage Ⅱ E patients were 59.7％ and 36.3％,respectively (x2 =0.21,P =0.648).The five-year OS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 70.0％ and 48.4％,respectively (x2 =0.01,P =0.933) ; the five-year DFS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 65.6％ and 48.4％,respectively (x2 =0.09,P =0.764).The grade 3-4 toxicity rates of radiotherapy alone and radiochemotherapy were 6.7％ and 54.1％,respectively (x2 =41.38,P=0.002).The radiation dose to the primary lesion and Eastern Cooperative Oncology Group (ECOG) score were correlated with OS (x2 =3.1 8,P =0.005 ; x2 =2.97,P =0.008).Conclusions The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage ⅠE and ⅡE nasal and Waldeyer ring NK/T cell lymphoma,but radiochemotherapy has higher toxicity than radiotherapy alone.The radiation dose to the primary lesion and ECOG score are the influential factors for OS.

ObjectiveTo assess the impact of set-up correction on dosimetry using non-daily kilovolt cone-beam computed tomography (KVCBCT) for nasopharyngeal cancer patients treated with intensitymodulated radiotherapy (IMRT). MethodsThe mean shift values from 14 nasopharyngeal cancer patients received KVCBCT scans during the first 5 treatment fractions were calculated as prediction of systemic set-up errors and used for off-line correction at 1.5 mm threshold level. Presumed that the systemic errors can be corrected by moving couch without residual errors, the pre-correction set-up errors in the remaining fractions were the sum of actual set-up errors and predicted errors. The dosimetric effects of non-daily protocol were simulated in the planning system and analyzed with physical dose parameters in 14 IMRT plans. ResultsIn 10 patients with predicted systemic errors ＞ 1.5 mm, target dose was reduced significantly. The mean reduction of GTV-D98 ( dose received by 98％ of the volume of GTV ), CTVnx-D95 ( dose received by 95％ of the volume of CTVnx ), CTV1 -D98 ( dose received by 98％ of the volume CTV1 ) were 3. 8 Gy ( Z =- 2. 81,P =0. 005 ) ,4. 8 Gy ( Z =- 1.96, P =0. 050 ), 1.0 Gy ( Z =- 2. 82, P =0. 005 ), respectively. The effect on dose to CTV2 was much less. After correction, mean 3D vector positioning errors was reduced from 3. 6mm to 2. 3 mm (t =2.00,P =0. 000). After correction, the dose led to increase in GTV-D98, CTVns-D95,CTV1-D95 was 3.8 Gy (t=-2. 70,P=0.007),5.0 Gy (t =-2. 15,P=0.030),0.9 Gy (Z=-2.80,P=0. 005 ) respectively, and reduced the dose deviation greater than 3％ or 5％ for organs at risk.Conclusion Non-daily KVCBCT correction reduced dosimetric effect of set-up errors in IMRT for nasopharyngeal cancer patients.

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.

Objective To define the patterns of local extension and nodal involvement in patients with early stage nasal NK/T-cell lymphoma, and to improve the delineation of clinical target volume.Methods Two hundred and twenty-two patients consecutively diagnosed with nasal NK/T-cell lymphoma were reviewed.All patients had stage Ⅰ E/Ⅱ E diseases.CT/MRI images were reviewed to determine the local invasion of adjacent organs or structures and involvement of lymph node.Results 143 of 222(64%) patients had primary tumor extended into adjacent organs or structures from nasal cavity.According to the incidence rates of tumor extension, the involved organs or structures were subclassified into three subgroups:high risk (≥40%):ethmoid sinus (60%) and maxillary sinus (55%);intermediate risk (5%-40%):nasopharynx (39%), skin (22%), oropharynx (12%), orbit (10%), and hard palate (10%);and low risk (≤5%):sphenoid sinus (3%), soft plate (3%),frontal sinus (3%) and skull base (1%).Cervical lymph node metastasis occurred in 16%(36/222) of the patients and these patients were staged as Ⅱ E.Thirty-three patients with stage Ⅱ E disease had available images and were analyzed for the pattern of nodal involvement.Submandibular or submental (57%) and the upper cervical lymph nodes (57%) were the most commonly involved sites of nodal region.For the 24 patients with primary tumor located in the unilateral nasal cavity, 54% presented with contralateral cervical lymph node metastasis.Whereas for the 9 patients with primary tumor located in the bilateral nasal cavity, 57% had bilateral cervical lymph node metastasis.For the 88 patients with extensive stage Ⅰ E disease who did not receive irradiation to the cervical lymph node, only one patient (1%) had disease relapse in cervical lymph node.Furthermore, all patients with disease extended to nasopharynx (n= 23) or oropharynx (n= 8) did not receive prophylactic cervical lymph node irradiation, and none of them developed cervical lymph node relapse.Conclusions The delineation of clinical target volume for early stage nasal NK/T-cell lymphoma should be determined by the risk of involvement of paranasal structures and cervical lymph node.Prophylactic neck irradiation is not recommended for patients with stage Ⅰ disease.

Objective To evaluate the clinical features, treatment outcome, and prognostic factors in patients with primary Waldeyer’ s ring diffuse large B?cell lymphoma (WR?DLBCL). Methods This study included 200 patients with a confirmed diagnosis of primary WR?DLBCL admitted to our hospital from 2000 to 2013, who consisted of 50 stage I patients, 125 stage II patients, and 25 stage III?IV patients. Most patients received 4?6 cycles of CHOP or CHOP?based chemotherapy with or without involved field radiotherapy (Waldeyer′s ring+cervical lymph node region). Results The 5?year sample size was 71. The 5?year overall survival (OS), progression?free survival (PFS), and locoregional control (LRC) rates for the whole group were 78%, 72%, and 87%, respectively. In the 175 early stage patients, chemoradiotherapy resulted in significantly higher OS, PFS, and LRC than chemotherapy alone (86% vs. 70%, P= 0?? 001;84% vs. 58%, P= 0?? 000;97% vs. 66%, P= 0?? 000). Univariate analysis showed that age, tumor size, stage, lactate dehydrogenase level, and International Prognostic Index were prognostic factors for OS, PFS, and LRC ( P= 0?? 000?0?? 036), while the prognostic factors for PFS also included Eastern Cooperative Oncology Group score and cervical nodal involvement (P= 0?? 018). Multivariate analysis showed that age and stage were prognostic factors for OS and LRC (P= 0?? 003?0?? 022), and age was the prognostic factor for PFS (P= 0?? 000). Conclusions WR?DLBCL has distinct clinical features and favorable prognoses. For early stage patients, combined?modality therapy results in significantly higher OS, PFS, and LRC.

Objective To evaluate the value of radiotherapy following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone ( R?CHOP )?based chemotherapy for patients with early?stage Waldeyer’ s ring diffuse large B?cell lymphoma ( WR?DLBCL). Methods Eighty?three patients diagnosed with early?stage WR?DLBCL who were admitted to our hospital from 2000 to 2013 were enrolled in the study. In these patients, twenty?five had stageⅠdisease and fifty?eight had stageⅡdisease. All patients received R?CHOP?based chemotherapy with ( n= 62 ) or without ( n= 21 ) involved?field radiotherapy ( Waldeyer’ s ring plus cervical lymph nodes ) . The overall survival ( OS ) , progression?free survival ( PFS) , and local?regional control ( LRC) rates were calculated using the Kaplan?Meier method. The univariate analysis was performed using the log?rank method. The multivariate analysis was performed using the Cox regression model. Results In all patients, the 5?year sample size was 18;the 5?year OS, PFS, and LRC rates were 89%, 84%, and 90%, respectively. According to the univariate analysis, patient age greater than 60 years, an increased lactate dehydrogenase level, Eastern Cooperative Oncology Group ( ECOG ) performance status no less than 2, and International Prognostic Index ( IPI ) no less than 2 were poor prognostic factors. Patient age greater than 60 years, a tumor size no less than 5 cm, ECOG performance status no less than 2, and IPI no less than 2 were influencing factors for PFS and LRC rates. In addition to the treatment with rituximab, patients treated with consolidative radiotherapy had significantly higher PFS and LRC rates (94% vs. 58%, P=0?003;100% vs. 61%, P=0?000) as well as slightly higher OS rate ( 9 4%vs . 7 1%, P=0?0 6 3 ) than those treated without radiotherapy . Conclusions Consolidative radiotherapy following R?CHOP?based chemotherapy significantly improves PFS, LRC, and probably OS rates for early?stage WR?DLBCL. This conclusion still needs to be confirmed by prospective studies with a large sample size.

Objective:To evaluate the psychological pain of patients with head and neck cancer aged ≥60 years old before and after intensity-modulated radiotherapy (IMRT).Methods:Distress Thermometer (DT)(Chinese version) was used to investigate the degree and problems of psychological pain before and after IMRT for 85 elderly patients with head and neck cancer. The results before and after IMRT were compared by paired t-test. Relevant factors were identified by Logistic regression analysis. Results:The median age in the cohort was 66 years old (60-85 years old). The incidence rates of psychological pain were 73% and 87% before and after IMRT ( P<0.001). The corresponding incidence rates of severe distress were 6% and 34%( P<0.001). The main distress problems before IMRT were memory loss/attention deficit, worry, oral pain, economic problems, stress, sleep problems, and dry nose. The significantly-increased distress problems after IMRT were oral pain, constipation, eating, nausea, and dry nose. Logistic regression analysis showed gender ( OR=5.520, 95% CI 1.437-21.212, P=0.013), pre-treatment PG-SGA score ( OR=1.220, 95% CI 1.048-1.421, P=0.010) and medical insurance ( OR=0.230, 95% CI 0.053-0.995, P=0.049) were the relevant factors of the severe psychological distress before IMRT. Occupation ( OR=2.286, 95% CI 1.291-4.050, P=0.005) and medical insurance ( OR=0.089, 95% CI 0.029-0.276, P<0.001) were the relevant factors of severe psychological distress after IMRT. Conclusion:The incidence rate of distress is high in elderly patients with head and neck cancer before IMRT, which can be aggravated after IMRT, primarily the treatment-related physical pain problems.

Objective To investigate the clinical characteristics and long-term outcome of patients with mucosa-associated lymphoid tissue ( MALT) lymphoma of Waldeyer's ring. Methods Ten patients were retrospectively analyzed. Seven patients had stage ⅠE and 3 patients had stage ⅡE disease. All patients received radiation therapy with a median dose of 40 Gy, and 7 patients also received 1 t0 4 cycles of CHOP-based chemotherapy before radiation. Results The ratio of male to　female was 1∶9. The median age was 58 years. No patient had B symptoms. One patient had elevated LDH level. The complete response rate after treatment was 100％. With median follow-up periods of 90 months, 1 patient died from rectal cancer. One patient developed brain metastasis and was salvaged by radiotherapy. The 5-year overall survival, cancer specific survival and progression-free survival rates were 90％ , 100％ and 80％ , respectively. Conclusions The clinical characteristics of Waldeyer's ring MALT lymphoma were similar to that of nongastric MALT lymphoma. For patients with Waldeyer's ring MALT lymphoma, primary radiotherapy can result in excellent long-term survival.

ObjectiveThis study aimed to compare the clinical characteristics and prognoses of primary Waldeyer's ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma ( ENKTCL).MethodsFrom 2000 to 2008,122 patients with primary Waldeyer's ring DLBCL and 44 patients with primary Waldeyer' s ring ENKTCL consecutively diagnosed were retrospectively compared.Patients with DLBCL usually received 4-6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy.Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy,or short courses ( 1 - 3 cycles ) of chemotherapy followed by radiotherapy.Kaplan-Meier method was used for survival analysis.Logrank method was used for univariate analysis.ResultsThe follow-up rate was 82％.The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL.DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph node involvement.ENKTCL occurred predominately in young males,as nasopharyngeal stage I disease with B symptoms and involving adjacent structures.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 74％ and 67％ in DLBCL,and 68％ and 59％ in ENKTCL (x2=0.53,1.06,P=0.468,0.303),respectively.In stage Ⅰ and Ⅱ diseases,the 5-year OS and PFS rates were 79％ and 76％ for DLBCL compared to 72％ and 62％ for ENKTCL (x2 =1.20,2.46,P=0.273,0.117).On univariate analysis,age ＞ 60 years,elevated lactate dehydrogenase,eastern cooperative oncology group performance status ＞ 1,international prognosis index ( IPI ) score ≥ 1,stage Ⅲ/Ⅳ diseases and bulky disease were associated with unfavorable survival for DLBCL (x2=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019),and only age＞60 years and IPI score ≥ 1 were associated with poor survival for ENKTCL (x2 =3.98,8.41,P =0.046,0.004).ConclusionsThese results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer's ring. Different treatment strategies for each can result in similarly favorable prognoses.

Objective This study aimed to evaluate the prognostic value of regional lymph node spread in patients with stage Ⅱ nasal-type NK/T-cell lymphoma of the upper aerodigestive tract (UADT-NKTCL).Methods From 1987 to 2013,a total of 97 patients with newly-diagnosed stage Ⅱ UADT-NKTCL were retrospectively reviewed.Primary tumors were located in the nasal cavity (n=52) or extranasal UADT sites (n=45).The majority of patients were treated with primary radiotherapy.Sixty-five patients were treated with combined modality therapy (CMT),and 32 patients were treated with radiotherapy alone (n=27) or chemotherapy alone (n=5).The Kaplan-Meier method was used to calculate the survival rate,and the log-rank test was used for survival difference analysis and monovariate prognostic analysis.The Cox regression model was used to multivariate prognostic analysis.Results The 5-year overall survival (OS) and progression-free survival (PFS) rates for all stage Ⅱ patients were 57% and 49%,respectively.The presence of a lower neck lymph node (defined as extension below the caudal border of the cricoid cartilage) was significantly associated with poor outcomes on univariate analysis and maintained significance on multivariate analysis.The median survival for patients with lower neck lymph node was 19.3 months and the 2-,5-years OS rates were 28% and 11%(P=0.000).For stage Ⅱ patients,CMT significantly improved survival.The 5-year OS and PFS rates were 64% and 52% for CMT,compared with 40.4%(P=0.006) and 42% for single modality therapy (P=0.088).Conclusion The level of regional lymph node is a powerful prognostic factor for stage Ⅱ UADT-NKTCL.The involvement of low neck lymph node is significantly associated with poorer survival outcomes.