With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective:To investigate the optimal treatment modalities and prognostic factors of adenoid cystic carcinoma of the head and neck salivary gland.Methods:From January 2016 to December 2018, clinical data of 166 patients with adenoid cystic carcinoma of the head and neck salivary gland who received postoperative radiotherapy at Department of Radiation Oncology of the Ninth People′s Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by log-rank test. Multivariate prognostic analysis was carried out by Cox proportional hazard regression model.Results:Among 166 enrolled patients, 70 cases were male and 96 female with an average age of 53 years (18 to 71 years). The median follow-up time was 31.2 months (8.6-63.1 months). Sixty-six patients underwent radical surgery (extended resection across the anatomical areas outside the tumor bed, pursuing negative margins of various resections), and the remaining 100 patients underwent conservative surgery (only extended resection of lesions, not pursuing negative nerve resection margins). The median dose of postoperative radiotherapy was 66 Gy (54-70 Gy). Seventy-three patients were treated with TP regime due to positive or close margins and 9 cases of cervical lymph node metastasis. The 3-and 5-year overall survival (OS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) rates were 95% and 95%, 93% and 93%, 74% and 66%, 73% and 65%, respectively. Seven patients experienced primary lesion recurrence, 5 cases of regional lymph node recurrence and 38 cases of distant metastasis. T 3-T 4 stage, lymph nodes (+ ), stage IV, solid pathologic subtype, Ki-67≥10% and perineural invasion were associated with worse PFS and DMFS. Multivariate analysis demonstrated that only solid pathologic subtype was the independent prognostic factor of OS, LRRFS, PFS and DMFS. Conclusions:The local control rate of salivary gland adenoid cystic carcinoma can be improved by postoperative intensity-modulated radiotherapy (IMRT) with a recommended dose of ≥66 Gy. Solid pathologic subtype is the most important adverse prognostic factor.

Objective To assess the efficacy and safety of post operative adjuvant concurrent chemoradiotherapy for patients with high-risk salivary gland tumors (SGT).Methods Fifty-two patients with moderate or high malignant pathological stage complicated with locally advanced stage Ⅲ/ⅣA±positive margin/close margin admitted to Shanghai Ninth People's Hospital from 2016 to 2018 were enrolled in this study.Among them,35 patients were male and 17 female with a median age of 55.5 years old (range:21-73 years old).All 52 patients were treated with intensity-modulated radiotherapy and concurrent chemotherapy.Patients with adeno carcinoma of the salivary gland receives concurrent chemotherapy with TP regimen.Patients with lympho epithelial cancer and squamous cell carcinoma were treated with cisplatin regimen.Results Forty-seven patients (90％) completed two cycles of concurrent chemotherapy,and five patients (10％) completed one cycle of concurrent chemotherapy.The median follow-up time was 15.7 months (3.2-34.8 months).The 2-year disease-free survival (DFS) and overall survival (OS) rates were 74％ and 98％.Three patients experienced regional lymph recurrence and 6 cases had distant metastasis.Grade Ⅲ oral mucositis was observed in 30 patients.Grade Ⅲ dermatitis occurred in 5 cases.Only one patient experienced Grade Ⅳ neutropenia,and 2 patients developed Grade Ⅲ neutropenia.DFS was positively correlated with the cycle of postoperative adjuvant concurrent chemotherapy (P=0.006).Conclusions Patients with high-risk SGT can obtain higher 2-year DFS and OS rates and tolerable adverse events after postoperative concurrent chemoradiotherapy.Nevertheless,the long-term outcomes remain to be validated by randomized controlled clinical trials.

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.

Objective To investigate the relationship between nutritional status and quality of life ( QOL) in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy, and to identify the optimal indices of body composition for evaluation of malnutrition. Methods Based on the European Society Parenteral and Enteral Nutrition ( ESPEN) consensus on the diagnosis of malnutrition and patient?generated subjective global assessment (PG?SGA), a prospective study was performed in 48 patients with nasopharyngeal carcinoma who received concurrent chemoradiotherapy in our hospital from 2014 to 2015. Changes in body composition and nutritional status were evaluated in those patients. The relationship between nutritional status and QOL was studied. The predictive factors for nutritional status in patients with nasopharyngeal carcinoma were explored. The correlation between datasets was evaluated by the Pearson correlation coefficient. The influencing factors for nutritional status were analyzed by Logistic regression. Results During concurrent chemoradiotherapy, some indices of body composition, including weight, body mass index ( BMI) , fat mass index ( FMI) , fat?free mass index ( FFMI) , body cell mass ( BCM) , skeletal muscle mass ( SM) , and phase angle ( PA) had different degrees of reduction ( P=0?00) , while the PG?SGA score gradually increased. The incidence of malnutrition in patients with nasopharyngeal carcinoma during radiotherapy was 2?1%?39?6% based on 2015 ESPEN consensus on the diagnosis of malnutrition and 12?5%?41?7% based on PG?SGA. These two methods showed good agreement at the fourth and sixth weeks of radiotherapy ( Kappa=0?911;Kappa=0?957) . The changes in QOL score were correlated with changes in FFMI and weight during radiotherapy ( r= 0?805, P= 0?00;r= 0?777, P= 0?00 ) . Logistic regression indicated that age, FMI, and FFMI were influencing factors for nutritional status ( P= 0?035, 0?013, 0?043) . Conclusions Patients with nasopharyngeal carcinoma have substantial nutritional deterioration during chemoradiotherapy. The nutritional status is closely associated with QOL. A prediction model of nutritional status can provide a comprehensive and accurate judgment of nutritional status in patients.

Objective To retrospectively analyze the efficacy and toxicity of intensity?modulated radiotherapy ( IMRT) alone and IMRT with concurrent chemotherapy ( CRT) in the treatment of early?stage nasopharyngeal carcinoma ( NPC) using pairwise group comparison. Methods A total of 98 patients with stage T1?2N1M0 NPC were treated with IMRT alone or CRT from 2009 to 2010, and 39 pairs out of them were selected for comparison of efficacy and toxicity. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. Results The 3?year follow?up rate was 95%. There were no significant differences in the 3?year overall survival ( OS ) , progression?free survival ( PFS ) , local recurrence?free survival ( LRFS ) , and distant metastasis?free survival ( DMFS ) rates between the IMRT alone group and the CRT group ( 97% vs. 95%, P=0?411;97% vs. 92%, P=0?301;97% vs. 97%, P=0?606;100% vs. 92%, P=0?082) . The incidence rates of leucopenia, anemia, and thrombocytopenia were significantly higher in the CRT group than in the IMRT alone group ( P=0?000;P=0?000;P=0?000 ) . There were no significant differences in the incidence rates of grade 3 oral mucositis and hearing loss between the IMRT alone group and the CRT group ( 26% vs. 23%, P= 0?093;41% vs. 62%, P= 0?100 ) . Conclusions CRT fails to increase the OS, PFS, and LRFS rates and reduce the DMFS rate in patients with stage T1?2 N1 NPC. Moreover, CRT results in higher incidence rates of hematotoxicity, grade 3 mucositis, and hearing loss than IMRT alone.

Objective To establish a rat model of radiation-induced optic neuropathy ( RION) by delivering a single radiation dose to the optic chiasm. The aim of our study was to analysis the feasibility and effectiveness of manganese-enhanced magnetic resonance imaging ( MEMRI) in RION. Methods 34 Wistar rats were randomized to the control group(4 rats), the 2-month group(5 rats),the 4-month group(4 rats) and the 6-month group(11 rats) according to the different feeding period after irradiation. MEMRI scan were performed when the respective feeding periods of all groups expired. The rats were then killed for histological studies with hematoxylin and eosin stain, Luxol Fast Blue stain, and electron microscopy analysis. Results The ratio of RION in the four groups were 0/3, 1/5, 2/4 and 11/11, respectively (χ2 =15?443, P<0?05). There was an inverse correlation between the relative optical density value in the LFB stain and the interval between irradiation and pathological examination(R= -0?643,P<0?05). The number of glial cells in the HE stain in the four groups were 194 ± 65, 234 ± 19, 124 ± 11 and 345 ± 98, respectively(R=0?590,P<0?05). When compared MEMRI scan with the corresponding histological examination, we found that there was loss of signals of optic nerve on MEMRI imaging in one of 5 rats in the 2-month group, while no significant histological difference was found between this rat and the others. Conclusions RION can be non-invasively detected and semi-quantitative analysed by MEMRI scan. Moreover, RION can be early diagnosed by MEMRI scan which is capable to show physiological change in advance of pathological change.

OBJECTIVETo investigate the treatment outcome of loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) after been treated with multi-modality approach since 2005 in our hospital and to explore the prognostic factors for treatment outcomes.

METHODSClinical data of 125 postoperative LA-SCCHN patients treated in our department with radiotherapy/chemoradiotherapy from May 2005 to December 2011 were collected and reviewed in this study. The radiotherapy technique was intensity-modulated radiotherapy (IMRT) (93.6%) and a minority of patients received 3D-conformal radiotherapy (3D-CRT).

RESULTSUp to January 6th, 2013, 124 patients were followed up with a median follow-up duration of 25 months. The 3-year overall survival (OS), disease-free survival (DFS), loco-regional control (LRC), distant metastasis-free survival (DMFS) were 69.7%, 56.1%, 80.8%, and 73.1%, respectively. A total of 37 patients died during the follow-up period. Among the 43 patients presented with treatment failure, 13 patients had loco-regional relapse, 20 patients had distant metastasis and 10 patients presented with both loco-regional and distant relapses. Distant metastasis accounted for the predominant cause of death. Lung and mediastinal lymph nodes are the most common sites involved by distant metastasis.Univariate analysis indicated that patients who underwent non-radical surgery, with larger size of invaded lymph nodes, higher N stage (N2b and above) and vascular tumor embolism had a lower OS (P = 0.001, 0.000, 0.032, 0.007, respectively). Patients who underwent neck dissection only, or those with higher N stage (N2b and above) or higher TNM stage or vascular tumor thrombi had higher distant metastasis rates (P = 0.017, 0.002, 0.008, 0.001, respectively). The multivariate analysis showed that non-radical surgery was an independent prognostic factor for OS (P = 0.001), larger size of invaded lymph nodes was an independent prognostic factor for poorer LRC (P = 0.001); higher N stage (N2b and above) or T4 stage and vascular tumor thrombi were independent prognostic factors for poorer distant metastasis-free survival (P = 0.035, 0.008 and 0.050, respectively).

CONCLUSIONSOur results indicate that multi-modality treatment for LA-SCCHN has achieved better outcome than before. Distant metastasis has become the predominant pattern of failure as well as the primary cause of death instead of loco-regional relapse as a result of improved local control modality. More efforts should be made to decrease the rate of distant metastasis in the future.

Adult ; Aged ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; pathology ; secondary ; therapy ; Cetuximab ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Fluorouracil ; therapeutic use ; Follow-Up Studies ; Head and Neck Neoplasms ; pathology ; secondary ; therapy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neoplastic Cells, Circulating ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Survival Rate ; Taxoids ; therapeutic use

Objective To study the immobilization effect and keep the accurate treating position of Body-Fix (R) device in the patients with vertebral metastatic tumor treated by hypofractionated intensitymodulated radiotherapy.Methods From October 2008 to February 2010,six nasopharyngeal carcinoma patients with 10 treated lesion with vertebral metastasis who were treated by hypofractionated intensitymodulated radiotherapy and immobilized by the Body-Fix (R) device were enrolled in this study.Three sets cone beam CT images were taken and recorded when patient was underway the initial setup,position correction and after radiation delivery.Comparing these images with the planning CT images to get the setup errors and the intrafractional position shifting,and the immobilization effect of Body-Fix (R) device was analyzed.Results In the upper,middle and lower sections of the vertebrae,the intrafractional setup errors in the left-right direction were (-0.6±0.5) mm,(-0.1 ±1.0) mm,(0.0±0.4) mm,with in the superior-inferior direction (1.0 ± 1.4) mm,(4.8 ± 5.7) mm,(0.0 ± 0.3) mm and in the anterior-posterior direction (1.2 ± 5.2) mm,(-0.3 ± 0.3) mm,(0.0 ± 0.5) mm,respectively.Conclusions With Body-Fix (R) device,the intrafractional setup errors can be minimized within 2 mm which make the accurate spinal radiosurgery technique possible.

ObjectiveTo evaluate the efficacy and toxicity of gemcitabine plus cisplatin (GP)chemotherapy combined with intensity-modulated radiation therapy (IMRT)in locoregionally advanced nasopharyngeal carcinoma (NPC).Methods71 patients (Stage Ⅲ:41,Stage ⅣA:30) with locoregionally advanced NPC were entered this study.Neoadjuvant chemotherapy was consisted of cisplatin 25 mg/m2 intravenously on d1-3 and gemcitabine 1000 mg/m2 in 30 minutes intravenous infusion on days 1 and 8,every 3 weeks for 2 cycles.Adjuvant chemotherapy consisted of 2 cycles of the same GP regimen was given at 28 days after the end of radiotherapy.The prescription doses was 66.0-70.4 Gy to the gross tumor volume,66 Gy to positive neck nodes,60 Gy to the high-risk clinical target volume,54 Gy to the low-risk clinical target volume.ResultsThe overall response rate to neoadjuvant chemotherapy was 91.2％,acute toxicity was mainly grade 1-2 myleosuppression.All patients completed IMRT.The median follow-up duration was 38 months.The 3-year nasopharyngeal local control,regional control,distant metastasis-free survival rate and overall survival rate were 93％,99％,91％,90％,respectively.Severe late toxicities included grade 3 trismus in 1 patient,grade 3 hearing impairment in 2 patients and cranial nerve palsy in 2 patients,respectively.No grade 4 late toxicities were observed.Conclusions The combination of GP chemotherapy and IMRT for locoregionally advanced nasopharyngeal carcinoma is well-tolerated,convenient,effective,and warrants further studies of more proper cycles of GP regimen.