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Research on Cluster Management in Nutritional Intervention for Nasopharynx Cancer Patients Undergoing Intensity Modulated Radiation Therapy

ObjectiveTo research on the influence of cluster management on the nutritional intervention for nasopharynx cancer patients undergoing intensity modulated radiation therapy (IMRT), in order to discuss effective and feasible nutrition management method. MethodEighty-three nasopharynx cancer patients undergoing IMRT between June 2013 and December 2014 were selected as the study subjects. They were divided into two groups randomly. Regular health education and nutritional guidance were carried out for the 41 patients in the control group, while nutritional risk screening (NRS)-2002 nutrition screening, nutrition assessment and nutritional intervention were carried out for the 42 patients in the intervention group. Nutrition risk, nutritional status and side-reaction were recorded and evaluated for both groups of patients. ResultsAfter treatment, NRS-2002 score of the intervention group was lower than the control group (P<0.05). Body weight, constitutional index, skinfold thickness of triceps brachii muscle, mid-arm circumference and mid-arm muscle circumference of the intervention group were better than the control group (P<0.05). Total serum protein, serum albumin, serum transferrin were better and the rate of levelⅢ-Ⅳ radiation-induced oral mucositis was lower in the intervention group than that in the control group (P<0.05). ConclusionsThe application of cluster management model in nutritional intervention is a way to promote patients' rehabilitation, which can effectively improve the whole body situation of nasopharynx cancer patients, and reduce malnutrition rate and side-reaction.

Analysis of Delayed Diagnosis in 324 Cases of Nasopharyngeal Carcinoma

目的:探讨鼻咽癌延误诊断的原因。从而提高鼻咽癌患者的早期诊断率,改善治疗效果。方法: 回顾性分析324例在我科接诊前因各种因素而延误诊断的鼻咽癌患者首发症状、首诊误诊科室、误诊疾病。结果: 本组病例首发症状分别为颈部包块138例(42.5%)、鼻部症状148例(45.6%)、耳部症状66例(20.3%)、头痛46例(14.2%)、其他17例(5.2%),有两种首发症状的病例为91例。首诊误诊的疾病有颈部淋巴结炎、慢性鼻鼻窦炎、鼻出血、分泌性中耳炎、脑动脉硬化等27种疾病。涉及普外科、耳鼻咽喉科、神经内科、骨科、呼吸内科、口腔科、烧伤科、眼科、中医科等9个科室。结论: 加强鼻咽癌知识普及,完善继续医学教育及住院医师培训,积极寻找鼻咽癌的早期诊断方法能减少鼻咽癌的延误诊断。

Efficacy and Adverse Effects of Chrono-chemotherapy Combined with Radiotherapy in Treating Nasopharyngeal Cancer

【摘要】　目的　观察时辰化学疗法联合放射治疗对比常规化学疗法联合放射治疗对鼻咽癌的近期疗效及其不良反应。　方法　2006年2月-2010年3月经病理学证实未接受过化学疗法的38例晚期鼻咽癌患者随机分为常规化学疗法联合放射治疗组（A组，n=20）和时辰化学疗法联合放射治疗组（B组，n=18）。两组均采用常规二维放射治疗。A组化学疗法方案为顺铂（DDP）80 mg/m2，采用完全水化方案，第1天静脉滴注；氟尿嘧啶800 mg/（m2•d），第2~6天120 h连续静脉滴注。B组时辰化学疗法采用Melodies多通道编程输液泵进行正弦曲线式时间调节给药。两组均为DDP 80 mg/m2，于10:00~22:00给药，浓度高峰设定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00给药，浓度高峰设定在凌晨4:00。每21天重复1次，行2~6疗程。　结果　A组3程化学疗法后有效率（PR）为95%（19/20），全程结束完全缓解率（complete remission，CR）达75%（15/20）；B组在2程化学疗法后PR达100%，全程治疗结束CR达94.4%（17/18）。两组不良反应主要为迟发性血小板减少，发生率分别为35%（7/20）和22.2%（4/18），其他不良反应两组间无明显差别。　结论　时辰化学疗法联合放射治疗对晚期鼻咽癌在减轻化学疗法造成的血小板减少方面有明显的优势，值得临床推广应用以及进一步发掘时辰化学疗法在临床治疗的价值。【Abstract】　Objective　To investigate the efficacy and the adverse effects of routine chemotherapy and chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal cancer patients. 　Methods　From March 2006 to March 2010, 38 patients diagnosed pathologically to have advanced nasopharyngeal cancer were randomly divided to the routine chemotherapy and radiotherapy group (group A, n=20) and the chrono-chemotherapy and radiotherapy group (group B, n=18). Patients in both groups received bi-dimensional radiotherapy. Patients in group A received a full hydration method, cisplatin (DDP) 80 mg/m2 intravenous infusion was also carried out on day 1; fluorouracil 800 mg/(m2•d) chemotherapy, and 120 hours of continuous intravenous infusion from day 2 to day 6. For patients in group B, Melodies multi-channel infusion pump programming to adjust the time of drug administering with a sinusoidal style was adopted; DDP 80 mg/m2 was administered intravenously on day 1 between 10:00 and 22:00 with the peak concentration set at 16:00; fluorouracil 800 mg/m2 was administered between 22:00 and 10:00 on the next day from day 2 to day 6 with the concentration peak set at 4:00. The treatments in both groups were repeated every 21 days, which was repeated for two to six courses of tremtment.　Results　After three courses of treatment for group A, partial response (PR) rate was 95% (19/20), and after six courses of treatment, the complete remission (CR) rate was 75% (15/20); After two courses of treatment for group B, the PR rate was 100%, and after six courses of treatment, the CR rate was 94.4% (17/18). The main adverse effect was thrombocytopenia at an incidence rate of 35% (7/20) and 22.4% (4/18) in the two groups respectively. There was no obvious difference in other adverse effects between the two groups.　Conclusion　Chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma has obvious advantages in reducing thrombocytopenia caused by chemotherapy, and it is worth further exploring the clinical applications and values of chrono-chemotherapy.

Feasibility of Automatic Treatment Planning in Intensity-modulated Radiotherapy of Nasopharyngeal Carcinoma

Intensity-modulated radiotherapy planning for nasopharyngeal carcinoma is very complex. The quality of plan is often closely linked to the experience of the treatment planner. In this study, 10 nasopharyngeal carcinoma patients at different stages were enrolled. Based on the scripting of Pinnacle3 9.2 treatment planning system, the computer program was used to set the basic parameters and objective parameters of the plans. At last, the nasopharyngeal carcinoma intensity-modulated radiotherapy plans were completed automatically. Then, the automatical and manual intensity-modulated radiotherapy plans were statistically compared and clinically evaluated. The results showed that there were no significant differences between those two kinds of plans with respect to the dosimetry parameters of most targets and organs at risk. The automatical nasopharyngeal carcinoma intensity-modulated radiotherapy plans can meet the requirements of clinical radiotherapy, significantly reduce planning time, and avoid the influence of human factors such as lack of experience to the quality of plan.

Treatment With Late Course Accelerated Fractionation (LCAF) Radiotherapy and Low Dose Cisplatin in Nasopharyngeal Carcinoma

摘要:目的:探讨鼻咽癌放疗后程同步辅以小剂量顺铂增敏的近期疗效,并与常规治疗和后程加速超分割放射治疗进行比较。方法:选取98例Ⅱ～Ⅳ期鼻咽癌患者,随机分为常规治疗组(简称T1组,32例)、后程加速超分割治疗组(简称T2组,32例)和顺铂加后程加速超分割治疗组(简称T3组,34例),并对治疗效果进行比较。 结果:1组鼻咽部肿瘤消除率为75.0%(24／32),颈部淋巴结消除率为87.5%(28/32);T2组鼻咽部肿瘤消除率为87.5%(28／32),颈部淋巴结消除率为84.4%(27/32);T3组鼻咽部肿瘤消除率为97.1%(33／34),颈部淋巴结消除率为91.2%(31/34)。进行两两比较,均为P＜0.05,有统计学意义,疗效:T3 组＞T2 组＞T1组。治疗副作用有增加(P＞0.05),但无统计学意义。 结论:小剂量顺铂加后程加速超分割治疗鼻咽癌,可以达到较常规治疗更好的近期治疗效果。Abstract: Objective: To study the later therapeutic efficacy of nasopharyngeal carcinoma in late course accelerated fractionation (LCAF) radiotherapy and low dose cisplatin, at same time compare with conventional fractionation and LCAF. Methods: Ninetyeight cases with stage ⅡⅣ of nasopharyngeal carcinoma were randomly assigned to three groups: conventional fractionation (T1), LCAF (T2), LCAF and low dose cisplatin (T3). At the end of treatment, therapeutic efficacy was compared with each other. Results: The survey periods was 3 months. Comlete response rate (CR) for groups T1, T2 and T3 was 75.0% (24／32), 87.5% (28／32) and 97.1% (33／34), respectively; the group treated with LCAF and cisplatin had highest effective later therapeutic efficacy than other groups. Lymph node of neck of group T3 got better control, although its side effects were more serious, but no significant difference was found among three group. Conclusion: Combined treatment of LCAF radiotherapy and low dose cisplatin has better later therapeutic efficacy on tumor control in patients with nasopharyngeal carcinoma

The Evaluation of Grommet Insertion for Secretory Otitis Media in the Patients of Nasopharyngeal Carcinoma

【摘要】目的探讨鼓膜置管对鼻咽癌(NPC)患者放疗前后分泌性中耳炎(SOM)的疗效。方法2005年3月2010年1月将60例(84耳)NPC并发SOM患者分为两组:A组30例行鼓膜切开鼓膜置管;B组30例保守治疗为对照组,并行随访,对两组患者有效率和并发症发生率进行统计。结果60例中58例存活,1例死于全身衰竭,1例死于大出血。存活患者中治疗SOM有效率为:A组85.4%(35/41),B组为30.2%(13/43),两组差异有统计学意义(Plt;0.05);并发症发生率A组为14.6%(6/41),B组为69.8%(30/43),B组并发症高于A组,差异有统计学意义(Plt;0.05)。结论NPC患者在放疗后,咽鼓管功能受到严重损害,是不可逆的病变,鼓膜置管治疗NPC并发SOM较保守治疗效果好,并发症的发生率低。

Correlation of P53 Protein Expression in Nasopharyngeal Carcinoma: A Meta-analysis

ObjectiveTo systematically review the correlation between the expression of P53 and nasopharyngeal carcinoma. MethodsDatabases including The Cochrane Library (Issue 1, 2016), PubMed, EMbase, CBM, CNKI, VIP, and WanFang Data were searched from the inception to January 1st 2016 to collect case-control studies about the correlation between the expression of P53 and nasopharyngeal carcinoma, as well as its clinically pathologic features. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.2 software. Results Twelve studies were finally included in this meta-analysis. There were 630 cases of nasopharyngeal carcinoma and 253 controls. The results of meta-analysis showed that, the expression of P53 protein were significantly different between the nasopharyngeal carcinoma group and the control group (OR=21.34, 95%CI 13.59 to 33.50, P < 0.000 01), between the nasopharyngeal carcinoma with lymphatic node metastasis group and without lymphatic node metastasis group (OR=3.69, 95%CI 1.67 to 8.17, P=0.001), between the clinical stage Ⅰ to Ⅱ group and the clinical stage Ⅲ to Ⅳ group (OR=0.19, 95%CI 0.08 to 0.49, P=0.000 6). However, there were no significant differences in expression of P53 between the male nasopharyngeal carcinoma group and the female nasopharyngeal carcinoma group (OR=0.92, 95%CI 0.49 to 1.74, P=0.80), and between the < 50 nasopharyngeal carcinoma group and the≥50 nasopharyngeal carcinoma group (OR=1.70, 95%CI 0.70 to 4.11, P=0.24). ConclusionsCurrent evidence shows that, the expression of P53 protein is associated with the occurrence, development of nasopharyngeal carcinoma and may be positively correlated to degree of tumor malignance. It may be an indicator poor prognosis.

放射性脑损伤所致精神障碍一例

Response of circulating tumor cells and circulating tumor endothelial cells to treatment modalities of nasopharyngeal carcinoma and its significance

Objective To investigate the relationships between circulating tumor cells (CTCs), circulating tumor endothelial cells (CTECs) and treatment methods in patients with nasopharyngeal carcinoma (NPC) at different stages of treatment. Methods The data of NPC patients at different treatment periods in West China Hospital of Sichuan University from March 2016 to November 2019 were retrospectively collected. The patients received CTCs test and part of those patients received CTECs test, by subtraction enrichment-immunostaining-fluorescence in situ hybridization. The relationships of CTCs and CTECs with radiotherapy and chemotherapy, and the correlations between CTCs and CTECs in NPC patients were analyzed. Results A total of 191 patients were included. Among them, there were 66 cases before initial treatment, 38 cases after induction chemotherapy, and 87 cases after concurrent chemoradiotherapy. A total of 127 patients received CTECs test, including 41 cases before initial treatment, 29 cases after induction chemotherapy, and 57 cases after concurrent chemoradiotherapy. The positive rates of CTCs were 89.4%, 81.6% and 69.0% respectively in the three stages of treatment, and the difference was statistically significant only between the pre-treatment group and the post-concurrent chemoradiotherapy group (P=0.003). The number of CTCs in the post-concurrent chemoradiotherapy group was lower than that in the pre-treatment group and the post-induction chemotherapy group (P<0.001, P=0.002). The number of triploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group and the post-induction chemotherapy group (P=0.009, P=0.013). The number of tetraploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the post-induction chemotherapy group (P=0.007). The number of polyploidy (pentaploid or > 5 copies of chromosome 8) CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group (P<0.001). The positive rates of CTECs were 70.7%, 82.8% and 64.9% respectively in the three stages of treatment, and the difference was not statistically significant (P>0.05). The number of CTECs in the post-concurrent chemoradiotherapy group was only lower than that in the post-induction chemotherapy group (P=0.009). There was no significant difference in the number of triploid or tetraploid CTECs among the three groups (P=0.265, P=0.088). The number of polyploid CTECs was statistically different only between the post-concurrent chemoradiotherapy group and the post-induction chemotherapy group (P=0.007). Spearman correlation analysis showed that there was a significant positive correlation between CTCs and CTECs (rs=0.437, P<0.001). Conclusions Concurrent chemoradiotherapy plays a decisive role in reducing the number of CTCs in the blood of NPC patients, while induction chemotherapy does not appear to directly cause changes in the number of CTCs. In NPC patients, different types of CTCs have different responses to different treatments. There is a significant positive correlation between CTECs level and CTCs level in NPC.

外照射加腔内放射治疗复发性鼻咽癌的临床研究

【摘要】 目的 探讨外照射加腔内放射治疗（放疗）对于局部复发鼻咽癌的临床疗效及价值。 方法 采用60Co γ射线对1998年8月-2003年8月收治的34例放疗后局部复发的鼻咽癌患者进行常规外照射。剂量为58～62 Gy，其中20例补充了腔内放射治疗，剂量参考点为黏膜下5 mm，每次剂量5 Gy，2～3次，间隔3～4 d。 结果 5年生存率为41.1%（14/34），局控率为47.0%（16/34），远处转移率为23.5%（8/34），补充腔内放疗的20例，5年生存率65%（13/20），未补充腔内放射治疗的14例，5年生存率为28.5%（4/14），比较有统计学意义（Plt;0.05）。 结论 鼻咽癌根治放疗后局部复发再行放疗仍是主要且为有效的治疗方法。外照射加腔内放疗对于复发患者其在降低外照射剂量的同时，不降低局控率及生存率；在恰当的技术条件下尚未观察到严重并发症。加用腔内放疗的患者5年生存率高于单纯外照组。