Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
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T1组,32例)、后程加速超分割治疗组(简称T2组,32例)和顺铂加后程加速超分割治疗组(简称T3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);T2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);T3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:T3 组＞T2 组＞T1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: Ninetyeight cases with stage ⅡⅣ of nasopharyngeal carcinoma were randomly assigned to three groups: conventional fractionation (T1), LCAF (T2), LCAF and low dose cisplatin (T3). 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
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.
The aim of this study is to compare the planning quality and delivery efficiency between dynamic intensity modulated radiation therapy (d-IMRT) and dual arc volumetric modulated arc therapy (VMAT) systematically for nasopharyngeal carcinoma (NPC) patients with multi-prescribed dose levels, and to analyze the correlations between target volumes and plan qualities. A total of 20 patients of NPC with 4–5 prescribed dose levels to achieve simultaneous integrated boost (SIB) treated by sliding window d-IMRT in our department from 2014 to 2015 were re-planned with dual arc VMAT. All optimization objectives for each VMAT plan were as the same as the corresponding d-IMRT plan. The dose parameters for targets and organ at risk (OAR), the delivery time and monitor units (MU) in two sets of plans were compared respectively. The treatment accuracy was tested by three dimensional dose validation system. Finally, the correlations between the difference of planning quality and the volume of targets were discussed. The conform indexes (CIs) of planning target volumes (PTVs) in VMAT plans were obviously high than those in d-IMRT plans (P < 0.05), but no significant correlations between the difference of CIs and the volume of targets were discovered ( P > 0.05). The target coverage and heterogeneity indexes (HIs) of PTV 1 and PGTVnd and PTV3 in two sets of plans were consistent. The doses of PTV2 decreased and HIs were worse in VMAT plans. VMAT could provide better spinal cord and brainstem sparing, but increase mean dose of parotids. The average number of MUs and delivery time for d-IMRT were 3.32 and 2.19 times of that for VMAT. The γ-index (3 mm, 3%) analysis for each plans was more than 97% in COMPASS® measurement for quality assurance (QA). The results show that target dose coverages in d-IMRT and VMAT plans are similar for NPC with multi-prescribed dose levels. VMAT could improve the the CIs of targets, but reduce the dose to the target volume in neck except for PGTVnd. The biggest advantages of VMAT over d-IMRT are delivery efficiency and QA.
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.