J. Yi

Nasopharyngeal carcinoma in children and adolescents - a single institution experience of 158 patients

BackgroundTo evaluate the clinical features, treatment results, prognostic factors and late toxicities of nasopharyngeal carcinoma in children and adolescents.MethodsBetween January 1990 and January 2011, 158 NPC patients younger than 20xa0years old were treated in our institution, and the patient’s clinical characteristics, treatment modalities, outcomes and prognostic factors were retrospectively analyzed.ResultsThere were 9 (5.7%) patients in stage II, 60 (38.0%) in stage III and 89 (56.3%) in stage IV according to the UICC2002 staging system. Neck mass (32.3%), headache (21.5%) and nasal obstruction (15.2%) were the most common chief complaints. With a median follow-up time of 62.5xa0months (range 2.0-225.0xa0months), the 5-year overall survival (OS) rate, local-regional control (LRC) rate and distant metastasis-free survival (DMFS) rate were 82.6%, 94.9% and 76.4%, respectively. There were 43 (27.2%) patients failed during the follow up, with seven local-regional recurrences and 38 distant metastases. In univariate analysis, the 5-year OS of T4 and T1-3 were 75% and 87.9%, pu2009=u20090.01, stage IV and stage II-III were 77.1% and 90%, pu2009=u20090.04, respectively. In multivariate analysis, T4 (pu2009=u20090.02) and stage IV (pu2009=u20090.04) were the independent adverse prognostic factors for OS. Significant reduction in trismus (27.3% v 3.6%, pu2009=u20090.03) and G2 xerostomia (37.9% v 10.3%, pu2009=u20090.02) was observed in patients treated by IMRT.ConclusionsMost childhood and adolescence nasopharyngeal carcinoma patients were locally advanced diseases at first diagnosed. The treatment results of radiotherapy, with or without chemotherapy, are excellent in our institution. Reducing distant metastasis with new strategies and late toxicities with intensity-modulated radiotherapy are the future directions for the treatment of adolescent nasopharyngeal carcinoma.

Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma

ObjectiveTo compare the treatment outcomes of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) alone to concurrent chemoradiotherapy (CCRT) for locoregionally advanced nasopharyngeal carcinoma (NPC).MethodsFrom November 2001 to December 2009, 333 patients with pathologically diagnosed, locoregionally advanced NPC were treated by IMRT-SIB with or without weekly cisplatin concurrent chemotherapy at our institute. Among them, 62 patients received neo- or adjuvant chemotherapy or molecular target drugs were excluded from this analysis. There were 129 patients received IMRT-SIB alone, and 142 patients received IMRT-SIB with weekly cisplatin 30xa0mg/m2 for 7xa0weeks. The radiotherapy protocol was identical for each group.ResultsThere were no significant differences in survival between CCRT and IMRT-SIB group in terms of gender, T/N classifications and concurrent chemoradiotherapy. The 5-year local control (LC), overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) for the entire group were 87.0%, 79.4%, 69.7 and 83.3%, respectively. The LC, OS, DFS and DMFS for CCRT and IMRT-SIB alone groups were 80.6% vs. 90.8% (Pu2009=u20090.10), 71.7% vs. 83.2% (Pu2009=u20090.201), 63.9% vs. 74.6% (Pu2009=u20090.07), and 79.6% vs. 86.0% (Pu2009=u20090.27), respectively.ConclusionCompared to CCRT, IMRT-SIB alone had demonstrated similar disease LC, OS, DFS and DMFS in locoregionally advanced NPC. Careful radiation target volume design and simultaneous integrated boost may play a role that overrides the benefit from concurrent chemotherapy. Further investigation with randomized study is necessary to determine whether IMRT-SIB alone can achieve similar outcomes of concurrent chemoradiotherapy.

Report on revision of the Chinese 1992 staging system for nasopharyngeal carcinoma

With the advances of diagnostic imaging and radiation therapy technology, the limitations of the Chinese 1992 staging system for nasopharyngeal carcinoma (NPC) become obvious, and the revision of this system was clearly needed. On December 16, 2008, the Chinese Committee for Staging of Nasopharyngeal Carcinoma (CCSNPC) was inaugurated in Guangzhou, China, with the purpose of establishing a platform for the study of the Chinese staging system and ensuring the continuity of the work of NPC staging research. Data from published studies on staging of NPC were collected and reviewed. After extensive evaluation and discussion, the Chinese 2008 staging system for NPC, which was a consensus based on evidence-based medicine and revisions made on the Chinese 1992 staging system, was recommended by CCSNPC. Changes of the staging system including emphasizing the status of MRI in diagnosis and staging; classification of parapharyngeal involvement, cranial nerve involvement, and retropharyngeal lymph node involvement; and T classification in the new system were simplified as well. CCSNPC also proposed a new criterion of the N category. This review discusses the rationale and bases of our primary revisions of this system and proposes an updated system, named the Chinese 2008 staging system for NPC. Further investigations are needed to confirm the effectiveness as well as to provide basis for further improvement of this system.With the advances of diagnostic imaging and radiation therapy technology, the limitations of the Chinese 1992 staging system for nasopharyngeal carcinoma (NPC) become obvious, and the revision of this system was clearly needed. On December 16, 2008, the Chinese Committee for Staging of Nasopharyngeal Carcinoma (CCSNPC) was inaugurated in Guangzhou, China, with the purpose of establishing a platform for the study of the Chinese staging system and ensuring the continuity of the work of NPC staging research. Data from published studies on staging of NPC were collected and reviewed. After extensive evaluation and discussion, the Chinese 2008 staging system for NPC, which was a consensus based on evidence-based medicine and revisions made on the Chinese 1992 staging system, was recommended by CCSNPC. Changes of the staging system including emphasizing the status of MRI in diagnosis and staging; classification of parapharyngeal involvement, cranial nerve involvement, and retropharyngeal lymph node involvement; and T classification in the new system were simplified as well. CCSNPC also proposed a new criterion of the N category. This review discusses the rationale and bases of our primary revisions of this system and proposes an updated system, named the Chinese 2008 staging system for NPC. Further investigations are needed to confirm the effectiveness as well as to provide basis for further improvement of this system.

Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma

Purpose To determine the role of preoperative concurrent chemoradiotherapy in the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC). Methods A total of 222 patients with stage III/IVA-B HNSCC were randomly assigned to receive preoperative concurrent chemoradiotherapy (Pre-S CRT, weekly cisplatin 30mg/m2) or preoperative radiotherapy alone (Pre-S RT). Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test. Results With a medial follow-up of 59 month, the 5-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) of Pre-S CRT v Pre-S RT group were 53.8% v 39.0% (hazard ratio [HR], 0.74, 95% CI, 0.50 to 1.10, P = 0.13), 53.2% v 38.7%, (HR, 0.69, 95% CI, 0.47 to 1.01, P =0.06), and 80.4% v 68.1% (HR, 0.53, 95% CI, 0.28 to 0.98, P = 0.04), respectively. In patients with larynx-hypopharynx primaries, the 5-year OS, PFS and DMFS of Pre-S CRT v Pre-S RT were 62.7% v 38.8% (HR, 0.59, 95% CI 0.35 to 1.02, P = 0.054), 63.1% v 39.9% (HR, 0.52; 95% CI 0.30 to 0.89, P = 0.03) and 86.2% v 63.3% (HR, 0.35, 95% CI 0.15 to 0.82, P = 0.01), respectively. Conclusion The addition of weekly cisplatin concurrent to preoperative RT does not improve OS, but improve DMFS in locally advanced HNSCC. However, in a subset of patients with the larynx-hypopharynx primaries, preoperative chemoradiotherapy has significantly improved PFS and DMFS, and has also provided a borderline benefit in OS in comparison with preoperative radiotherapy alone.