Lai-Lei Ting

Impact of magnetic resonance imaging versus CT on nasopharyngeal carcinoma: Primary tumor target delineation for radiotherapy

Our aim was to assess the capacity of CT versus MRI for delineating to the primary tumor extent of nasopharyngeal carcinoma (NPC) in treated patients.

Induction Chemotherapy With Mitomycin, Epirubicin, Cisplatin, Fluorouracil, and Leucovorin Followed by Radiotherapy in the Treatment of Locoregionally Advanced Nasopharyngeal Carcinoma

PURPOSE Survival in advanced nasopharyngeal carcinoma (NPC) is compromised by distant metastasis. Because mitomycin is active against hypoxic and G0 cells, which may help to eradicate micrometastasis, we investigated the effect of mitomycin-containing cisplatin-based induction chemotherapy. PATIENTS AND METHODS Recruited for this study were American Joint Committee on Cancer (AJCC) 1992 staging system stage IV NPC patients with the following adverse features: obvious intracranial invasion, supraclavicular or bilateral neck lymph node metastasis, large neck node (> 6 cm), or elevated serum lactate dehydrogenase (LDH) level. Patients were given three cycles of chemotherapy before radiotherapy. The chemotherapy comprised a 3-week cycle of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL). RESULTS From January 1994 to December 1997, 111 patients were recruited. The median follow-up period was 43 months. The actuarial 5-year overall survival rate was 70% (95% confidence interval [CI], 60% to 80%; n = 111). For patients having completed radiotherapy (n = 100), the 5-year locoregional control rate was 70% (95% CI, 55% to 84%) and the distant metastasis-free rate was 81% (95% CI, 73% to 89%). The 5-year distant metastasis-free rate of N3a and N3b disease of AJCC 1997 staging system were 79% (95% CI, 62% to 95%) and 74% (95% CI, 60% to 89%), respectively. By Cox multivariate analysis, high pretreatment serum LDH level (P = .04) and neck nodal enlargement before radiotherapy (P = .001) were adverse prognostic factors of survival. CONCLUSION The good 5-year survival of N3 disease supports the effectiveness of induction MEPFL in the primary treatment of advanced NPC. Further investigation to incorporate concurrent chemoradiotherapy is warranted.

Quality of life in patients of nasopharyngeal carcinoma: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35

The authors followed the guidelines of translation and pilot testing of the EORTC QLQ-C30 and EORTC-QLQ-H&N35 questionnaires. The questionnaires were given to 50 nasopharyngeal carcinoma patients under active treatment and 50 under follow-up at our institution from November 2000 to June 2001. A retest was conducted 2 weeks after the first interview/form completion for the follow-up group. The intraclass correlation coefficients of the two questionnaires were moderate to high in the follow-up group. Cronbachs α coefficients of all scales of the two questionnaires were ≥ 0.70 except that of cognitive functioning. Correlation of scales measuring similar dimensions of the QLQ-C30 and the SF-36 were moderate to high, while that of the QLQ-H&N35 and the QLQ-C30 and the SF-36 were moderate to low. Patients in the active treatment group had more serious acute problems due to disease and chemotherapy. Patients in the follow-up group had more serious chronic problems due to radiation therapy. We concluded that the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35 had moderate to high test–retest reliability, high internal consistency in most scales, and could show the expected differences between patients in active treatment and follow-up group.

Comparison of surgery or radiotherapy on complications and quality of life in patients with the stage IB and IIA uterine cervical cancer.

OBJECTIVES To compare the long-term complications and quality of life of patients with stage IB and stage IIA uterine cervical carcinoma treated by surgery or radiotherapy. METHODS From August 2003 to May 2004, 202 patients with uterine cervical carcinoma were treated with surgery or radiotherapy at two institutions and were enrolled in this study upon follow-up at least 2 years post treatment. All patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and complications Questionnaire. RESULTS Constipation (p<0.001), flushing (p<0.001), dysuria (p<0.001), urinary incontinence (p<0.01), dysparia (p<0.05) and vaginal dryness (p<0.05) were statistically higher in the surgery treated group, while diarrhea (p<0.001), bloody stools (p<0.001) and abdominal pain (p<0.01) were higher in the radiotherapy group. Using factor analysis and introducing personal conditioned variables, pelvic neural dysfunction was significantly higher in surgery group and intestinal dysfunction was higher in radiotherapy group. There was no difference in sexual dysfunction between these two modalities. Comparison of EORTC QLQ-C30 showed that the majority of issues had minimal differences between these two treatment modalities, except social functioning (p<0.05; higher in radiotherapy group), constipation (p<0.001; higher in surgery group) and diarrhea (p<0.01; higher in radiotherapy group). CONCLUSIONS In early stage uterine cervical cancer patients, surgery or radiotherapy resulted in different complications, whereas long-term quality of life showed few differences between these two different modalities. These data were helpful for physicians in regards to the changes of patients, and moreover, for rehabilitation and supportive care of the patients after treatment.

Early restaging whole-body 18 F-FDG PET during induction chemotherapy predicts clinical outcome in patients with locoregionally advanced nasopharyngeal carcinoma

PurposeThis study was undertaken to evaluate the utility of whole-body 18F-FDG PET in monitoring therapeutic effect during induction chemotherapy (IC) and in predicting prognosis in patients with locoregionally advanced nasopharyngeal carcinoma (NPC).MethodsFifty patients who had histologically proven, locoregionally advanced NPC without distant metastasis and had received IC were recruited in this study. The study cohort consisted of 19 females and 31 males (age 17–72 years, mean 45.9±11.9). Whole-body 18F-FDG PET was performed in each patient after completion of one (33 patients) or two (17 patients) courses of IC. Each patient was restaged on the basis of the 18F-FDG PET results. Patients who were downstaged to stage I or II were classified as major responders; the rest were classified as non-major responders.ResultsOnly 1 of the 23 major responders subsequently developed local recurrence. At the time of data analysis, all major responders were alive; by contrast, of the 27 non-major responders, 15 had locoregional recurrence or distant metastasis and nine had died (seven of NPC and two of treatment-related complications). Kaplan-Meier survival analysis showed significantly longer recurrence-free survival and overall survival in major responders (56.4±9.2 and 58.1±2.2 months) as compared with non-major responders (33.7±23.2 and 44.7±20.0 months), with p<0.0001 and p=0.0024, respectively.ConclusionThe results of this study suggest that early restaging by a single whole-body 18F-FDG PET scan after the first or second course of IC is useful for predicting therapeutic response and outcome in patients with locoregionally advanced NPC.

Endoscopic nasopharyngectomy with potassium-titanyl-phosphate (KTP) laser for early locally recurrent nasopharyngeal carcinoma.

Although early recurrent nasopharyngeal carcinoma (NPC) can be treated with surgery alone, conventional nasopharyngectomy still results in serious complications. Endoscopic nasopharyngectomy has been introduced, but data on the treatment outcomes of this technique are lacking.

Malignant fibrous histiocytoma of the sinonasal tract

Sinonasal malignant fibrous histiocytoma (MFH) is rare.

Postoperative radiotherapy for primary early oral tongue cancer with pathologic N1 neck

The benefit of postoperative radiotherapy (PORT) for early squamous cell carcinoma of the tongue (SCCOT) with pathologic N1 disease remains unclear.

Malignancies of the ear in irradiated patients of nasopharyngeal carcinoma.

Objectives/Hypothesis: To report on the clinical profiles and treatment experiences of patients with second primary ear malignancy after treatment of nasopharyngeal carcinoma (NPC).

Postirradiated Neuroendocrine Carcinoma of the Sinonasal Tract

Objectives/Hypothesis: Neuroendocrine carcinoma (NEC) of the sinonasal tract is rare. In this present study, we report our treatment experience with sinonasal NEC.