Shu-Chen Huang

Nasopharyngeal cancer: Study III. A review of 1206 patients treated with combined modalities

A combination of radiation therapy and chemotherapy was used in an attempt to improve the control of nasopharyngeal cancer (NPC). From 1979 through 1983, 1206 patients with histologically proven NPC were treated with routine radiation along with 5 combinations of drug or drugs in small to maintenance doses. The drugs used were: 1) cyclophosphamide p.o. (CTX), 2) methotrexate p.o. (MTX), 3) CTX + MTX, 4) bleomycin i.v. (BLM), and 5) cisplatin + BLM i.v. (BP). The actuarial survival rates and recurrence rates were chosen as endpoints for comparison to previous studies. The overall survival rate increased from 43.5% in study I, and 56% in study II to 70.6% in the present study. The recurrence rate declined to 13%, but was less impressive. The encouraging results were more obvious in groups of patients with bilateral large cervical lymph nodes, reaching statistical significance (p less than 0.01).

Nasopharyngeal cancer: Study II

Abstract The actuarial survival rates, recurrence rates and complication frequencies in 2 studies of nasopharyngeai cancer of different treatment modalities are compared. Study I was comprised of 1605 patients treated in a form schedule throughout 15 years from 1958 through 1973. 5 This report is the second study, comprised of another 1032 patients treated during the period of 1974 to 1978. These patients were treated by 3 modalities, namely: 1) the conventional 35 fractionated total dose of 7000 read in 7–8 weeks, 2) the split-course treatment of the same dose with an interruption of about 10 days in the middle of the treatment, and 3) the split-course of the same dose and adjuvant cyclopbosphamide with an average dose of 4900 mg in 4–5 weeks. The patient populations were more or less similar in the 2 studies, except in study II the tumors were more aeaplastic in histology and in an earlier stage. The comparison revealed positive results with improved overall actuarial survival rates, less recurrences, and reduced post-radiation complications. Systemic spread remained tbel cause of failure in this disease. Adjuvant chemotherapy either in a large dose or a small stimulating dose is suggested in further study.

Pathology of nasopharyngeal carcinoma. Proposal of a new histologic classification correlated with prognosis

To establish a new histologic classification with better correlation with patient prognosis, the histologic features of nasopharyngeal carcinoma (NPC) were correlated with prognosis and clinical stage among 494 patients who had been followed a minimum of 5 years after initial radiotherapy. A slight modification of World Health Organization (WHO) classification by the separation of spindle cell variant from the nonkeratinizing (NK) and undifferentiated carcinomas (UD) provided a better prognostic correlation: keratinizing squamous cell carcinoma (KS), spindle cell carcinoma (SP), round cell carcinoma (RC), and mixed cell carcinoma (Mix, or NK); 5‐year survival rates were 21%, 41%, 51.8%, and 54% respectively. This prognostic distinction was further improved by dividing the three nonkeratinizing carcinomas (SP, RC, and Mix) into two subtypes each, according to the degree of cell anaplasia and pleomorphism: Type A (with marked anaplasia and/or pleomorphism), and Type B (with moderate or little anaplasia). The three Type A carcinomas had very similar 5‐year survival rates (33.3 to 38.6%), as did the three Type B carcinomas (60% to 71.8%). Therefore, a working formulation for the malignancy of NPC emerged: (1) high‐grade malignancy (KS; 5‐year survival, 21%), (2) intermediate malignancy (Type A carcinomas, 5‐year survival, 30%–40%), and (3) low‐grade malignancy (Type B carcinomas, 5‐year survival rate, 60%–72%). The prognostic distinction remained true after stratification by clinical stage. Therefore, the histologic condition of the tumor of NPC correlated with patients prognosis. Cancer 59:945‐951, 1987.

Immunologic Reactivity in Patients with Nasopharyngeal Carcinoma

Immunologic reactivity was measured in 344 patients with nasopharyngeal carcinoma (NPC), before treatment, and in 398 age-matched control subjects. The data recorded suggest that depressed cell-mediated immunity in patients with NPC is a consequence rather than a cause of the disease. In order to reduce tumor burden in patients with NPC, radiation therapy with chemotherapy or immunopotentiation or both is recommended.

EBV-Associated Antibodies and Other Antibodies in Nasopharyngeal Cancer Patients before and after Radiotherapy

Patients with nasopharyngeal carcinoma(NPC) have, in general, elevated antibody titers against EBV-associated antigens(1–3). These antibody titers are decreased in general after radiation therapy(4,5). On the other hand, antibodies against H. simplex virus(HSV) and H. zoster virus (HZV) in NPC patients may be normal(6–8) or increased(9). The present communication revealed that the decrease of EBV-associated antibodies after radiation therapy was a unique and specific phenomenon in NPC patients.

Long-Term Follow-Up of Cervical Cancer Patients Treated with Preloaded Radium Brachytherapy from 1977 to 1983

Before the afterloading technique was available, preloaded radium was the mainstay for radiotherapy of carcinoma of the uterine cervix. After many decades of clinical practice, the experience is still useful as references in t he developments of brachytherapy for cervical cancer. This study reports our results during 1977 through 1983 when preloaded radium was used for intracavitary brachytherapy. Comparison is made with results treated with afterloading technique in later years. Three hundred and forty seven cases were in eluded in this retrospective analysis. The 5-year and 10-year actuarial survival rates were: stage I 89.2% and 45.6%; stage II 67.8% and 53.5%; and stage III 48.9% and 40.3%, respectively. There were 8 cases of major complications of the urinary tract and rectum which occurred one or more years after treatment. Five patients were diagnosed to have second malignant tumor 1-11 years after irradiation. These tumors include 2 breast cancers, 1 multiple myeloma, I squamous cell carcinoma of the lung, and 1 soft tissue sarcoma of the abdominal wall.