Objective:To investigate the need for elective neck irradiation (ENI) to nodal Level IB in patients with nasopharyngeal carcinoma (NPC) with negative Level IB lymph nodes (IB-negative) treated by intensity-modulated radiotherapy (IMRT).Methods:We conducted a Phase 2 prospective study in 123 newly diagnosed IB-negative patients with NPC treated by IMRT, who met at least 1 of the following criteria: (1) unilateral or bilateral Level II involvement with 1 of the following: Level IIA involvement or any Level II node ≥2 cm/with extracapsular spread; (2) ≥2 unilateral node-positive regions. Bilateral Level IB nodes were not contoured as part of the treatment target and treated electively. Level IB regional recurrence rate; pattern of treatment failure; 3-year overall survival (3y-OS), 3-year local control (3y-LC) and 3-year regional control (3y-RC) rates; toxicities; and dosimetric data for planning target volumes, organs at risk, Level IB and submandibular glands (SMGs) were evaluated.Results:Two patients deve...

/pdf/effects-of-omitting-elective-neck-irradiation-to-nodal-level-57vj9d57xr.pdf

Effects of omitting elective neck irradiation to nodal Level IB in nasopharyngeal carcinoma patients with negative Level IB lymph nodes treated by intensity-modulated radiotherapy: a Phase 2 study

Comparison of induction chemotherapy plus concurrent chemoradiotherapy and induction chemotherapy plus radiotherapy in locally advanced nasopharyngeal carcinoma

Background Although most studies proved that thoracic esophageal cancer surgery with supraclavicular lymph nodes (SCLNs) metastasis could benefit, less than 30% of the 5-year survival rate remained controversy on its surgical treatment. In this study, we aimed to analyze the prognosis of SCLNs on the different segments of thoracic esophageal cancer, which will supply a reference for the treatment of this disease. Methods Retrospectively collected the clinical data of 163 patients with thoracic esophageal squamous cancer (ESCC) and compared the effects of SCLNs on prognosis in different segments. Results Patients with SCLNs metastasis had a worse prognosis than the negative group (P<0.001). In the upper thoracic group, there was no significant difference in OS between SCLNs positive group and negative group (P=0.077); however, in the middle and lower thoracic group, SCLNs positive group had a worse prognosis than the negative group (P<0.001) and lymph nodes positive in other sites (except for SCLNs) (P=0.039). Multivariate analysis found that SCLNs metastasis was an independent risk factor affecting the prognosis of ESCC in the middle and lower thoracic segments (P=0.007). Conclusions For patients with upper thoracic ESCC, SCLNs appear to be regional nodes. For the middle and lower thoracic ESCC, SCLNs should be defined as distant metastasis, and neoadjuvant therapy first may be an available therapy.

/pdf/clinical-significance-and-prognosis-of-supraclavicular-lymph-5cbovcz9uv.pdf

Clinical significance and prognosis of supraclavicular lymph node metastasis in patients with thoracic esophageal cancer

Effects of omitting elective neck irradiation to nodal Level IB in nasopharyngeal carcinoma patients with negative Level IB lymph nodes treated by intensity-modulated radiotherapy: a Phase 2 study.

Objective
To investigate the level Ⅰb contouring, dose analysis and regional recurrence in level Ⅰb lymph node-negative (Ⅰb-negative) nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT).


Methods
One hundred ninety newly-diagnosed, Ⅰb-negative NPC patients treated by IMRT were enrolled. Level Ⅰb contouring and dose prescribing in this cohort were classified into planned prophylactic irradiation (PPI) group (56 cases) and non-planned prophylactic irradiation (non-PPI) group (134 cases). The mean dose (Dmean) of the level Ⅰb bilaterally and submandibular glands (SMGs) was recorded for comparison.


Results
After a median follow-up of 47 months, there was no level Ⅰb regional recurrences noted in the entire group. The mean doses of level Ⅰb and the submandibular glands were significantly lower in the non-PPI group than those in the PPI group as follows: (50.81±5.37) Gy vs (59.68±3.32) Gy for the left level Ⅰb, (51.55±5.02) Gy vs (59.66±3.85) Gy for the left submandibular gland, (51.55±5.02) Gy vs (59.66±3.85) Gy for the right level Ⅰb and (57.25±4.69) Gy vs (63.41±2.88) Gy for the right submandibular gland (all P=0.000).


Conclusion
In this retrospective analysis of non-randomized single institute data, it seems unlikely that PPI to level Ⅰb is necessary in Ⅰb-negative NPC patients treated by IMRT.


Key words: 
Nasopharyngeal neoplasms; Intensity-modulated radiotherapy; Prophylactic irradiation

Study of level Ib delineation, dose analysis and regional recurrence in level Ib lymph node-negative nasopharyngeal carcinoma patients treated by intensity-modulated radiotherapy

Objective
To explore a desirable therapeutic regimen, which is effective, reasonable and practicable for locally advanced nasopharyngeal cancer (LA-NPC) patients in the era of IMRT, with a potential of translating into survival improvement of these patients.


Methods
Patients presented with stage Ⅲ-ⅣB, WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy (CCRT group) (45 cases) or induction chemotherapy plus radiotherapy alone (IC+ RT group) (43 cases), with random number table. IMRT and rapid arc planning were generated in the same treatment planning system for all patients. These two arms received docetaxel plus cisplatin for first cycle of chemotherapy, and cisplatin only for the second cycle.


Results
Forty-five patients received CCRT and 43 received IC+ RT. All the patients completed two cycles chemotherapy. Compared to the CCRT group, the incidence rate of grade 2-4 leukopenia was lower in IC + RT group[67.4% (29/43) vs. 86.7% (39/45), χ2= 4.628, P= 0.031], while the incidence rate of dermatitis, mucositis, neutropenia and fungal infection of oral cavity had no significant differences (all P > 0.05). The tumor response rate (95.3% vs. 100.0%, P= 0.236), 2-year overall survival rate (95.5% vs. 94.2%, P= 0.627), 2-year progression free survival rate (94.6% vs. 88.6%, P= 0.303), 2-year local recurrent free survival rate (97.3% vs. 95.5%, P= 0.951), 2-year regional recurrent free survival rate (94.7% vs. 96.2%, P= 0.949), and 2-years distant metastasis free survival rate (93.7% vs. 91.5%, P= 0.454) of the two groups were similar while comparing CCRT to IC+ RT group.


Conclusion
Combined IMRT with TP/DDP regimen, the efficacy of IC+ RT is similar to CCRT for LA-NPC. The IC+ RT group has less severe leukopenia than CCRT group, which is worth further study.


Key words: 
Nasopharyngeal neoplasms; Radiotherapy planning, computer-assisted; Antineoplastic combined chemotherapy protocols

Intensity-modulated radiotherapy plus induction chemotherapy versus concurrent chemotherapy in locally advanced nasopharyngeal carcinoma: the preliminary result of a prospective study

Background: To evaluate the clinical characteristics and prognostic factors of esophageal carcinoma (EC) with multiple primary carcinomas (ECWMPC). Methods: Clinical and survival data of 268 ECWMPC patients with two different primary carcinomas and 9,101 individual EC patients taken from hospital records dating from January 1996 to December 2012 were analyzed retrospectively. Results: There were a total of 11,066 EC patients treated over this period of which 330 patients met the diagnostic criteria of ECWMPC. Two hundred and sixty-eight patients who had two different primary carcinomas and survival data were recruited in this analysis. The median age of the first carcinoma occurrence was 59 (31 to 85) years old, and the median age of the second carcinoma occurrence was 62 (32 to 86) years old, with a male to female ratio of 6:1. The predilection sites were located in the head and neck, followed by the gastric-esophageal junction. For the subgroup of synchronous ECWMPC (S-ECWMPC) and metachronous ECWMPC (M-ECWMPC), head and neck remain the popular site of S-ECWMPC but cardiac became the top of the M-ECWMPC. More breast and colon rectum disease were found in S-ECWMPC patients. The ECWMPC patients had a significantly lower median survival time (MST) and 1, 3, and 5 years overall survival (OS) than the single EC patients [12.4 months and 51.8%, 21.9%, 14.7% vs . 17.0 months and 59.4%, 31.3%, and 23.9% (P vs . 13.9 months and 56.2%, 25.6%, 19.5% (P=0.001)]. Within the S-ECWMPC group, patients who only received radiotherapy and/or chemotherapy (RoC) (n=52) had a shorter/poorer survival time (MST and 1, 3, and 5 years OS are 9.8 months, 44.2%, 8.7%, 3.2%) compared to patients who received surgery (n=43) (MST and 1, 3, and 5 years OS are 16.4 months, 64.8%, 33.3%, 18.6%) (P=0.031), but a longer survival time compared to patients who had no treatment (n=20) (MST and 1, 3, and 5 years OS are 4.1 months, 10.0%, 5.0%, and 0%)(P=0.002). Within the M-ECWMPC group, patients who had received surgery (n=103) had a longer survival time than patients who had only received RoC (n=38) (MST 22.5 vs . 10.6 months, P=0.026). Among the 103 M-ECWMPC patients who had received surgery, 55 of them had an esophagus resection, whose OS was similar to those 3,633 operated EC patients (MST 31 months vs . 30 months, P=0.905). Within the M-ECWMPC group, patients with greater than 3 years interval time of diagnosis (ITD) had a better prognosis compared to patients with less than 3 years ITD (MST 24.8 vs . 13.2 months, P=0.021) There is no statistical difference in the prognosis between M-ECWMPC patients and Single EC patients (P=0.585).
 Conclusions: ECWMPC is not rare among EC patients. There is more cardiac in the M-ECWMPC patients and more Breast and Colon rectum disease were found in S-ECWMPC patients. Prognosis of M-ECWMPC patients was better than that of the S-ECWMPC patients. M-ECWMPC patients with a more than 3 years ITD had a better prognosis. In M-ECWMPC patients, esophageal surgery can acquire better survival benefits than other treatments. Surgery is highly recommended for ECWMPC patients.

/pdf/clinical-characteristics-and-prognostic-factors-of-200ivzxvt2.pdf

Clinical characteristics and prognostic factors of esophageal carcinoma associated with multiple primary carcinomas: a report of 268 cases

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Papers

Study of level Ib delineation, dose analysis and regional recurrence in level Ib lymph node-negative nasopharyngeal carcinoma patients treated by intensity-modulated radiotherapy

Intensity-modulated radiotherapy plus induction chemotherapy versus concurrent chemotherapy in locally advanced nasopharyngeal carcinoma: the preliminary result of a prospective study

Clinical characteristics and prognostic factors of esophageal carcinoma associated with multiple primary carcinomas: a report of 268 cases