Study On Correlations Of Radiosensitization Of Nasopharyngeal Carcinoma And Syndrome Types Of TCM

Objective:TO probe into the dependence of radiosensitization on nasopharyngeal carcinoma and syndrome types of TCM about it .TO probe into the dependence of syndrome types of TCM about it and the expresstions of nm23 , cerbB2 , VEGF , MVD in carcinoma tissues which measured by immunohistochemical analysis . Method:It is about 162 cases entering into this research, 2 stop radiotherapy in midway because of seriously acute radioreaction, so the real qualified cases are 160 . All cases including in and getting rid of according to the criteria, are diagnosed definitely by pathology. One week before the radiotherapy, All the cases are divided into different syndrome types of TCM according to the standard , And measured the expresstions of nm23, cerbB2 , VEGF, MVD. Radiotherapy method: The radiotherapy equipment is SIEMENS PRIMUS linear accelerator, adopt the conventional fractionation radiotherapy, 2. OGy /a time, 1 time a day, 5 times everyweek;And with irregular Facio-cervical-portals and face or neck field radiotherapy through low melting point lead block, The total radiotherapy dosage is 68-76Gy. During the radiotherapy, observe the disappearing situation of the nasopharyngeal focus , lymph node every week, and write down the radiotherapy dosage when all the lymph node and tumour focus disappeared. Reexamined nasopharyngeal focus and the neck with MRI (before radiotherapy, when it finished and 3 month after it) .To found out the change of tumour focus and the neck lymph node , And analysed by SPSS11.05.Result:The positive rates of VCA-IgA titre is up to 86. 7%(98/113) ; And the VCA-IgA titre under 1:60 represents 35. 4%(40/113); 1:80 and the above accounts for 51. 33%(58/113). The EA-IgA titre under 1:40, represents 42.5%; 1:60 and the above accounts for 24.8%(58/113). The positive rates of EA-IgA titre is 67. 3%.The positive rate of nm-23 expression is up to 69.7% (53/76), And VEGF is 32. 9%, Cerb-B2 is 36. 8%; MVD accounts for 25% in 15-30 (19/76); 31-45 , 39. 5% (30/76);46-60, 35.5% (27/76).The expression of MVD is negative correlation with nm23 (P =0.000), the means of MVD in nm23 between in positive and in negative show significant differences (P =0. 000); MVD and cerbB2, show negative correlation (P =0. 003); nm23 and cerbB2, show positive correlation (P =0. 020); nm23 and VEGF, show positive correlation (P =0.015); VEGF and cerbB2, show positive correlation (P =0.000); The research find out that VEGF and MVD have relevant trend (P=0. 052). And T-test show significant differences in MVD between the cases which VEGF in negative and in positive(p =0.051)Comparing the blood and phlegm stasis syndromes with phlegm stasis syndromes , the difference in the mean of MVD has significance in statistics (P =0. 024); The syndrome types of TCM has no dependence with nm23, MVD, VEGF, cerbB2 shown by relevant analysis.The blood stasis syndromes involve basis cranii, paranasal sinus mainly while the most pyretic lung syndromes, do not involve tissues outside the epipharynx(58. 06%, 18/31). Among phlegm stasis syndromes, the number of the cases which do not involve tissues outside the epipharynx is larger than other types(63. 64%, 35/55). As far as the involve area is concerned, the difference of every syndrome types of TCM reach statistical significance (P=0.016) .As far as the involve lymph node is concerned, pyretic lung syndromes, The blood stasis syndromes, phlegm stasis syndromes and the blood and phlegm stasis syndromes are 54. 84(17/31), 54. 54(18/33), 98. 18%(54/55) and 82. 93%(34/41) respectively. The blood and phlegm stasis syndromes and pyretic lung syndromes ,have significantly differences (P=0. 000) ; The pyretic lung syndromes and phlegm stasis syndromes , significantly different (P=0. 000) ;The blood stasis syndromes and phlegm stasis syndromes, significantly different (P=0.000) ; phlegm stasis syndromes with the blood and phlegm stasis syndromes , significantly different (P=0. 000).The rate of nasopharyngeal focus all disappeared (81.9%, 131/160),is higher than that of the local lymph nodes(75. 34%, 110/146); The radiotherapy dosage when The nasopharyngeal focus are all disappeared (53.97 ±6.89) is larger than that of local lymph nodes (46.98 ± 4.33) .There are two cases in this research that the reduction of their nasopharyngeal focus is less than 50% (one is well differentied squamous carcinoma and another is moderate adenocarcinoma ) .The radiotherapy dosages when the nasopharyngeal focus are all disappeared is concerned, from the highest to the lowest in rank, they are:The blood and phlegm stasis syndromes, The blood stasis syndromes, phlegm stasis syndromes, pyretic lung syndromes, there are differences among the four types (P=0. 000) . Comparing pyretic lung syndromes with the others, the difference reach statistical significance (P = 0.000—0.002) ;And the phlegm stasis syndromes with the blood and phlegm stasis syndromes, also has statistical significance (p=0.002) .As far as that of local lymph nodes is concerned, from the highest to the lowest in rank, they are:The blood and phlegm stasis syndromes, phlegm stasis syndromes, The blood stasis syndromes, pyretic lung syndromes. The difference reach statistical significance(P=0. 001). Compareing pyretic lung syndromes with The blood and phlegm stasis syndromes, phlegm stasis syndromes,The difference reach statistical significance (P = 0.007-0.014).As far as the rate of nasopharyngeal focus all disappeared is concerned, the difference reach statistical significance (P=0.004) .The pyretic lung syndromes with The blood stasis syndromes, statistical significance (P=0.00) ;The phlegm stasis syndromes with the blood stasis syndromes, statistical significance (P=0. 002) ;The blood and phlegm stasis syndromes with The blood stasis, statistical significance (P=0. 032) .As far as that of local lymph nodes is concerned, the difference reach statistical significance (P=0. 000) . The pyretic lung syndromes with The blood and phlegm stasis syndromes, statistical significance (P=0. 001) .pyretic lung syndromes with phlegm stasis syndromes, statistical significance(P=0. 004);The blood stasis syndromes with The phlegm stasis syndromes, statistical significance (P=0. 001) ;The blood stasis syndromes with The blood and phlegm stasis syndromes,statistical significance (P=0.001) ;The blood and phlegm stasis syndromes with phlegm stasis syndromes,no statistical significance(p=0.614) .If divided into two groups:sensitive group (pyretic lung syndromes, phlegm stasis syndromes )and insensitive group (The blood and phlegm stasis syndromes, The blood stasis syndromes ), The rate of nasopharyngeal focus all disappeared is 89. 53%(77/86), 72.97%(54/74), respectively. The difference reach statistical significance (P=0.007) .It indicates that this classification can mirror the radiosensitivity on nasopharyngeal carcinoma effectively. In the sensitive group, the cases in 1, 2 stage represent 33. 72%(29/86), And in 3, 4 stage represent 66.28% (57/86); while in the insensitive group, 6. 76%(5/74), 93. 24%(69/74), respectively. The TNM stages has significant difference(P=0.000);cerb-B2 expression positive rate is 28. 57%(14/49),51. 85%(14/27), respectively. That has significant difference(P=0.044) ; VEGF, (P=0.952) ;nm-23, (P=0. 340) ; the mean of MVD, (p=0.127). It shows that cerb-B2 may be one of the indexes to predict radiotherapy sensitiveness of the nasopharyngeal carcinoma . In this research, because only 76 patients used immunohistochemical analysis , the value of nm23 , VEGF , MVD on predicting radiotherapy sensitiveness of the nasopharyngeal carcinoma , needs to expand cases to make sure .Among the 3 stage patients, the mean of radiotherapy dosage when the nasopharyngeal focus are all disappeared , from the highest to the lowest in rank, are The blood and phlegm stasis syndromes, The blood stasis syndromes, The pyretic lung syndromes, phlegm stasis syndromes (P=0. 022) .The difference between pyretic lung syndromes and the blood and phlegm stasis syndromes reach statistical significance (P=0. 042) ;the difference between The blood and phlegm stasis syndromes and phlegm stasis syndromes reach statistical significance (P=0. 003) .As far as that of local lymph nodes is concerned, they are The blood and phlegm stasis syndromes, phlegm stasis syndromes , The blood stasis syndromes, pyretic lung syndromes, the differences reach statistical significance (P=0.018) . Conclusion:1. VCA-IgA, EA-IgA can be one of the basic diagnosis of nasopharyngeal carcinoma.2. Besides influenced by VEGF, this research also find out that MVD is regulated by nm23 and cerbB2. It indicated that the growth and metastasis of thenasopharyngeal carcinoma may be the result of complicated regulation of polygene expressions .3. This research shows that Positive expression rate of cerb-B2 has significant difference in sensitive group and insensitive group. Proved cerb-B2 may be one of the indexes to predict radiotherapy sensitiveness of the nasopharyngeal carcinoma . The expression of nm23 , VEGF , MVD has no statistical significance, so the value of them on predicting radiotherapy sensitiveness of the nasopharyngeal carcinoma , needs to expand cases to make sure . 4.The syndrome types of TCM is closely related with with TNM stages. The patients with blood stasis syndromes are mostly in the stage of T3, T4 ; and with phlegm stasis syndromes are mostly in the stage of N2, N3 ;with blood and phlegm stasis syndromes are mostly in the stage of 3,4.5. The mean radiotherapy dosage when the nasopharyngeal focus are all disappeared is concerned, from the highest to the lowest in rank, they are:The blood and phlegm stasis syndromes, The blood stasis syndromes, The phlegm stasis syndromes, The pyretic lung syndromes.As far as that of local lymph nodes is concerned, from the highest to the lowest in rank, they are:The blood and phlegm stasis syndromes, The phlegm stasis syndromes, The blood stasis syndromes, The pyretic lung syndromes.6. As far as the rate of nasopharyngeal focus all disappeared and that of local lymph nodes is concerned, The sensitive group and insensitive group have statistical significance.7. The ratio of 1, 2 stage and 3,4 stage in the two groups (sensitive group, insensitive group), has statistical significance. The patients in 1,2 stages represent 70. 27%, while in 3,4 stages represent 34.88%. TNM stages is a important factor of influencing the radiotherapy curative effect of nasopharyngeal carcinoma , the later by stages, the worse radiotherapy curative effect is. So it needs to eliminate the TNM stage's influences when investigating the relationship of the syndromes types of TCM and radiotherapy sensitivity.8. Because of the cases in 1,2,4 stages , one or two syndrome types lack or too few, reject while investigating the relationship of syndromes types of TCM and radiotherapy sensitivity. Analysis of the patients in the 3 stages ,pyretic lung syndromes, phlegm stasis syndromes are sensitive,The blood stasis syndrome is insensitive, The blood and phlegm stasis syndromes...