| Part I:Long-term outcome of patients with esthesioneuroblastoma:a large cohort of a single institutionObjective:To analyze the treatment modalities and outcomes of patients with esthesioneuroblastoma (ENB) treated at a single institution.Material and methods:113 consecutive patients with biopsy proven undisseminated ENB treated at our center between June 1978 and Jan 2015 were retrospectively reviewed. There was 1 patient stage A,23 stage B and 89 stage C according to Kadish classification. Initial treatment included preoperative radiotherapy (RT) followed by surgery in 11, surgery followed by post-operative radiotherapy (PORT) in 51, primary RT in 47, and surgery alone in 3, only 1 patient treated with palliative chemotherapy alone.Results:After a median follow-up of 75 months, the 5-year overall survival (OS), loco-regional control rate and distant metastasis-free survival were 65%,73% and 67%, respectively. Overall survival at 5-year was 91% in preoperative RT group,82% in postoperative RT group, and 50% in primary RT group (p<0.001). As to patients with early disease (Kadish A/B) or with node metastasis, no survival difference was observed between patients treated with primary RT and combined modality. With regarding to node negative Kadish C disease, combined therapy showed superior survivals than primary RT, and preoperative RT plus surgery yielded best prognosis with 5-year OS of 100%.Conclusions:The optimal treatment policy for patients with esthesioneuroblastoma was surgery plus radiotherapy, especially preoperative RT plus surgery yielded best prognosis. When choosing most adequate therapy for ENBs disease stage should be taken into consideration. Age, node status and treatment modality were independent predictors of overall survival.Part II:Patterns of regional spread and the value of elective neck irradiation for EsthesioneuroblastomaObjective:Esthesioneuroblastoma (ENB) is a rare malignant neoplasm with great controversies on management of the neck. The aim of this study is to characterize the incidence and regional lymphatic spread patterns of N+disease on initial presentation, and assess the role of elective neck irradiation (ENI) in patients with NO disease.Material and methods:This is a retrospective analysis of 116 patients with treated naive ENB in our institution between Jun.1979 and Jun.2014.32 patients showed cervical lymph node metastasis in initial staging. Among 84 patients with NO disease,50 patients were delivered with ENI and 30 patients without any prophylactic neck treatment,4 patients were excluded for unknown management of neck.Results:Overall,32/116 (28%) patients were N-positive at the time of initial diagnosis. The most frequently involved locations were the level II lymph nodes (81%) and level Ib (53%), followed by level III (28%) and retropharyngeal nodes (22%). The 5-year regional failure-free survival rate was 98% in patient treated with ENI and 75% in patients without ENI (p=0.005), the 5-year disease-free survival rate was 71% and 50% (p=0.258), and 5-year overall survival rate was 77% and 62%(p=0.424). The regional failure rate was 2% for patients with ENI, while in patients without neck treatment was 23%(p=0.002). Multivariate analysis suggested ENI was the independent predictor for reducing regional failure (hazard ratio,0.093; 95%CI:0.011-0.756; p=0.026).Conclusions:ENB present some predictable patterns of cervical node metastases, the most common locations were level II and Ib. Prophylactic elective neck irradiation reduced the regional failure significantly, should be recommended as a part of primary treatment for patients staged with Kadish B/C.Part III:A retrospective case-control study:treatment outcome of IMRT combined with EGFR monoclonal antibody, concurrent chemo-radiotherapy or IMRT alone in nasopharyngeal Carcinoma patientsObjective:We designed a retrospective case-control study to compare the treatment outcome and toxicities in nasopharyngeal carcinoma patients who were treated with IMRT combined with EGFR monoclonal antibody, concurrent chemo-radiotherapy or IMRT alone.Material and methods:From Jan.2008 to Sep.2012,68 untreated stage Ⅱ-Ⅳb (7th AJCC staging system) NPC patients who received IMRT combined with cetuximab or nimotuzumab were included in BRT group, then matched (1:2) with 136 patients in concurrent chemo-radiotherapy (CCRT) group and 136 patients in IMRT alone group treated in same period for staging, age by using SAS software. The Kaplan-Meier method was used for calculating survival, and the differences between these three groups were analyzed by Logrank test. Multivariate prognostic factor was analyzed by Cox model.Results:The 3-year OS, DFS, LRCR and DMFS in the whole patients were 91.2%,80.2%,93.1% and 87.2% for all group, respectively. The 3-year OS were 91.9%,92.1% and 89.9%(P=0.379) in BRT group, IMRT group and CCRT group, respectively; with 3-year DFS 82.1%,77.9% and 81.6% (P=0.594),3-year LRCR 98.2%,90.6% and 93.0%(P=0.249),3-year DMFS 85.2%,85.2% and 90.3%(P=0.383) in BRT group, IMRT group and CCRT group, respectively. Multivariate prognostic analysis showed that stage T and combined with EGFR monoclonal antibody were influence factors for loco-regional control rate(P=0.034,0.032).Conclusions:IMRT yielded an encouraged treatment outcome for nasopharyngeal carcinoma. Although there were no significant differences in terms of overall survival rate in three groups, IMRT combined with EGFR monoclonal antibody has a tendency to improve loco-regional control rate.Part IV:Analysis of clinical and dosimetric factors related to post radiation nasopharyngeal necrosis for nasopharyngeal carcinoma with intensity modulated conformal radiationObjective:Postradiation nasopharyngeal necrosis (PRNN) is an important adverse effect of radiotherapy for nasopharyngeal carcinoma. In this study, we aimed to evaluate the clinical features, dosimetric factors and treatment outcomes of patients with PRNN.Material and methods:From Oct.2001 to Oct.2013,21 patients were diagnosed with PRNN with pathologic evidence from 1217 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated conformal radiotherapy (IMRT) in our institute.Results:17 patients were male,4 were female. The T stage distribution was 1 patient in T2,3 in T3,17 in T4. The median volume of primary tumor was 83cm3. All patients received radiotherapy with prescriptive dose at 73.92Gy except only 1 patient received 69.96Gy with T2 disease. The median time of onset of PRNN was 6.2 months (1.8-21.9months) after the last irradiation, the rate of nasopharyngeal massive bleeding was 48%(10/21). Only 6 of 21 patients were cured of their PRNN,8 patients were died,4 of them died of sudden nasopharyngeal massive bleeding,3 patients died of exhaustion (cachexia), and one patient died of distant metastasis.Conclusions:PRNN is an important and severe late effect of radiotherapy in NPC which is difficult to be cured. The development of PRNN is related to advanced disease, large tumor volume, poor nutrient, infection and high radiation dose. Massive bleeding and cachexia are the primary cause of death. |
PDF Full Text Request