A Clinical Research Of Radiochemotherapy For Nasopharyngeal Carcinoma And Intraoperative Radiotherapy For Thyroid Cancer

PURPOSE: To evaluate the efficacy and adverse effects of radiation therapy for the head and neck cancer,including nasopharyngeal carcinoma and thyroid cancer.METHODS: 1.From 2006.04-2016.07,98 patients with nasopharyngeal carcinoma(NPC)who received radiation therapy and chemotherapy were analyzed retrospectively.All patients received radical intensity modulated radiotherapy(IMRT)and chemotherapy,the clinical target volume 1(CTV1)were primary lesion and metastatic lymph nodes which received 66-72Gy/30-35Fx/5-7.5weeks,the CTV2 were Nasopharyngeal region and drainage area of the lymph node of neck which received 60-64Gy/25-31Fx/5-7weeks.For the chemotherapy,22 cases got induction chemotherapy,23 cases got concurrent chemotherapy,52 cases got induction chemotherapy combined with concurrent chemotherapy.The basic situation and clinical data were collected.The acute radiation toxicity including,radiodermatitis,mucositis,larynx/esophagitis,myelosuppression were evaluated based on RTOG/EORTC standards.The influencing factors were analyzed by SPSS22.0.2.From 2014.07 to 2015.03,9 patients with thyroid cancer were treated by intrabeam as intraoperative radiation therapy.These patients' quality of life,survival time,adverse effects were analyzed retrospectively to preliminarily estimate the intrabeam system for the treatment of poorly differentiated or recurrent thyroid cancers.RESULTS: 1.98 patients(89 cases of poorly differentiated squamous cell carcinoma,9 cases of squamous cell carcinoma)with NPC were confirmed by pathologic diagnosis,clinical imagings and clinical manifestations.The acute radiation toxicity were: radiodermatitis(68,69.4%),mucositis(59,60.2%),larynx / esophagitis(56,57.1%),myelosuppression(15,15.3%).Theses acute radiation toxicity mainly concentrated on level I-II.The level IV acute radiation toxicity was 1 case of mucositis,4 cases of radiodermatitis.Based on IMRT,induction chemotherapy or concurrent chemotherapy or induction chemotherapy combined with concurrent chemotherapy showed no significant difference in severe acute radiation toxicity.2.9 cases of thyroid cancer finished the intraoperative radiation by intrabeam system;One patient with poorly differentiated thyroid carcinoma had a recurrence 5 months later.1case developed a postoperative tracheal skin fistula,and 1case developed wound infection.Other vessel related adverse effects(aneurysm,venous thrombosis,jugular venous distention)were not found during the follow-up,neither the osteonecrosis nor neuropathy.The follow-up period ranged from 14-22 months(mean: 17.6 months),and 2 patients were lost to follow-up.CONCLUSIONS: 1.For the NPC patients,IMRT delivered the ideal dose distribution,the primary lesions received high dose of irradiation,and the peripheral normal tissue received low dose of irradiation with less adverse effects.Combined with IMRT,induction chemotherapy or concurrent chemotherapy or induction chemotherapy combined with concurrent chemotherapy showed no significant difference in severe acute radiation toxicity.2.For the patients with thyroid cancer,the affected areas were treated with both surgical resection and radiotherapy,it is hard to figure which of those led to the adverse effects.But intraoperative radiotherapy relieved the symptoms associated with thyroid cancer and improved the quality of life for these patients.It thus appears feasible to treat thyroid cancer patients with intraoperative radiotherapy.