Auditory brainstem responses after radiotherapy for nasopharyngeal carcinoma

The effect of irradiation for nasopharyngeal carcinoma on auditory brainstem responses and hearing was investigated in 19 otologically normal patients undergoing standard fractionated megavoltage radiotherapy. Auditory brainstem responses and pure tone audiometry were performed before radiotherapy, and at 3 and 12 months after completion of radiotherapy. There were no significant changes in the wave I–III and III–V interpeak intervals, or in sensorineural hearing thresholds (bone conduction at 4 kHz and average of bone conduction at 0.5, 1, 2 and 4 kHz), after radiotherapy. In contrast to previous studies, we found no evoked potential evidence of subclinical brainstem damage arising from irradiation for nasopharyngeal carcinoma.     

Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors

OBJECTIVES/HYPOTHESIS: Nasopharyngectomy is a well-established treatment option for recurrent nasopharyngeal carcinoma. Over a period of 4 years and 3 months, in a total of 43 patients, 45 nasopharyngectomies were performed. Thirty-one patients with follow-up ranging from 12 to 58 months were studied. Twenty-two patients (58%) survived; of these, 18 patients (82%) remained disease free. All patients who developed repeat recurrence or died (n = 12) had a high recurrent T-stage tumor, skull base involvement, multiple recurrences, positive surgical margins, or concurrent neck node metastasis. These factors are poor prognostic parameters and might mitigate the indications for aggressive salvage surgery. However, low recurrent T-stage tumor without neck metastasis carries a good prognosis. Modern minimally invasive surgery carries minimal morbidity.STUDY DESIGN A retrospective study was made to determine prognostic indicators in patients treated with salvage surgery for recurrent nasopharyngeal carcinoma. METHODS: Medical records were analyzed for all patients who had received nasopharyngectomy for recurrent nasopharyngeal carcinoma from March 1997 to June 2001. They were followed up from March 1997 to January 2002. Recurrent T stage, nodal metastasis, surgical approach, surgical margins, and pathological nodal status, together with surgical mortality, morbidity, and the delivery of postoperative irradiation, were compared with survival. RESULTS: In all, 43 patients underwent 45 nasopharyngectomies over a period of 4 years and 3 months. Patients with less than 1 year of follow-up were excluded. Four patients with residual disease, who represent a more favorable group, and five patients with planned debulking, nasopharyngectomy, and postoperative stereotactic irradiation were also excluded. The study group comprised 25 men and 6 women (ratio of 4:1) with age ranging from 26 to 69 years (mean age, 49.5 y). In 28 patients (90.3%), the recurrence of nasopharyngeal carcinoma was their first recurrence; in 3 patients (9.7%), the recurrences were second recurrences. Twenty-two patients (71%) survived, achieving a mean survival of 28.5 months. Nine patients died with a mean interval of 7.8 months (range, 1-14 mo). Of the nine patients who died, six (67%) had T3 or T4 tumor, four (44.4%) had concurrent recurrent neck disease, and five (55.5%) had positive surgical margins. Two patients died of perioperative meningitis. Fifteen (83.3%) of the 18 disease-free survivors had a low recurrent T-stage tumor. Mean intervals for development of repeat recurrence or distant metastasis were 16 and 7.9 months, respectively. CONCLUSIONS: High recurrent T stage, skull base involvement, repeated recurrence before surgery, nodal metastasis, and positive surgical margins carry a poor prognosis. This is particularly evident with high T stage and concurrent nodal metastasis. However, patients with low T stage have a survival advantage and benefit most from surgical treatment.     

放化疗联合治疗局部晚期鼻咽癌的临床研究

目的：探讨放化疗交替疗治疗局部晚期鼻咽癌的临床疗效。方法：回顾性分析106例局部晚期鼻咽癌患者临床资料。单纯放疗15例;91例接受PF方案为基础的诱导化疗和（或）辅助化疗,其中诱导化疗加放疗加辅助化疗36例,诱导化疗加放疗25例,放疗加辅助化疗30例。诱导化疗1～2周期,辅助化疗3～6周期。放疗于诱导化疗结束后第1天进行,辅助化疗在放疗结束后1周开始进行。鼻咽原发灶采用60Co,常规分割照射68-74Gy,颈部根治量60～70Gy,颈部预防量48～50Gy,每组均完成根治量放疗。结果：中位随访时间51个月,58例患者死亡,全组总生存率为45．3％。单纯放疗、诱导化疗加放疗加辅助化疗、诱导化疗加放疗、放疔加辅助化疗的5年总生存率分别为33％、63％、60％、50％,无瘤生存率分别为13％、56％、48％、40％,无局部复发率分别为13％、53％、48％、50％,无远处转移率分别为6％、50％、44％、47％,均差异有统计学意义（P〈0．05）。各组发生复发、转移的中位时间分别为22、29、28、25个月;10、19、15、12个月,均差异无统计学意义（P〉0．05）。诱导化疗加放疗加辅助化疗组急性毒性反应较其他组重,但未影响治疗进程,患者均可耐受。结论：诱导化疗和辅助化疗联合尽早开始的放疗治疗局部晚期鼻咽癌疗效较好,不良反应轻,适合局部晚期鼻咽癌患者的综合治疗。     

鼻咽癌放疗后鼻咽出血原因分析

目的:探讨鼻咽癌放疗后鼻咽部出血的原因。方法:回顾性分析70例因鼻咽癌放疗后鼻咽出血住院患者的出血原因。结果:70例患者中,由鼻咽癌复发引起鼻咽出血24例(34.3%),其中7例因大出血死亡;10例(14.3%)由假性动脉瘤引起,其中3例鼻咽大出血死亡;36例(51.4%)为鼻咽放疗后痂皮及肉芽出血,1例因大出血窒息死亡。结论:鼻咽癌放疗后鼻咽部出血是死亡率高的放疗并发症,其中以鼻咽癌复发及假性动脉瘤危险性最高,鼻咽癌放疗后痂皮及肉芽要积极处理。     

紫杉醇联合放疗治疗鼻咽癌裸鼠移植瘤Survivin mRNA的表达及其意义过程中

目的：研究紫杉醇联合放疗治疗鼻咽癌CNE-2裸鼠移植瘤的疗效及凋亡抑制基因Survivin的表达和意义。方法：建立鼻咽癌CNE2裸鼠移植瘤,分别进行紫杉醇（紫杉醇组）、放疗（放疗组）、紫杉醇＋放疗（紫杉醇＋放疗组）处理,测量移植瘤体积并对移植瘤标本进行苏木精-伊红染色、流式细胞仪检测凋亡指数及onestep RT—PCR检测Survivin mRNA的表达。结果：紫杉醇＋放疗组对裸鼠移植瘤的生长抑制最为明显,抑制率为99．3％。与对照组相比,紫杉醇组、放疗组和紫杉醇＋放疗组的凋亡指数均明显增加（P〈0．05）,其中紫杉醇＋破疗组更为明显（P〈0．05）。紫杉醇组和放疗组的裸鼠移植瘤组织中Survivin mRNA的表达与对照组无明显差异（P〉0．05）,但紫杉醇＋放疗组中Survivin mRNA的表达显著下降（P〈0．05）。结论：紫杉醇联合放疗对鼻咽癌低分化移植瘤具有明显的杀伤作用,紫杉醇对鼻咽癌裸鼠移植瘤具有放疗增敏作用,这种作用可能与凋亡抑制基因Survivin的表达下调有关。     

克拉霉素治疗鼻咽癌放疗后鼻窦炎的临床观察

目的:观察大环内酯类药物克拉霉素治疗鼻咽癌放疗后鼻窦炎的临床效果。方法:对鼻咽癌放疗1年后并发鼻窦炎的24例患者,口服小剂量克拉霉素,250mg/d,疗程12～20周;根据慢性鼻窦炎视觉模拟量表(VAS)、Lund-Mackay鼻窦CT影像评分系统,通过治疗前后比较,对治疗效果进行综合评估。结果:治疗前与治疗后及停药6个月后相比,VAS评分和CT影像评分差异均有统计学意义(P<0.01),治疗后与停药6个月后相比,两种评分结果差异均无统计学意义(P>0.05)。疗效评价为非常好9例,好11例,不好4例。结论:小剂量克拉霉素长期治疗鼻咽癌放疗后鼻窦炎有比较明显的临床效果,是鼻咽癌放疗后鼻窦炎较好的治疗方法。     

鼻咽癌放化疗局部失败的相关因素分析

目的：探讨鼻咽癌放化疗后局部失败（残留或复发）的相关影响因素。方法：对308例鼻咽部原发癌患者的临床病理资料进行回顾分析。选择性别、年龄、T分级、N分级、原发癌病理类型、有无颈淋巴结转移、颈转移淋巴结大小、颈淋巴结转移侧数、颈淋巴结转移累及区域、放疗方法、有无同步化疗等临床病理因素,用x^2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果：在308例头颈部原发鳞状细胞癌患者中,93例（30．2％）发生原发灶和颈部的残留或复发。单因素分析显示,T分级（P〈0.01）、N分级（P〈0.01）、有无颈淋巴结转移（P〈0.05）、颈转移淋巴结大小（P〈0.05）、颈淋巴结转移侧数（P〈0.01）与残留或复发有关。多因素分析结果表明,仅T分级与残留或复发明显相关。用Kaplan-Meier法进行生存分析显示71例残留或复发患者再次治疗的1年、3年、5年生存率分别为77．2％、40．4％、22．4％。结论：原发癌T分级是鼻咽癌治疗局部失败的决定性因素。而有无颈淋巴结转移、原发癌N分级、颈淋巴结转移侧数、颈淋巴结大小是影响因素和T分级的协同因素,但不是导致残留和复发的的初始和根本因素。鼻咽癌侵犯骨时易导致治疗失败。治疗失败者经再次治疗可以提高生存率。     

Effect of irradiation on middle ear effusion due to nasopharyngeal carcinoma

The management of middle ear effusion by myringotomy and insertion of ventilation tubes in 75 adult patients was evaluated. In Group 1 the middle ear effusion was not related to nasopharyngeal carcinoma. The patients with nasopharyngeal carcinoma were subdivided into pre and post-radiotherapy groups (Group 2 and Group 3) according to the time of insertion of the ventilation tubes. Myringotomy and insertion of ventilation tubes achieved significant hearing gain in all three groups. The pre and post-radiotherapy groups had a higher post-operative infection rate than Group 1 (P > 0.01). The duration of a persistent tympanic membrane defect in the post-radiotherapy group was significantly longer than Group 1 (P = 0.03). The post-radiotherapy group had more perforations than Group 1 (P= 0.02). A total of 28% of ears in the post-radiotherapy group were discharging at the last visit. In view of the higher complication rate in the post-radiotherapy group, the role of myringotomy and insertion of ventilation tube is reassessed.     

Treatment outcomes for radiotherapy alone are comparable with neoadjuvant chemotherapy followed by radiotherapy in early-stage nasopharyngeal carcinoma

OBJECTIVES: To analyze the impact of neoadjuvant chemotherapy (CT) on the treatment of early-stage nasopharyngeal carcinoma (NPC) as compared with radiotherapy (RT) alone. METHODS: We analyzed retrospectively the outcome of 60 previously untreated and histologically confirmed early-stage NPC patients treated with either RT alone or with neoadjuvant CT followed by RT (CT/RT) at the Seoul National University Hospital between 1986 and 2004. Neoadjuvant CT consisted of three cycles with 5-fluourouracil and cisplatin. RT was given to the nasopharynx and neck nodes. The median dose to the primary site, involved nodes, and elective nodes was 70.2 Gy, 63 Gy, and 45 Gy, respectively. According to the 1997 American Joint Committee on Cancer staging system, 9 patients had stage I or IIA disease, and 22 patients had stage IIB disease in the RT group. For the CT/RT group, 8 patients had stage I or IIA disease, and 21 patients had stage IIB disease. The median follow-up for all patients was 124.5 (range, 5-239) months. RESULTS: The 5-year locoregional failure-free (LRFF), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) rate was 84%, 93%, 81%, and 84% for the RT group and 77%, 86%, 71%, and 79% for the CT/RT group, respectively. There were no significant differences in LRFF (P = .728), DMF (P = .433), DFS (P = .562), and OS (P = .625) rates between the RT and CT/RT groups. Multivariate analysis revealed that delaying RT for more than 81 days was significantly associated with an increased risk of locoregional failure in the subgroup of patients with stage IIB disease (P = .044). CONCLUSIONS: In our retrospective analysis, the use of neoadjuvant CT showed no additional benefit to treatment with RT alone. Neoadjuvant CT may cause deleterious effect on stage IIB disease by delaying RT.     

基于因果分析的风险干预对鼻咽癌放疗患者放射性口腔炎的预防效果研究

目的 研究基于因果分析的风险干预对鼻咽癌放疗患者放射性口腔炎(ROM)的预防效果.方法 选取2017年1月至2019年12月在本院放疗科治疗的90例鼻咽癌患者,根据护理方式将患者分为常规组(常规护理)37例和干预组(常规组基础上进行因果分析的风险干预)43例,比较两组患者ROM发生率、发生时间、放射性黏膜损伤(RTOG...     

鼻咽癌伴脑神经损伤与预后关系的探讨

目的：探讨鼻咽癌脑神经损伤的特点及其与预后的关系。方法：收集2002-01—2003—12中山大学肿瘤防治中心经病理确诊的初治无远处转移鼻咽癌患者共1892例,分析脑神经损伤的情况和对预后的影响。结果：全组脑神经损伤率为9．4％,5年总生存率为61．0％,5年无瘤生存率为55．3％,5年局部区域无进展生存率为75．2％,5年无远处转移生存率为73．4％。单因素分析显示治疗前脑神经损伤症状期长短、治疗后3个月内脑神经损伤恢复程度、92分期、颈部淋巴结大小、海绵窦侵犯与否与预后相关。多因素分析显示,治疗后3个月内脑神经损伤恢复程度是影响5年总生存率的独立预后因素,其相对危险度为2．087。颈部淋巴结最大径超过20mm和海绵窦侵犯是影响5年无远处转移生存率的独立预后因素,其相对危险度分别为1．954和2．136。结论：鼻咽癌治疗前脑神经损伤症状期长短、治疗后脑神经损伤功能恢复程度与预后显著相关,海绵窦侵犯是远处转移的独立预后不良因素。     

Caloric response and postural control in patients with nasopharyngeal carcinoma after radiotherapy

Since radiotherapy is the treatment of choice for nasopharyngeal carcinoma, the influence of irradiation on the temporal bone is of great concern for these patients. In this study, the caloric test and posturography were used to investigate vestibular function in 41 irradiated patients with nasopharyngeal carcinoma. Caloric testing showed a high incidence of canal paresis; five unilateral and 10 bilateral. Factors such as middle ear effusion had no significant effect on the occurrence of canal paresis. Posturography showed no difference from the control group. The authors conclude that the influence of irradiation on the vestibular apparatus of patients with nasopharyngeal carcinoma might result in a canal paresis, while postural control is preserved. Central compensation may play an important role in the postural control of these patients.     

pAdKDR-tk/GCV自杀基因系统联合γ射线放疗鼻咽癌的体内实验

目的:探讨pAdKDR-tk/GCV自杀基因系统联合γ射线放疗人鼻咽癌的杀伤效应。方法:分别以pAdKDR-tk/GCV、60Coγ射线放疗及两者联合治疗裸鼠人鼻咽癌移植瘤模型,比较疗效;利用肿瘤生长曲线及肿瘤抑瘤率评价该自杀基因系统联合放疗的疗效。结果:单纯基因治疗与放疗对鼻咽癌CNE-2细胞裸鼠皮下移植瘤生长的抑瘤率分别为58.43%和70.88%,而基因治疗与放疗联合应用的抑瘤率达到84.39%,与前两者比较,差异有统计学意义(P<0.01);第21天基因治疗与放疗联合治疗组肿瘤平均体积仅为对照组的13.5%,明显低于单纯基因治疗与放疗。结论:pAdKDR-tk/GCV自杀基因系统联合放疗的疗效较单一治疗方案有显著的提高,为进一步开展靶向肿瘤血管内皮自杀基因联合放疗研究奠定了良好的理论和临床基础。     

Endoscopic nasopharyngectomy and its role in managing locally recurrent nasopharyngeal carcinoma

Local recurrence after primary radiation of nasopharyngeal carcinoma (NPC) remains an important cause of morbidity and mortality. Salvage treatment using reirradiation or surgery has been shown to improve survival over nontreatment. Surgery is traditionally performed using an open approach. Advances in endoscopic approaches for resection of paranasal sinus tumors have been extended to NPC. This article reviews the treatment options, in particular the role of endoscopic nasopharyngectomy in the management of recurrent NPC. The endoscopic anatomy, surgical principles, and published results on endoscopic nasopharyngectomy are presented. Short-term outcomes for early-stage recurrences are promising but long-term follow-up is needed.     

鼻咽癌误诊原因分析及防范措施

鼻咽癌为我国多发肿瘤之一,发病率为耳鼻咽喉科恶性肿瘤之首,对于放化疗较敏感,但随着疾病进展,疗效明显下降。早发现、早治疗是改善鼻咽癌患者预后的重要途径。由于其原发部位深而隐蔽,初期原发病灶小,不易观察,加之周围毗邻关系复杂,又与眼、耳鼻咽喉及颅底相毗邻,易从黏膜下向邻近器官直接浸润或经淋巴转移,临床表现多种多样,无特异性,易误诊;多属于低分化或未分化癌,恶性程度高、发展快、转移早,