scholarly journals IMRT Images Based on Swarm Intelligence Algorithm in the Treatment of Nasopharyngeal Carcinoma and Pain

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiaoli Fu ◽  
Minxiang Li ◽  
Mantian Yin ◽  
Qing Li ◽  
Ying Chen
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Total Dose ◽  
Survival Rates ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Target Volume ◽  
Acute Radiation ◽  
Free Survival ◽  
Sliding Windows ◽  
Technical Features

Objective. To investigate the IMRT treatment of nasopharyngeal carcinoma term effect, toxicity, and technical features. Methods. Sliding windows dynamic CT image-guided IMRT techniques on 31 patients for treatment of nasopharyngeal carcinoma radical radiotherapy, with 30 to 33 min irradiation. Target prescription dose GTVnx, GTVnd, CTV1, and CTV2 were 70∼76Gy, 68∼70Gy, 60∼66Gy, and 54Gy, while giving a dose of vital organs, the brain stem, and other restrictions to protect the parotid gland. Results. During 3 to 18 months of follow-up for a median period of 10 months, 1-year locoregional patients’ progression-free survival, distant metastasis-free survival, and overall survival rates were 93.5%, 87.1%, and 93.5%, respectively. Acute radiation reactions of grade I and II, xerostomia, and radioactive stomatitis were not observed. IMRT DVH analysis showed increased total dose and the irradiation target volume divided doses, reduced OARs illuminated, and the total dose divided doses. Conclusion. Intensity-modulated radiation therapy can achieve good short-term effects, significantly reduce the acute radiation response, and improve the quality of life of patients. It is worthy of promotion and application and in-depth research.

Phase III Study of Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Advanced Nasopharyngeal Carcinoma: Positive Effect on Overall and Progression-Free Survival

2003 ◽  
Vol 21 (4) ◽  
pp. 631-637 ◽  
Author(s):  
Jin-Ching Lin ◽  
Jian-Sheng Jan ◽  
Chen-Yi Hsu ◽  
Wen-Miin Liang ◽  
Rong-San Jiang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Combined Treatment ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Concurrent Chemotherapy ◽  
Phase Iii ◽  
Rank Test ◽  
Free Survival

Purpose: Nasopharyngeal carcinoma (NPC) is a radiosensitive and chemosensitive tumor. This randomized phase III trial compared concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in patients with advanced NPC. Patients and Methods: From December 1993 to April 1999, 284 patients with 1992 American Joint Committee on Cancer stage III to IV (M0) NPC were randomly allocated into two arms. Similar dosage and fractionation of RT was administered in both arms. The investigational arm received two cycles of concurrent chemotherapy with cisplatin 20 mg/m2/d plus fluorouracil 400 mg/m2/d by 96-hour continuous infusion during the weeks 1 and 5 of RT. Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Baseline patient characteristics were comparable in both arms. After a median follow-up of 65 months, 26.2% (37 of 141) and 46.2% (66 of 143) of patients developed tumor relapse in the CCRT and RT-alone groups, respectively. The 5-year overall survival rates were 72.3% for the CCRT arm and 54.2% for the RT-only arm (P = .0022). The 5-year progression-free survival rates were 71.6% for the CCRT group compared with 53.0% for the RT-only group (P = .0012). Although significantly more toxicity was noted in the CCRT arm, including leukopenia and emesis, compliance with the combined treatment was good. The second cycle of concurrent chemotherapy was refused by nine patients and was delayed for ≥ 1 week for another nine patients. There were no treatment-related deaths in either arm. Conclusion: We conclude that CCRT is superior to RT alone for patients with advanced NPC in endemic areas.

scholarly journals The Most Efficacious Induction Chemotherapy Regimen for Locoregionally Advanced Nasopharyngeal Carcinoma: A Network Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Horace Cheuk-Wai Choi ◽  
Sik-Kwan Chan ◽  
Ka-On Lam ◽  
Sum-Yin Chan ◽  
Sze-Chun Chau ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Fixed Effects ◽  
Concurrent Chemoradiotherapy ◽  
Meta Analysis ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Hazard Ratios ◽  
Analysis Models

BackgroundInduction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) for non-metastatic locoregionally advanced nasopharyngeal carcinoma (NPC) has gained considerable attention. However, the most efficacious IC regimens remain investigational. We aimed to compare the survival benefits of all available IC regimens followed by CCRT in this network meta-analysis.MethodsAll randomized-controlled trials of CCRT with or without IC in non-metastatic locoregionally advanced NPC were included, with an overall nine trials of 2,705 patients counted in the analysis. CCRT alone was the reference category. Eight IC regimens followed by CCRT were analyzed: docetaxel + cisplatin (DC), gemcitabine + carboplatin + paclitaxel (GCP), gemcitabine + cisplatin (GP), mitomycin + epirubicin + cisplatin + fluorouracil + leucovorin (MEPFL), cisplatin + epirubicin + paclitaxel (PET), cisplatin + fluorouracil (PF), cisplatin + capecitabine (PX) and cisplatin + fluorouracil (PF), cisplatin + capecitabine (PX). Fixed-effects frequentist network meta-analysis models was applied and P-score was used to rank the treatments.ResultsDC, GP, and PX were the top three IC regimens with the highest probability of benefit on overall survival (OS). Their corresponding hazard ratios (HRs) (95% CIs) compared with CCRT alone were of 0.24 (0.08–0.73), 0.43 (0.24–0.77), and 0.54 (0.27–1.09) and the respective P-scores were 94%, 82%, and 68%. The first three IC regimens showing significantly improved progression-free survival (PFS) were PX, followed by GP and DC with respective HRs of 0.46 (0.24–0.88), 0.51 (0.34–0.77), and 0.49 (0.20–1.20), and P-scores of 82%, 78%, and 74%. Among the studies in the intensity-modulated radiation therapy (IMRT) era, GP and PX were the best performed IC regimens, whilst DC performed the best among non-IMRT studies. Doublet and gemcitabine-based IC regimens had better survival benefits compared to triplet and taxane-based IC regimens, respectively.ConclusionsGiven its consistent superiority in both OS and PFS, DC, GP, and PX ranked among the three most efficacious IC regimens in both the overall and subgroup analysis of IMRT or non-IMRT studies. Exploratory analyses suggested that doublet and gemcitabine-based IC regimens showed better survival performance.

scholarly journals Adding Concurrent Chemotherapy Significantly Improves the Survival of Stage II-IVb Nasopharyngeal Carcinoma Patients Treated With Concurrent Anti-EGFR Agents

2021 ◽  
Vol 11 ◽  
Author(s):  
Zi-Kun Yu ◽  
Xu-Yin Chen ◽  
Si-Han Liu ◽  
You-Ping Liu ◽  
Rui You ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Clinical Stage ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Survival Outcome ◽  
Stage Ii ◽  
Hematologic Toxicity ◽  
Free Survival

ObjectiveAnti-EGFR Targeted agents were found to be capable of modulating the antitumor immunity in head and neck cancer and become more and more frequently used in the treatment of nasopharyngeal carcinoma(NPC). We aimed to explore whether adding concurrent chemotherapy influences the survival outcome of patients with stage II-IVb NPC treated with concurrent anti-EGFR agents and intensity-modulated radiation therapy (IMRT) and explore other prognostic factors for the patients.Materials and MethodsA total of 656 stage II-IVb NPC patients treated with concurrent anti-EGFR agents plus IMRT between January 2011 and November 2015 were enrolled. Firstly, from these patients, a well-balanced cohort of 302 patients who received concurrent chemotherapy was created by matching potential prognostic factors. Furthermore, for all 656 stage II-IVb NPC patients, univariate and multivariate analyses of overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) were conducted to identify prognostic factors and to confirm the findings from the matching cohort.ResultsCompared with concurrent anti-EGFR agents alone, combining concurrent cisplatin and anti-EGFR agents significantly improved the OS (5-year 94.7% versus 84.3%, P=0.012) and PFS (5-year 82.0% versus 71.7%, P=0.039) of NPC patients with more severe hematologic toxicity and mucositis. The independent prognostic factors identified by multivariate analysis of OS and PFS included concurrent chemotherapy, epstein-barr virus(EBV) status and clinical stage. Patients treated without induction chemotherapy (IC) may achieve more benefits from the addition of concurrent chemotherapy to concurrent anti-EGFR agents.ConclusionsFor stage II-IVb NPC patients treated with concurrent anti-EGFR agents, the addition of concurrent chemotherapy can significantly improve the survival outcome.

scholarly journals Development and Validation of a Prognostic Nomogram Based on Residual Tumor in Patients With Nondisseminated Nasopharyngeal Carcinoma

2020 ◽  
Vol 19 ◽  
pp. 153303382095703
Author(s):  
Ping-Yan Liao ◽  
Zhong-Yi Dong ◽  
Chan-Tao Huang ◽  
Xin-Ran Tang ◽  
Guan-Dong Liu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Clinical Decision Making ◽  
Predictive Accuracy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Related Factors ◽  
Discriminative Ability ◽  
Predictive Values ◽  
Free Survival

Objectives: To investigate the prognostic value of residual tumor based on Magnetic resonance imaging(MRI) and establish an effective prognostic nomogram model referring to clinical,pathological and other related factors for predicting prognosis in nasopharyngeal carcinoma. Methods: Overall, 538 patients with non-metastatic, histologically-confirmed nasopharyngeal carcinoma were retrospectively examined. Data from 397 patients were used for the construction and validation of a nomogram based on the presence of residual tumor. A concordance index (C-index) was employed to assess the predictive accuracy and discriminative ability of the nomogram. Results: The 3-year survival rates in the non-residual and residual tumor cohorts were as follows: progression-free survival, 73.4% vs. 61.0%, P = 0.009; locoregional recurrence-free survival, 81.9% vs. 72.0%, P = 0.02; and distant metastasis-free survival, 80.7% vs. 73.5%, P = 0.11. Nine significant factors were included in the nomogram model. The calibration curve for the probability of progression-free survival showed that the nomogram-based predictive values had good concordance with the actual observations. Conclusion: The results showed that the patients in the residual tumor cohorts had a worse prognosis.The proposed nomogram may predict the prognosis and guide clinical decision-making concerning local residual tumors in nasopharyngeal carcinoma patients. Patients with a high risk of progression require more timely and aggressive treatment.

scholarly journals Photon Versus Proton Beam Therapy for T1–3 Squamous Cell Carcinoma of the Thoracic Esophagus Without Lymph Node Metastasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Yang-Gun Suh ◽  
Unurjargal Bayasgalan ◽  
Heung Tae Kim ◽  
Jong Mog Lee ◽  
Moon Soo Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Clinical Target Volume ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Proton Beam Therapy ◽  
Target Volume ◽  
Thoracic Esophagus ◽  
Free Survival ◽  
Extended Field ◽  
Photon Radiotherapy

Background and PurposeWe compared treatment outcomes and toxicities of photon radiotherapy versus proton beam therapy (PBT) and evaluated radiation field effects for T1–3 squamous cell carcinoma of the thoracic esophagus (EC) without lymph node metastasis.MethodsMedical records of 77 patients with T1–3N0M0 thoracic EC treated with radiotherapy between 2011 and 2019 were retrospectively analyzed. Among these patients, 61 (79.2%) individuals had T1 EC. The initial clinical target volume encompassed the whole esophagus with or without supraclavicular and/or abdominal lymph nodes (extended-field radiotherapy; 67 patients, 87.0%) or the area 3–5 cm craniocaudally and 1–2 cm radially from the gross tumor volume (involved-field radiotherapy; 10 patients, 13.0%). The final clinical target volume included margins of at least 1 cm from the gross tumor volume, with total radiation doses of 50–66 (median, 66) cobalt gray equivalent. Three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and PBT were used in twenty-four, five, and forty-eight patients, respectively. Concurrent chemotherapy was administered to 17 (22.0%) patients overall and only five (8.0%) T1 patients.ResultsPBT showed significantly lower lung and heart radiation exposure in mean dose, V5, V10, V20, and V30 than photon radiotherapy. The median follow-up for all patients was 46 (interquartile range, 22–72) months. The 5-year progression-free survival and overall survival rates were 56.5 and 64.9%, respectively, with no significant survival difference between photon radiotherapy and PBT. In patients with T1 EC, 5-year progression-free survival and overall survival rates were 62.6 and 73.5%, respectively.ConclusionsExtended-field radiotherapy using modern radiotherapy techniques without chemotherapy showed satisfactory clinical outcomes for lymph node-negative T1 EC.

Correlation of outcome with early metabolic response on FDG-PET in treatment of locally advanced nasopharyngeal carcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17555-e17555 ◽  
Author(s):  
Dora Lai Wan Kwong ◽  
Victor HF Lee ◽  
Pek lan Khong
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Metabolic Response ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Favourable Outcome ◽  
Free Survival ◽  
Pet Scans ◽  
Early Metabolic Response

e17555 Background: Skull base changes often persist on CT and MRI after treatment in locally advanced nasopharyngeal carcinoma (NPC) and cannot be differentiated from active tumor. We prospectively evaluated the metabolic response of T3/T4 NPC during treatment with PET scans. Early metabolic response was correlated with outcome after treatment. Methods: 50 patients with T3/T4, N0-3, M0 NPC were recruited. All patients had 3 cycles of induction chemotherapy (IC, physician’s choice of regime) before concurrent chemoradiation (CRT) with cisplatin 100mg/sqm for 3 cycles. PET scans were performed before and after IC and at 30Gy of CRT. For primary tumor that showed complete metabolic response (mCR, defined as SUV max in tumor ≤1.25x liver background activity) on reassessment PET, the dose to tumor stopped at 70Gy. For those who did not achieve mCR, a boost dose was given to the residual tumor to total 76Gy. Results: On post-IC PET scan, 2 patients with extensive intracranial disease showed no response with static and progressive disease respectively and did not proceed to CRT. 48 patients showed regression of tumor and decreased metabolic activity on post-IC PET, 16 of whom achieved mCR. One patient with mCR after IC refused CRT. 47 patients proceeded to CRT. 44 patients had reassessment PET at around 30Gy and 25 patients had mCR during CRT. 47 patients who completed CRT were included in survival analysis. Median follow up after completion of CRT was 28 months. Among the 15 cases who achieved mCR after IC, all patients were disease free without relapse at time of analysis. Among the 32 patients who did not achieve mCR after IC, there was 1 persistent loco-regional disease, 1 local and 1 regional relapse and 6 developed distant metastases. The 3 year NP control, regional control, distant metastases free, progression free survival and overall survival were 89.4%, 96.9%, 79.5%, 49.2% and 81% respectively compared with 100% corresponding survival rates among patients who achieved mCR after IC. The difference in progression-free survival was statistically significant (p = 0.045) Conclusions: Early mCR was observed in 32% patient after IC and 56.8% of patients during CRT. mCR after IC predicts for very favourable outcome.

scholarly journals Radiotherapy in nodal oligorecurrent prostate cancer

2021 ◽  
Author(s):  
Michael Pinkawa ◽  
Daniel M. Aebersold ◽  
Dirk Böhmer ◽  
Michael Flentje ◽  
Pirus Ghadjar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Literature Review ◽  
Survival Rates ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Nodal Metastasis ◽  
Stereotactic Ablative Radiotherapy ◽  
Current Standard ◽  
Free Survival ◽  
Systemic Treatments

Abstract Objective The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer. Materials and methods A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurrence patterns after local nodal treatment was performed. The DEGRO Prostate Cancer Expert Panel discussed the results and developed treatment recommendations. Results Metastasis-directed radiotherapy results in high local control (often > 90% within a follow-up of 1–2 years) and can be used to improve progression-free survival or defer androgen deprivation therapy (ADT) according to prospective randomized phase II data. Distant progression after involved-node SABR only occurs within a few months in the majority of patients. ENRT improves metastases-free survival rates with increased toxicity in comparison to SABR according to retrospective comparative studies. The majority of nodal recurrences after initial local treatment of pelvic nodal metastasis are detected within the true pelvis and common iliac vessels. Conclusion ENRT with or without a boost should be preferred to SABR in pelvic nodal recurrences. In oligometastatic prostate cancer with distant (extrapelvic) nodal recurrences, SABR alone can be performed in selected cases. Application of additional systemic treatments should be based on current guidelines, with ADT as first-line treatment for hormone-sensitive prostate cancer. Only in carefully selected patients can radiotherapy be initially used without additional ADT outside of the current standard recommendations. Results of (randomized) prospective studies are needed for definitive recommendations.

scholarly journals Comprehensive single-cell sequencing reveals the stromal dynamics and tumor-specific characteristics in the microenvironment of nasopharyngeal carcinoma

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Lanqi Gong ◽  
Dora Lai-Wan Kwong ◽  
Wei Dai ◽  
Pingan Wu ◽  
Shanshan Li ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Single Cell ◽  
Rna Sequencing ◽  
Progression Free Survival ◽  
Developmental Trajectory ◽  
Free Survival ◽  
Genetic Profiling ◽  
Single Cell Rna Sequencing ◽  
Infiltrating Cells ◽  
Patient Prognosis

AbstractThe tumor microenvironment (TME) of nasopharyngeal carcinoma (NPC) harbors a heterogeneous and dynamic stromal population. A comprehensive understanding of this tumor-specific ecosystem is necessary to enhance cancer diagnosis, therapeutics, and prognosis. However, recent advances based on bulk RNA sequencing remain insufficient to construct an in-depth landscape of infiltrating stromal cells in NPC. Here we apply single-cell RNA sequencing to 66,627 cells from 14 patients, integrated with clonotype identification on T and B cells. We identify and characterize five major stromal clusters and 36 distinct subpopulations based on genetic profiling. By comparing with the infiltrating cells in the non-malignant microenvironment, we report highly representative features in the TME, including phenotypic abundance, genetic alternations, immune dynamics, clonal expansion, developmental trajectory, and molecular interactions that profoundly influence patient prognosis and therapeutic outcome. The key findings are further independently validated in two single-cell RNA sequencing cohorts and two bulk RNA-sequencing cohorts. In the present study, we reveal the correlation between NPC-specific characteristics and progression-free survival. Together, these data facilitate the understanding of the stromal landscape and immune dynamics in NPC patients and provides deeper insights into the development of prognostic biomarkers and therapeutic targets in the TME.

Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS202-ONS211 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
U. Kumar Kakarla ◽  
Louis J. Kim ◽  
Peter Nakaji ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Survival Rates ◽  
Progression Free Survival ◽  
Surgical Approaches ◽  
Single Institution ◽  
Short Term ◽  
Total Resection ◽  
Free Survival ◽  
Petroclival Meningioma ◽  
Petroclival Meningiomas

Abstract Objective: We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time. Methods: Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression. Conclusion: Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

scholarly journals Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

1997 ◽  
Vol 2 (3) ◽  
pp. E1
Author(s):  
Roger J. Packer ◽  
Joanne Ater ◽  
Jeffrey Allen ◽  
Peter Phillips ◽  
Russell Geyer ◽  
...  
Keyword(s):  
Objective Response ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
Low Grade ◽  
Significant Prognostic Factor ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Low Grade Gliomas ◽  
Response To Chemotherapy

The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.

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