A Novel Endoscopic Nasopharyngectomy Technique Using Low-Temperature Plasma Radiofrequency Ablation with Piece Resection In Resectable Locally Recurrent Nasopharyngeal Carcinoma: Operative Video and Technical Nuances

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Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma

Background The present study compared the effectiveness and toxicity of two treatment modalities, namely radiotherapy combined with nimotuzumab (N) and chemoradiotherapy (CRT) in patients with locally recurrent nasopharyngeal carcinoma (LR-NPC). Methods Patients with LR-NPC who were treated with radiotherapy were retrospectively enrolled from January 2015 to December 2018. The treatment included radiotherapy combined with N or platinum-based induction chemotherapy and/or concurrent chemotherapy. The comparison of survival and toxicity between the two treatment modalities was evaluated using the log-rank and chi-squared tests. Overall survival (OS) was the primary endpoint. Results A total of 87 patients were included, of whom 32 and 55 were divided into the N group and the CRT group, respectively. No significant differences were noted in the survival rate between the N and the CRT groups (4-year OS rates, 37.1% vs. 40.7%, respectively; P = 0.735). Mild to moderate acute complications were common during the radiation period and mainly included mucositis and xerostomia. The majority of the acute toxic reactions were tolerated well. A total of 48 patients (55.2%) demonstrated late radiation injuries of grade ≥ 3, including 12 patients (37.5%) in the N group and 36 patients (66.5%) in the CRT group. The CRT group exhibited significantly higher incidence of severe late radiation injuries compared with that of the N group (P = 0.011). Conclusion Radiotherapy combined with N did not appear to enhance treatment efficacy compared with CRT in patients with LR-NPC. However, radiotherapy combined with N may be superior to CRT due to its lower incidence of acute and late toxicities. Further studies are required to confirm the current findings.

A Novel Endoscopic Nasopharyngectomy Technique Using Low-Temperature Plasma Radiofrequency Ablation with Piece Resection In Resectable Locally Recurrent Nasopharyngeal Carcinoma: Operative Video and Technical Nuances

Objectives: Endoscopic nasopharyngectomy (ENPG) with en bloc resection has been well accepted in resectable locally recurrent nasopharyngeal carcinoma (rNPC), but it is difficult to master the technique and disseminate. We designed a novel method using low-temperature plasma radiofrequency ablation (LPRA) with piece resection and evaluated the survival benefit.Materials and Methods: A total of 56 resectable rNPC patients were retrospectively analyzed, and the following factors were assessed: ratio of R0 margin, overall survival rate (OS), local relapse-free survival rate (LRFS), and progression-free survival rate (PFS).Results: All surgeries were successfully performed without any severe postoperative complications or deaths. The median operation time was 130 minutes (range, 32–280 minutes), with little blood loss (median, 30 ml; range, 5–500 ml). The average number of hospital days postoperation was 3 days (range, 2–5 days). All cases (100.0%) had R0 margins. The nasopharyngeal defects were completely re-epithelialized in 53 (94.6%) patients. The 2-year OS, LRFS, and PFS rates of the entire cohort were 100%, 90.7% and 88.6%, respectively. Multivariate Cox proportional hazards model analysis indicated that cycles of radiotherapy were independent risk factors for LRFS (hazard ratio [HR], 16.607; 95% CI 1.638–168.417; P = 0.017) and PFS (HR, 7.424; 95% CI 1.190–46.320; P = 0.032).Conclusions: Radical endoscopic nasopharyngectomy is a novel, safe and relatively easier method for treating resectable rNPC by using low-temperature plasma radiofrequency ablation with piece resection. However, further data and longer follow-up time are needed to prove its efficacy.

Toripalimab plus intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma: an open-label single-arm, phase II trial

BackgroundToripalimab is a humanized immunoglobulin G4 monoclonal antibody against programmed death 1. We aimed to investigate the efficacy and safety of toripalimab in combination with intensity-modulated radiotherapy (IMRT) for recurrent nasopharyngeal carcinoma (rNPC).MethodsWe conducted a single-arm, phase II trial with patients with rNPC who had biopsy-proven disease and were unsuitable for local surgery. Eligible patients received IMRT in combination with toripalimab administered via intravenous infusion of 240 mg once every 3 weeks for a maximum of seven cycles. The primary endpoint was the objective response rate at 3 months post radiotherapy. The secondary endpoints included safety profiles, progression-free survival (PFS).ResultsBetween May 2019 and January 2020, a total of 25 patients with rNPC were enrolled (18 men (72.0%) and 7 women (28.0%); median (IQR) age, 49.0 (43.5–52.5) years). With a median (IQR) follow-up duration of 14.6 months (13.1–16.2) months, 19 patients (79.2%) achieved an overall response, and disease control was achieved in 23 (95.8%) patients at 3 months post radiotherapy. The 12-month PFS was 91.8% (95% CI 91.7% to 91.9%). The incidences of acute (grade ≥3) blood triglyceride elevation, creatine kinase elevation, skin reaction, and mucositis were 1 (4.0%), 1 (4.0%), 2 (8.0%), and 1 (4.0%), respectively. The incidences of late severe (grade ≥3) nasopharyngeal wall necrosis, nasal bleeding, and trismus were 28.0%, 12.0%, and 4.0%, respectively.ConclusionsToripalimab combined with IMRT was tolerable and showed promising antitumor activity in patients with rNPC.Trial registration numberNCT03854838.

Outcomes of Recurrent Nasopharyngeal Carcinoma Patients Treated With Salvage Surgery: A Meta-Analysis

ObjectiveTo assess the efficacy of treatment outcomes of salvage surgery for recurrent nasopharyngeal carcinoma (rNPC).MethodsWe conducted a detailed search of the literatures in biomedical databases published from January 1990 to December 2020. The main research features and results of interest were retrieved from the articles that met the selection criteria for meta-analysis.ResultsA total of 21 articles with 778 patients were included, 17 of which met the meta-analysis inclusion criteria. The pooled 2-year overall survival (OS), 5-year OS, and 2-year disease-free survival (DFS) were 71%, 50% and 61%, respectively. Subgroup analysis was conducted with postoperative adjuvant therapy. The pooled 2-year OS, 5-year OS and 2-year DFS of the postoperative adjuvant therapy group compared with the surgery alone group were 69% vs 72%, 44% vs 56%, and 77% vs 54%, respectively. Univariate and multivariate analyses were performed on 178 patients with detailed individual postoperative survival data in 10 articles. On multivariate analysis, recurrent T (RT) stage and adjuvant therapy were independent predictors of outcomes.ConclusionsThis meta-analysis indicated that recurrent NPC patients can obtain survival benefits from salvage surgery. Accurately assessing the RT stage of the tumor and choosing the appropriate surgical method are important to the success of the surgery. Although the prognostic factors influencing outcome have been studied, conclusive data on the survival benefits are still lacking. Random controlled trials (RCTs) to compare surgery alone and postoperative adjuvant therapy are needed in patients with positive margin status after salvage surgery.

Effect of triptolide and chemotherapy on carcinoembryonic and carbohydrate antigens levels and first-line treatment of recurrent nasopharyngeal carcinoma

To investigate the first-line treatment of recurrent Nasopharyngeal Carcinoma treprimcab combined with chemotherapy. From January 2019 to January 2020, 48 patients with recurrent nasopharyngeal Carcinoma (RNPC) were treated in our hospital. According to the method of the random number, 24 patients were divided into the combined group and the Control Group. The patients in the combined group were given the Combined Treatment of triptolide and chemotherapy. While the Control Group only received chemotherapy. The therapeutic effects and adverse reactions of the two groups were compared, the levels of Carcinoembryonic Antigen (CEA) and carbohydrate Antigen 19-9 (CA19-9) were measured before and after treatment. The total effective rate of the combined group was 79.17% higher than that of the control group (62.50%). The total effective rate of the two groups was statistically significant (P & Lt; 0.05). The incidence of grade i/ii adverse reaction in the control group was lower than that in the combined group, such as nausea and vomiting, oral mucositis, Leukopenia, liver and kidney function damage, central granulocyte count reduction, anaemia adverse reaction. The incidence of grade iii/iv Adr in the control group was higher than that in the combined group. The incidence of grade i/ii Adr in the thrombocytopenia group was higher than that in the combined group, and the incidence of grade iii/iv Adr in the control group was lower than that in the combined group. The side effects of nausea and vomiting and oral mucositis in the control group and the combined group were statistically significant (P & Lt; 0.05). There was no significant difference between the control group and the combined group in the incidence of Leukopenia, liver and kidney injury, neutrophil, anaemia and Thrombocytopenia (P & GT; 0.05). The level of CD4 + / CD8 + in control group and combined group before treatment was higher than that after treatment (P & Lt; 0.05). The quality of life of the combined group was 91.67% higher than that of the control group (70.83%). The quality of life of the control group was significantly higher than that of the combined group (P & Lt; 0.05). The levels of CEA and CA19-9 in the two groups after treatment were lower than those before treatment, and the levels of CEA and CA19-9 in the combined group were lower than those in the control group (P & Lt; 0.05). The first-line treatment of recurrent nasopharyngeal Carcinoma with triprimmab combined with chemotherapy has a good clinical effect and has a broad clinical research prospect.

Preliminary Efficacy Report and Prognosis Analysis of Endoscopic Endonasal Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma

Background: Compared with radiotherapy, endoscopic endonasal nasopharyngectomy (EEN) is increasingly used to treat recurrent nasopharyngeal carcinoma (NPC) because of its good prognosis and mild complications. This study aims to investigate the efficacy of EEN in the treatment of recurrent NPC and factors affecting prognosis.Methods: This study included all patients who received EEN for recurrent nasopharyngeal carcinoma from April 2016 to April 2020. All operations were performed in Xiangya Hospital Central South University. The patient's 2-year overall survival (OS) rate, disease-free survival (DFS) rate and significant prognostic factors are reported.Results: There were 38 (67.9%) males and 28 (32.1%) females, with a median age of 43 (range, 24–69 years).43 (76.8%) of the patients in our study were in advanced rT3-rT4 stage and 32 (74.4%) of the patients in the advanced stage had tumor growth closely related to the internal carotid artery (ICA). During a mean follow up period of 44 month (range 1–65 months) post-surgery. The 2-year OS rate was 48.6%, 2-year DFS rate was 42.6%. The 2-year OS rates of rT1-2 and rT3-4 recurrent NPC were 83.9 and 35.6%, respectively. The 2-year DFS rates of rT1-2 and rT3-4 recurrent NPC 76.2 and 56.3%. The advanced T stage were associated with a poor prognosis in terms of OS and DFS.Conclusions: Data indicate that T staging may be an independent prognostic factor for OS and DFS. Through proper preoperative evaluation, EEN is an alternative treatment option for advanced recurrent NPC that ensures a certain level of efficacy and is relatively safe with few complications. However, additional studies with long-term follow-up and a larger sample size are required.

Immune Microenvironment Change and Involvement of Circular RNAs in TIL Cells of Recurrent Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a malignant tumor that is highly prevalent in southern China and the Southeast Asian belt. Recent studies have shown that the T cells play important regulatory roles in tumorigenesis and progression. We test TIL cell of recurrent nasopharyngeal carcinoma and primary nasopharyngeal carcinoma cell. We found that T cell change in recurrent nasopharyngeal carcinoma and primary nasopharyngeal carcinoma cell. Based on GEO database, we selected differently expressed circRNAs in nasopharyngeal carcinoma tissues. qRTPCR show that some circRNAs also highly expressed in TIL cells. In conclusion, immune microenvironment changed in recurrent nasopharyngeal carcinoma. There is involvement of circular RNAs in this progress, with should be researched further.