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Doi H, Ri A, Inada M, Tatsuno S, Uehara T, Matsuura T, Ishikawa K, Nakamatsu K, Hosono M, Nishimura Y. Clinical course of longer than five years after definitive radiotherapy for nasopharyngeal carcinoma. Int J Clin Oncol 2023; 28:1607-1615. [PMID: 37798414 DOI: 10.1007/s10147-023-02418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND This study aimed to reveal the long-term outcomes and late toxicities (> 5 years) after definitive intensity-modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). METHODS Data from 43 patients (median age, 55 years; range, 17-72 years) with NPC who underwent definitive IMRT between 2001 and 2018 were analyzed. All patients were alive and disease-free 5 years after IMRT. A total dose of 70 (range, 66-70) Gy was delivered in 35 (33-35) fractions with concurrent cisplatin chemotherapy. RESULTS The median follow-up duration was 119 (range, 61.5-242.1) months. Three patients developed locoregional failure at 79, 92, and 149 months after IMRT, respectively. Of these, 2 patients died of disease progression at 136 and 153 months after IMRT. One patient died of aspiration pneumonia 141 months after IMRT, despite salvage of the recurrent tumor by re-irradiation. In addition, one patient died of aspiration pneumonia 62 months after the IMRT. Thus, the 10-year overall survival, progression-free survival, and locoregional control rates were 98%, 92%, and 94%, respectively. Grade ≥ 2 and ≥ 3 late toxicities were observed in 28 (65%) and 9 (21%) patients, respectively. Nine second primary cancers, including five tongue cancers and two external auditory canal carcinomas, were observed in seven (16%) patients. CONCLUSION Late recurrences, severe late toxicities, and second primary cancers were observed > 5 years after IMRT. A long-term follow-up of > 5 years is needed in patients with NPC.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
| | - Aritoshi Ri
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Saori Tatsuno
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Tomohiro Matsuura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
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Svärd F, Alabi RO, Leivo I, Mäkitie AA, Almangush A. The risk of second primary cancer after nasopharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:4775-4781. [PMID: 37495725 PMCID: PMC10562268 DOI: 10.1007/s00405-023-08144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Second primary cancers (SPCs) after nasopharyngeal cancer (NPC) are rare, but have an impact on the follow-up of this patient population. The aim of this study is to systematically review the literature to determine the prevalence and most typical sites of SPCs after NPC. METHODS We searched the databases of PubMed, Web of Science, and Scopus for articles on SPCs after NPC. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. RESULTS This review includes data on 89 168 patients with NPC from 21 articles. The mean occurrence for SPCs was 6.6% and varied from 4.9% in endemic areas to 8.7% in non-endemic areas. The most frequent locations of SPCs were oral cavity, pharynx, nose and paranasal sinuses, esophagus and lung. CONCLUSION There is an increased risk for a SPC after NPC management, especially in non-endemic areas. However, their mean rate is lower than after other head and neck carcinomas.
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Affiliation(s)
- Fanni Svärd
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Alhadi Almangush
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
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Giannini L, Alliata A, Cristofaro V, Incandela F, Pompilio M, Ottini A, Cavalieri S, Nuzzolese I, Iacovelli NA, Franceschini M, Deganello A. Radiation-Induced Oropharyngeal Squamous Cell Carcinoma: Case Report and Review of the Literature. Curr Oncol 2023; 30:6708-6719. [PMID: 37504352 PMCID: PMC10378216 DOI: 10.3390/curroncol30070492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Radiation therapy (RT) is a mainstay for the treatment of head and neck (HN) cancers, with 80% of patients receiving such treatment. Radiation-induced malignancies represent a life-threatening long-term effect of RT, with an incidence of 0.5% to 15%. CASE DESCRIPTION After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins. DISCUSSION The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable. CONCLUSIONS Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.
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Affiliation(s)
- Lorenzo Giannini
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Andrea Alliata
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Valentina Cristofaro
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Madia Pompilio
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Arianna Ottini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Imperia Nuzzolese
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | | | - Marzia Franceschini
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Case series report: radiation-induced oropharyngeal carcinoma. Anticancer Drugs 2023; 34:325-331. [PMID: 36730617 DOI: 10.1097/cad.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The incidence of radiation-induced secondary primary tumors (SPTs) is estimated to be between 1 and 20%. The oropharynx is not a common site for postradiotherapy head and neck SPTs. We describe the cases of eight patients, each with an SPT of the oropharynx. These developed after a long median latency of 17.7 years with each receiving two-dimensional radiation therapy and delivery of at least 5000 cGy per pharynx, except for one who was treated with IMRT. Tumor histological commonalities revealed squamous cell carcinoma p16 negative staining, local invasion, and limited lymphatic spread, with posterior wall of the oropharynx and the base of the tongue being the most common locations. Limited and challenging treatment options have been reported such as surgery, reirradiation, or clinical trials. Radiation-induced SP oropharyngeal carcinoma has unique clinical and pathological features. Patients with this disease have limited treatment options, which should be discussed in a multidisciplinary tumor board meeting. For this population, lifelong follow-up may help in early diagnosis and improve outcomes.
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Shen T, Cai W, Li T, Yu D, Ren C, Yu J. Impact of primary site on survival in patients with nasopharyngeal carcinoma from 2004 to 2015. Front Surg 2022; 9:1001849. [PMID: 36406355 PMCID: PMC9671952 DOI: 10.3389/fsurg.2022.1001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nasopharynx carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Many studies have shown some factors related with the prognosis of NPC patients. Our study aims to evaluate the differences of prognosis between initial and second primary NPC. Material and methods The Surveillance, Epidemiology, and End Results (SEER) program was used to perform the population-based analysis in NPC patients who were newly diagnosed between 2004 and 2015. Kaplan-Meier and Cox regressions were used to evaluate the effects of primary site on the overall survival (OS), as well as the cancer-specific survival (CSS). Results Our study included 5,012 NPC patients: 4,474 initial primary NPC patients and 5,38 s primary NPC patients. Significant differences were observed in sex, age at diagnosis, race, median household income, histological type, American Joint Committee on Cancer (AJCC) stage, N-stage, radiation treatment and chemotherapy between patients with initial and second NPC (P < 0.05). Moreover, the patients with second NPC had longer survival months. In addition, radiation and chemotherapy were recommended both in first and second primary NPC patients. Conclusion Worse prognosis was observed in patients with second primary NPC compared with those with primary NPC in all subgroups of AJCC stage and age at diagnosis.
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Affiliation(s)
- Tianyi Shen
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wenting Cai
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Tingting Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Donghui Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Chengda Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Jing Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
- Department of Ophthalmology, The Third People’s Hospital of Bengbu, Bengbu, China
- Correspondence: Jing Yu
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Lee V, Chan J, Vardhanabhuti V, Kwong D, Leung T, Chan S, Tong C, Xu Z, Shen L, Lee A. Advancing Care for Head and Neck Cancers in a Multidisciplinary Tumour Board in the East. Clin Oncol (R Coll Radiol) 2019; 31:549-559. [DOI: 10.1016/j.clon.2019.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 02/06/2023]
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Zhang LL, Li GH, Li YY, Qi ZY, Lin AH, Sun Y. Risk Assessment of Secondary Primary Malignancies in Nasopharyngeal Carcinoma: A Big-Data Intelligence Platform-Based Analysis of 6,377 Long-term Survivors from an Endemic Area Treated with Intensity-Modulated Radiation Therapy during 2003-2013. Cancer Res Treat 2019; 51:982-991. [PMID: 30309219 PMCID: PMC6639237 DOI: 10.4143/crt.2018.298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The incidence, risk factors and survival impact of secondary primary malignancies (SPMs) among survivors of nasopharyngeal carcinoma (NPC) treated with definitive intensity-modulated radiation therapy (IMRT) with or without chemotherapy are poorly characterized. METHODS AND MATERIALS Consecutive patients (n=6,377) from the big-data intelligence platform at Sun Yat-sen University Cancer Center, China (in a high-incidence area) with newly diagnosed non-metastatic pathologically proven non-keratinizing undifferentiated NPC treated with IMRT±chemotherapy between January 2003 and June 2013 were retrospectively analyzed. Cumulative incidence of SPMs was calculated using the Kaplan-Meier method. Cox proportional hazards model was used to identify potential risk factors for SPMs and assess whether SPMs affect overall survival. RESULTS Of the 6,377 patients, 189 (3.0%) suffered SPMs (median follow-up, 62 months). One-, 2-, 3-, 4-, and 5-cumulative risks of SPMs were 0.4%, 0.9%, 1.6%, 2.2%, and 2.6%, respectively. Latency from start of IMRT to SPMs diagnosis was 37 months (range, 6 to 102 months). In patients with SPMs, 14.3% suffered SPMs within 1 year post-IMRT: 1-3 years, 38.1%; 3-5 years, 33.9%; and >5 years, 13.7%. Lung cancer was the most common SPM (50/6,377, 0.78%). Multivariate analysis demonstrated sex (male, 64% increase), age (≥50 years, 68% increase), and smoking history (41% increase) were significant risk factors for SPMs, and SPMs were associated with poorer overall survival. CONCLUSION This large cohort study confirms SPMs a dreadful complication for long-term survivors of NPC treated with IMRT. SPMs negatively impact overall survival in NPC. Close follow-up is recommended for older male survivors with a smoking history.
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Affiliation(s)
- Lu-Lu Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-Hong Li
- Department of Radiology, Guangdong No.2 Provincial People’s Hospital, Guangdong Provincial Emergency Hospital, Guangzhou, China
| | - Yi-Yang Li
- Department of Oncology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhen-Yu Qi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Correspondence: Ying Sun, PhD Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China Tel: 86-20-87343816 Fax: 86-20-87343295
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Liu F, Luo T, Jin T, Zhang J, Xiang Z, Yan R, Xie L, Wu X, Zhang H, Wang F, Li P, Liu L. Advantages of using reduced-volume intensity modulated radiation therapy for the treatment of nasopharyngeal carcinoma: a retrospective paired study. BMC Cancer 2019; 19:554. [PMID: 31176358 PMCID: PMC6556221 DOI: 10.1186/s12885-019-5774-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed. We performed this study to assess the feasibility and efficacy of using IMRT with reduced-volume CTV for the treatment of nasopharyngeal carcinoma. METHODS We retrospectively reviewed 293 non-metastatic NPC patients treated with IMRT from 2002 to 2013. A total of 180 matched cases finally included with 90 received conventional-volume IMRT (CV-IMRT) and 90 received reduced-volume IMRT (RV-IMRT). Kaplan-Meier method and log-rank tests were used to compare NPC-specific survival. Multivariate analyses using the Cox proportional hazards model were conducted to detect independent predictors. RESULTS With a median follow-up of 70 months, the 3-year overall survival, progression-free survival, distant metastasis-free survival, local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival rates were 88.9, 84.4, 92.2, 91.1, 98.9, 91.1% for the CV-IMRT arm and 92.2, 85.6, 90.0, 93.3, 98.9, 93.3% for the RV-IMRT arm, respectively. None significant survival difference was observed. Additionally, RV-IMRT was associated with reduced risk of late xerostomia (P = 0.039) and hearing loss (P = 0.008), compared versus CV-IMRT. CONCLUSIONS The use of RV-IMRT for the treatment of NPC led to comparable survival condition and truly reduced toxicity reactions compared versus CV-IMRT.
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Affiliation(s)
- Fang Liu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ting Luo
- Mammary Oncology and Department of Medical Oncology, Clinical Research Center for Breast, Cancer Center, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Tao Jin
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Jiahui Zhang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zhongzheng Xiang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ruonan Yan
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Li Xie
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xin Wu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Hong Zhang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Feng Wang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ping Li
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Lei Liu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
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Dai L, Fang Q, Li P, Wu J, Zhang X. Secondary Squamous Cell Carcinoma of the Oral Cavity after Nasopharyngeal Carcinoma. Cancer Res Treat 2019; 52:109-116. [PMID: 31163959 PMCID: PMC6962465 DOI: 10.4143/crt.2019.202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose The main goal of this study was to analyze the prognosis of secondary oral squamous cell carcinoma (SCC) with a comparison with sporadic oral SCC by a matched-pair design. Materials and Methods Records of patients with surgically treated primary oral SCC were reviewed, and a total of 83 patients with previous history of radiotherapy for nasopharyngeal carcinoma (NPC) were retrospectively enrolled. A matched-pair study was performed, each NPC survivor was matched with two sporadic oral SCC patients by age, sex, primary tumor site, adverse pathologic characteristics, disease stage, neck node status, and tumor stage. The overall survival (OS) and disease-specific survival (DSS) rates were calculated by the Kaplan-Meier method; independent prognostic factors were evaluated by the Cox proportional hazards method. Results Compared with sporadic oral SCC patients, NPC survivors were less likely to be smokers (p=0.004), perineural invasion and lymphovascular invasion were more common in NPC survivors (both p < 0.001). The 5-year OS and DSS rates in NPC survivors were 47% and 54%, respectively; the 5-year OS and DSS rates in sporadic oral SCC patients were 62% and 67%, respectively; the difference was significant (both p < 0.05). In survival analysis, disease stage remained to be independent prognostic factor for both the OS and DSS. Conclusion NPC survivors had worse OS and DSS than sporadic oral SCC patients, NPC survivors were less likely to be smokers, but had higher opportunity of perineural invasion and lymphovascular invasion. Disease stage was the most important predictor for the survival in NPC survivors.
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Affiliation(s)
- Liyuan Dai
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Peng Li
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Junfu Wu
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xu Zhang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Documentation and incidence of late effects and screening recommendations for adolescent and young adult head and neck cancer survivors treated with radiotherapy. Support Care Cancer 2018; 27:2609-2616. [PMID: 30467794 DOI: 10.1007/s00520-018-4559-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE A retrospective review of adolescent and young adult (AYA) head and neck cancer (HNC) patients treated with radiation therapy (RT) at British Columbia Cancer was performed to determine the incidence of late toxicities, the documented late side effects discussed and the screening recommendations provided at the time of transfer of care to primary care providers (PCPs). METHODS Charts (n = 162) were reviewed for all patients 15 to 35 years at diagnosis with HNC treated with RT from 1960 to 2010 who survived > 5 years after diagnosis. RESULTS A discussion regarding the risk of long-term side effects was documented in the initial consultation for 85% of patients. The majority of patients (78%) developed > 1 documented late effect. The most common were xerostomia (44%), skin changes (28%), neck fibrosis (22%), nasal crusting (16%), epistaxis (16%), and dental decay (14%). In all, 20% were currently followed or were followed until they died. Of the 80% transferred to their PCP, 14% had a formal discharge summary. For those discharged from British Columbia Cancer, documented recommendations included regular dental care (34%) and screening for hypothyroidism (5%) and second malignancy (4%). CONCLUSIONS The majority of AYA HNC patients treated with RT developed late side effects, and most PCPs were not sent a discharge summary outlining screening recommendations for delayed late effects. IMPLICATIONS FOR CANCER SURVIVORS AYA HNC survivors treated with RT are at high risk for late effects and would benefit from a survivorship care plan outlining these risks and screening recommendations.
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11
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Chow JCH, Au KH, Mang OWK, Cheung KM, Ngan RKC. Risk, pattern and survival impact of second primary tumors in patients with nasopharyngeal carcinoma following definitive intensity-modulated radiotherapy. Asia Pac J Clin Oncol 2018; 15:48-55. [PMID: 29932287 DOI: 10.1111/ajco.12994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 04/29/2018] [Indexed: 11/25/2022]
Abstract
AIM Second primary tumor (SPT) is a serious late complication after definitive radiotherapy for nasopharyngeal carcinoma (NPC). We evaluated the incidence, pattern, risk factors and survival impact of SPT in NPC patients following definitive intensity-modulated radiotherapy (IMRT). METHODS A retrospective review of 780 consecutive IMRT-treated NPC patients between February 2003 and September 2011 was conducted. Cumulative SPT incidence and overall survival after SPT diagnosis were estimated. Associations between clinical characteristics and SPT risk were analyzed. Standardized incidence ratios (SIR) were calculated using age, gender and calendar-year-specific cancer incidences from the Hong Kong Cancer Registry. RESULTS At a median follow-up of 7.5 years, 51 SPTs (6.7%) were identified, 22 (43.1%) of which occurred within previous radiotherapy fields. Tongue cancers (31.8%) and sarcomas of the head and neck (31.8%) were the most common in-field SPTs. Age [hazard ratio (HR), 1.051; 95% confidence interval (CI), 1.025-1.078] and smoking status (HR, 1.755; 95% CI, 1.002-3.075) were independent risk factors associated with SPT development. Median overall survival after SPT diagnosis was 2.9 years. There was an 84% increase in cancer risk (SIR, 1.84; 95% CI, 1.37-2.42) compared with the general population. Significant excess risks were observed for sarcoma, tongue, oropharyngeal, prostate and liver cancer. Excess risks were higher beyond 5 years of follow-up. CONCLUSION Substantial risk of SPT, especially for in-field sarcoma and tongue cancers, exists after definitive IMRT for NPC. SPT severely negates longevity of NPC survivors. High awareness and careful surveillance is warranted for this late lethal complication.
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Affiliation(s)
- James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Kwok Hung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | | | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Roger K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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12
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Zhao W, Lei H, Zhu X, Li L, Qu S, Liang X. Investigation of long-term survival outcomes and failure patterns of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: a retrospective analysis. Oncotarget 2018; 7:86914-86925. [PMID: 27894100 PMCID: PMC5349963 DOI: 10.18632/oncotarget.13564] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022] Open
Abstract
Intensity-modulated radiotherapy (IMRT) has replaced the conventional radiotherapy (2D-RT) and improved clinical efficacy in Nasopharyngeal Carcinoma (NPC) patients. In the present study, we retrospectively analyzed the clinical characteristics of patients with NPC treated with IMRT to assess the long-term survival outcomes and failure patterns. Of the 527 patients, One hundred and twenty-one patients experienced treatment failure, 86 patients developed distant metastases, and 12 patients developed a second primary tumor. The local and regional recurrence rates were 31.4% and 14.0%, respectively. The 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional relapse-free survival (RRFS), and distant metastatic relapse-free survival (DMFS) rates were 80.9%, 75.6%, 91.7%, 96.2%, and 83.0%, respectively. The 5-year LRFS rates of Stage T1-4 patients were 100.0%, 93.1%, 92.0%, and 85.8%, respectively. The 5-year DMFS rates of Stage N0-3 patients were 95.0%, 86.1%, 79.5%, and 67.2%, respectively. Multivariate analysis showed age and T-stage were independent predictors of OS, T-stage was an independent predictor of LRFS, and age and N-stage were independent predictors of PFS and DMFS. In summary, the improved treatment results with IMRT are primarily due to the achievement of a higher local tumor control rate and OS in NPC patients. However, distant metastasis was the most commonly observed failure pattern after treatment. These results provide deep insights about the value of IMRT in the treatment and prognosis of NPC patients.
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Affiliation(s)
- Wei Zhao
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Hao Lei
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China.,Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, 430079, China
| | - Xiaodong Zhu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Ling Li
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Song Qu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xia Liang
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, 530021, China
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13
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Wang X, Li Y, Gao Y, Ouyang D, Guo Z. Second primary squamous cell carcinoma in patients with nasopharyngeal carcinoma after radiotherapy-Predictors and prognostic factors. Head Neck 2018. [PMID: 29522261 DOI: 10.1002/hed.25130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We investigated risk and prognostic factors for second primary squamous cell carcinoma (SCC) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy (RT). METHODS A total of 49 021 patients with NPC were treated at Sun Yat-Sen Cancer Center between January 1970 and December 2009. The incidence and management of second primary SCCs were analyzed. RESULTS A total of 142 patients (0.29%) developed second primary SCC, with 78.2% in the upper aerodigestive tract. Older age, smoking, and chemotherapy were associated with an increased rate of second primary SCC. The 3, 5, and 10-year overall survival (OS) rates for second primary SCC were 47.18%, 31.69%, and 11.97%, respectively. Advanced age, family history of cancer, and treatment modality were independent prognostic factors for survival. CONCLUSION Second primary tumors rarely develop in patients with NPC treated with RT, but when this occurs, second primary SCC comprises a majority of these. Intensity-modulated RT may shorten the latency to second primary SCC. Surgery as the first-line treatment may improve survival and prognosis.
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Affiliation(s)
- Xi Wang
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yin Li
- Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yunfei Gao
- Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Dian Ouyang
- Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zhuming Guo
- Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
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14
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Development of cavernous haemangioma following radical chemo-radiotherapy for nasopharyngeal carcinoma. The Journal of Laryngology & Otology 2017; 123:925-7. [DOI: 10.1017/s0022215108003605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:We report an adult case of nasopharyngeal carcinoma treated with radical chemo-radiotherapy, with subsequent development of a histologically proved temporal cavernous haemangioma within the radiation field.Method:Case report and review of the current literature concerning radiation-induced, secondary, space-occupying lesions.Conclusion:The increasing role of radiotherapy in nasopharyngeal carcinoma treatment, together with improved patient survival, is likely to lead to radiation-induced, secondary, space-occupying lesions being encountered more frequently. We emphasise the need to be vigilant for this important but relatively rare complication, which has significant associated morbidity.
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15
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Zhao W, Lei H, Zhu X, Li L, Qu S, Liang X, Wang X. The clinical characteristics of secondary primary tumors in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy: A retrospective analysis. Medicine (Baltimore) 2016; 95:e5364. [PMID: 27828863 PMCID: PMC5106069 DOI: 10.1097/md.0000000000005364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
To investigate the clinical characteristics associated with the risk of developing secondary primary tumors (SPTs) in patients with nasopharyngeal carcinoma (NPC) who underwent intensity-modulated radiotherapy (IMRT).Data from 527 patients with biopsy-proven nonmetastatic NPC who were treated with IMRT between January 2007 and December 2011 were analyzed retrospectively. The cumulative incidence of SPTs after IMRT completion was estimated using the Kaplan-Meier method. Intergroup differences in the cumulative incidence were determined using the log-rank test. The Cox proportional hazards regression model was used to confirm the risk factors associated with IMRT-induced SPTs.The median follow-up duration was 45.5 months (range, 4-97 months). Of the 527 patients, 12 (2.3%) developed posttreatment SPTs (9 men, 3 women), 6 of which were located in the irradiation field. SPTs were mostly located in the upper aerodigestive tract (n = 7), head and neck (n = 6), lungs (n = 3), and tongue (n = 2). The 1-, 3-, and 5-year cumulative SPT risk rates were 0.4%, 1.4%, and 3.1%, respectively, and the mean annual growth in cumulative incidence was approximately 0.6%. The 1-, 3-, and 5-year cumulative in-field SPT risk rates were 0.4%, 0.8%, and 1.5%, respectively, and the mean annual growth in the in-field cumulative incidence was approximately 0.3%. Univariate and multivariate analysis revealed that sex, age, clinical stage, chemotherapy, and overall IMRT duration did not significantly affect SPT risk. However, the history of smoking was the independent risk factor associated with SPT.The 5-year SPT incidence among patients with NPC after IMRT is concordant with or lower than that in previous 2-dimensional radiotherapy studies study. Among patients with NPC who underwent IMRT, the upper aerodigestive tract was the most common SPT site, and lung cancer was the most common pathology. Smoking history, but not sex, age, clinical stage, chemotherapy, and overall IMRT duration is the independent risk factor associated with SPT. Additional large-scale studies with longer-term follow-ups are needed to determine risk factors associated with SPT development after IMRT.
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Affiliation(s)
- Wei Zhao
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
| | - Hao Lei
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Xiaodong Zhu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
- Correspondence: Xiaodong Zhu, Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, 71 Hedi Road, Nanning, China (e-mail: )
| | - Ling Li
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
| | - Song Qu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
| | - Xia Liang
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning
| | - Xiao Wang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers The State University of New Jersey, New Brunswick, NJ
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16
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Zhang P, Zhang L, Liu H, Zhao L, Li Y, Shen JX, Liu Q, Liu MZ, Xi M. Clinicopathologic Characteristics and Prognosis of Tongue Squamous Cell Carcinoma in Patients with and without a History of Radiation for Nasopharyngeal Carcinoma: A Matched Case-Control Study. Cancer Res Treat 2016; 49:695-705. [PMID: 27737535 PMCID: PMC5512375 DOI: 10.4143/crt.2016.317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Previous studies reported an association between an increased risk of tongue cancer and radiation treatment for nasopharyngeal carcinoma (NPC). This study compared the clinicopathologic characteristics and outcomes of tongue squamous cell carcinoma (TSCC) in patients with and without a history of radiotherapy for NPC. Materials and Methods From 1965 to 2009, a total of 73 patients were diagnosed with TSCC with a history of radiotherapy for NPC. The patients were matched in a 1:3 ratio with patients with sporadic TSCC according to age, sex, and year of the TSCC diagnosis. The primary endpoint was the overall survival. Results The median interval from NPC to TSCC was 82 months. The NPC survivors were more likely to be diagnosed with a more advanced T classification, less likely to have lymph node involvement, and more likely to have the tumor located in the dorsum of the tongue than sporadic TSCC. Regarding the histologic characteristics, the NPC survivors were more likely to have a weak lymphocytic host response, low tumor budding, and low risk of a worse pattern of invasion. The sporadic TSCC patients had a better overall survival (hazard ratio, 0.690; p=0.033) than the NPC survivors. In competing risks analysis, the cumulative incidence functions for the competing event (documented non-tongue cancer death) were significantly higher in the NPC survivors (Gray’s test, p=0.001). Conclusion TSCC patients with a history of radiotherapy for NPC appear to have particular clinicopathologic features, a poorer survival, and are more likely to die from non-tongue cancer causes than those with sporadic TSCC.
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Affiliation(s)
- Peng Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lei Zhao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing-Xian Shen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qing Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meng-Zhong Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mian Xi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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17
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Zhang P, Zhao L, Zhu YJ, Qiu B, Guo SP, Li Y, Liu Q, Liu MZ, Xi M. Prognosis of Fibrosarcoma in Patients With and Without a History of Radiation for Nasopharyngeal Carcinoma. Ann Surg Oncol 2016; 24:434-440. [PMID: 27654106 DOI: 10.1245/s10434-016-5589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether radiation-induced fibrosarcoma (RIF) in patients with a history of radiotherapy for nasopharyngeal carcinoma (NPC) was associated with an inferior prognosis compared to sporadic fibrosarcoma of the head and neck. METHODS Forty-two patients with RIF who previously received radiotherapy for NPC and 124 patients with sporadic fibrosarcoma of the head and neck were identified between January 1965 and December 2013 at our institution. Information on clinicopathologic characteristics and treatment was abstracted from medical records. The primary end point was disease-specific survival (DSS). RESULTS The median latency from NPC diagnosis to RIF diagnosis was 9.9 years (range 3.1-36.8 years). RIF was diagnosed at an older age than sporadic fibrosarcoma. Treatment modality was significantly different between the two groups, with only 64.3 % of the RIF group receiving surgery ± adjuvant treatment versus 91.1 % in the sporadic fibrosarcoma group (P < 0.001). Patients with RIF had poorer 5-year DSS compared to the sporadic fibrosarcoma group (36.2 vs. 50.4 %; P = 0.026). Multivariate analysis of the combined group indicated that patient group (P = 0.032), tumor, node, metastasis classification system stage (P = 0.019), histologic grade (P = 0.046) and treatment modality (P < 0.001) were independent variables affecting DSS. CONCLUSIONS Compared to patients with sporadic fibrosarcoma, NPC survivors who develop RIF are older at diagnosis of fibrosarcoma and have an inferior prognosis.
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Affiliation(s)
- Peng Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lei Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu-Jia Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Su-Ping Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Pathology, Cancer Center, Sun Yat-Sen University, Guangzhou, China
| | - Qing Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Meng-Zhong Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mian Xi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
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18
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Chan JYK, Gooi Z, Mydlarz WK, Agrawal N. Risk of second primary malignancy after nasopharyngeal carcinoma in the United States: A population-based study. Head Neck 2015; 38 Suppl 1:E1130-6. [PMID: 26314805 DOI: 10.1002/hed.24173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the incidence of second primary malignancies in patients diagnosed with an index nasopharyngeal carcinoma (NPC) in the United States. METHODS The cohort was assembled from the Surveillance, Epidemiology, and End Results (SEER) database with a primary NPC between 1973 and 2005. RESULTS There was a 47% increased risk of second primary malignancy. The sites with increased risk include the oral cavity and pharynx (standardized incidence ratio [SIR] = 7.11; 95% confidence interval [CI] = 5.21-9.49), esophagus (SIR = 3.50; 95% CI = 1.68-6.44), nose, nasal cavity, and middle ear (SIR = 15.54; 95% CI = 5.70-33.83), and lung and bronchus (SIR = 2.39; 95% CI = 1.91-2.96). CONCLUSION Patients with NPC are likely at a significant risk for second primary malignancies, most notably in the oral cavity and pharynx, which is most likely related to genetic susceptibility, increased surveillance, and treatment effects. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1130-E1136, 2016.
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Affiliation(s)
- Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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19
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20
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Chung J, Lee V, Tsang R, Chan J, Kwong DLW, Lam KO, Sze HCK, Leung TW. Treatment outcomes of postradiation second head and neck malignancies managed by a multidisciplinary approach. Head Neck 2014; 37:815-22. [PMID: 24623597 DOI: 10.1002/hed.23674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 01/01/2014] [Accepted: 03/06/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to report on the treatment outcomes of patients with postradiation second head and neck malignancies. METHODS Fifty-seven consecutive patients with postradiation second malignancy were reviewed. Progression-free survival (PFS), overall survival (OS), and prognostic factors were analyzed. RESULTS Mean time interval between first course of radiation therapy to the development of postradiation second malignancy was 13.2 years. Median PFS and OS for the whole group were 12.0 and 67.0 months, respectively. Postradiation sarcoma conferred a worse PFS (p = .003) and OS (p = .001) as compared to postradiation carcinoma. Multivariate analysis revealed that Eastern Cooperative Oncology Group (ECOG) performance status ≥3 (p = .034), postradiation sarcoma (p = .007), and lack of radical surgery (p = .044) are prognostic of PFS, whereas postradiation sarcoma (p = .002), lack of postprogression surgery (p < .001), and lack of postprogression systemic therapy (p = .011) were prognostic factors of OS. CONCLUSION Treatment outcomes of postradiation second malignancy seemed promising under a multidisciplinary management.
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Affiliation(s)
- Joseph Chung
- Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Victor Lee
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Raymond Tsang
- Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jimmy Chan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Dora L W Kwong
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ka-On Lam
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Henry C K Sze
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - To-Wai Leung
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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21
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Chan JYW, To VSH, Wong STS, Wei WI. Radiation-induced squamous cell carcinoma of the nasopharynx after radiotherapy for nasopharyngeal carcinoma. Head Neck 2014; 36:772-5. [PMID: 23616235 DOI: 10.1002/hed.23363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/18/2013] [Accepted: 04/10/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the treatment outcome of radiation-induced squamous cell carcinoma (SCC) of the nasopharynx after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). METHODS We conducted a retrospective review of patients who underwent radiation therapy for NPC, which resulted in radiation-induced SCC of the nasopharynx. RESULTS Between 1998 and 2011, 24 patients had radiation-induced SCC of the nasopharynx. The median age of diagnosis was 68.2 years. The majority of patients (66.7%) presented with early-stage NPC initially, and they were treated with RT alone (n = 18) or concurrent chemoradiation (n = 6). The mean latency period for the second malignancy was 10.5 years. All the patients were treated with maxillary-swing nasopharyngectomy. Clear resection margin was achieved in 66.7%, and 75% of those with involved margin received adjuvant RT. The mean follow-up duration was 48.2 months. The overall 5-year actuarial local tumor control was 56% and the overall 5-year disease-free survival was 38%. CONCLUSION Radiation-induced SCC of the nasopharynx is rare after RT for NPC. The prognosis remained poor despite aggressive surgery and adjuvant RT.
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Affiliation(s)
- Jimmy Yu Wai Chan
- Diion of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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22
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Xi M, Liu SL, Zhao L, Shen JX, Zhang L, Zhang P, Liu MZ. Prognostic factors and survival in patients with radiation-related second malignant neoplasms following radiotherapy for nasopharyngeal carcinoma. PLoS One 2013; 8:e84586. [PMID: 24367679 PMCID: PMC3867505 DOI: 10.1371/journal.pone.0084586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/15/2013] [Indexed: 12/13/2022] Open
Abstract
Purpose To analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases. Methods and Materials Institutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included. Results Median latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1–36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN. Conclusions Sex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.
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Affiliation(s)
- Mian Xi
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Shi-Liang Liu
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Lei Zhao
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jing-Xian Shen
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Peng Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Meng-Zhong Liu
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- * E-mail:
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Tay G, Tan HK, Thiagarajan A, Soo KC, Iyer NG. Squamous cell carcinoma of the ear arising in patients after radiotherapy for nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2013; 271:149-56. [DOI: 10.1007/s00405-013-2495-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/10/2013] [Indexed: 11/27/2022]
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Lin Q, Yang R, Sun L, Chen S, Wu H. Biological response of nasopharyngeal carcinoma to radiation therapy: a pilot study using serial 18F-FDG PET/CT scans. Cancer Invest 2012; 30:528-36. [PMID: 22668086 DOI: 10.3109/07357907.2012.691193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We used serial (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to evaluate tumors' maximum standardized uptake value (SUV(max)) before, during, and after radiotherapy to explore the biological behavior of and response to radiation therapy in various subtypes of nasopharyngeal carcinoma (NPC). Sixty-one patients with pathologically diagnosed NPC were prospectively enrolled into the study. WHO type II(B) disease had a higher initial SUV(max) and more significant biological response at the primary site as compared with type II(A) subtype. The two subtypes of WHO type II NPC may significantly differ in their biological behavior and response to radiotherapy.
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Affiliation(s)
- Qin Lin
- School of Life Sciences, Xiamen University, The First Affiliated Hospital of Xiamen University, China
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Song M, Zhuang SM, Chen SW, Zhang Q, Yang AK, Wang LP, Guo ZM. Survival study and treatment strategy for second primary tumors in the oral cavity in patients with nasopharyngeal carcinoma after definitive radiation. Head Neck 2011; 34:1551-5. [DOI: 10.1002/hed.21959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/08/2011] [Accepted: 09/06/2011] [Indexed: 11/10/2022] Open
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Second primary esophageal or lung cancer in patients with head and neck carcinoma in Taiwan: incidence and risk in relation to primary index tumor site. J Cancer Res Clin Oncol 2010; 137:115-23. [DOI: 10.1007/s00432-010-0865-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 03/05/2010] [Indexed: 01/24/2023]
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Nasopharyngeal Carcinoma Treated With Reduced-Volume Intensity-Modulated Radiation Therapy: Report on the 3-Year Outcome of a Prospective Series. Int J Radiat Oncol Biol Phys 2009; 75:1071-8. [DOI: 10.1016/j.ijrobp.2008.12.015] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/10/2008] [Accepted: 12/10/2008] [Indexed: 11/19/2022]
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Park SM, Park CT, Park SY, Bae DS, Nam JH, Cho CH, Lee JM, Earle CC, Yun YH. Factors related to second cancer screening practice in disease-free cervical cancer survivors. Cancer Causes Control 2009; 20:1697-703. [DOI: 10.1007/s10552-009-9421-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 08/04/2009] [Indexed: 11/27/2022]
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Primary Small Cell Neuroendocrine Carcinoma of the Nasal Cavity After Successful Curative Therapy of Nasopharyngeal Carcinoma: A Case Report. Kaohsiung J Med Sci 2009; 25:145-50. [DOI: 10.1016/s1607-551x(09)70054-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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d'Espiney Amaro C, Montalvão P, Henriques P, Magalhães M, Olias J. Nasopharyngeal carcinoma: our experience. Eur Arch Otorhinolaryngol 2008; 266:833-8. [PMID: 18830701 DOI: 10.1007/s00405-008-0822-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 09/19/2008] [Indexed: 11/30/2022]
Abstract
The objectives of our study were to characterize nasopharyngeal carcinoma patients in the Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG) and identify the main factors that interfere with patients survival rate. We performed a retrospective study involving 157 patients (65% male and 35% female) between the years 2000 and 2005, and a histological classification according to Health World Organization. We constructed a Kaplan-Meier survival curve for the studied patients and evaluated the significance of the different studied factors with a Pearson correlation study. With an average age of 53 years, most of the carcinomas were type III (58%), followed by type II (30%) and at last type I (8%). Fifty-one of carcinomas were in stage IV at time of diagnosis. Ninety-five patients (60%) had remission. Five-year actuarial survival rate of all patients was 65.1%. There was a significant difference (P = 0.033) in the actuarial survival rate of staged IV patients treated with adjuvant chemotherapy. Undifferentiated nasopharyngeal carcinoma is the most frequent type in our geographic area. Chemotherapy improves survival rate, mainly in late stages.
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Affiliation(s)
- Carla d'Espiney Amaro
- Otorhinolaryngology Department, Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG-EPE), Lisbon, Portugal.
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Abstract
PURPOSE OF REVIEW Nasopharyngeal carcinoma prognosis is related to its potential locoregional invasion and metastatic spread. Among prognostic factors, initial tumor-node-metastasis stage is the main one, besides other biological parameters. Worldwide development of positron emission tomography imaging is changing modalities of staging. Concomitant chemoradiotherapy represents one of the most recent advances in the treatment of nasopharyngeal carcinoma patients, besides intensity-modulated radiation therapy. This review updates these recent advances in diagnosis and treatment of nasopharyngeal carcinoma. RECENT FINDINGS Recent publications have shown the superiority of fused positron emission tomography/computed tomography over positron emission tomography alone and conventional imaging to do an accurate staging and to impact on patient management. Circulating Epstein-Barr virus DNA load may be a useful prognostic marker in endemic regions. Recent meta-analysis confirmed the superiority of concurrent chemoradiotherapy to radiotherapy alone. Previous publications have shown that induction chemotherapy with new agents might be promising. Data demonstrating targeted therapies efficacy in metastatic nasopharyngeal carcinoma are limited to date. SUMMARY Positron emission tomography-computed tomography is replacing conventional imaging in the initial M staging of nasopharyngeal carcinoma. Its usefulness in response evaluation after therapy and its place in the follow-up need to be prospectively evaluated. Cisplatin-based concomitant chemoradiotherapy is now the standard treatment for locally advanced patients. However, incidence of relapses remains high, and new multimodal therapy is needed.
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Chen MC, Feng IJ, Lu CH, Chen CC, Lin JT, Huang SH, Lee KD. The incidence and risk of second primary cancers in patients with nasopharyngeal carcinoma: a population-based study in Taiwan over a 25-year period (1979–2003). Ann Oncol 2008; 19:1180-6. [DOI: 10.1093/annonc/mdn003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maranhão-Filho P, Campos JCS, Lima MA. Bilateral ptosis and supranuclear downgaze paralysis. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:1007-9. [DOI: 10.1590/s0004-282x2007000600017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 08/01/2007] [Indexed: 05/25/2023]
Abstract
The purpose of this article is to highlight an uncommon combination of supranuclear downward gaze paralysis with bilateral eyelid ptosis in a 53-years-old man with a radiation induced midbrain tumor and to discuss the aspects regarding the centers and pathways that mediate supranuclear vertical gaze movements.
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