Efficacy and Safety of Chemotherapy Combined with Stereotactic Radiotherapy in the Treatment of Nasopharyngeal Carcinoma

Extracranial vertebral artery to middle cerebral artery bypass in therapeutic internal carotid artery occlusion for epipharyngeal carcinoma: A technical case report

Background:

Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture.

Methods:

A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx.

Results:

The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy.

Conclusion:

ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.

Development and validation of immune inflammation-based index for predicting the clinical outcome in patients with nasopharyngeal carcinoma

Inflammation indicators, such as systemic inflammation response index (SIRI), systemic immune‐inflammation index (SII), neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR), are associated with poor prognosis in various solid cancers. In this study, we investigated the predictive value of these inflammation indicators in nasopharyngeal carcinoma (NPC). This retrospective study involved 559 patients with NPC and 500 patients with chronic rhinitis, and 255 NPC patients were followed up successfully. Continuous variables and qualitative variables were measured by t test and chi‐square test, respectively. The optimal cut‐off values of various inflammation indicators were determined by receiver operating characteristic (ROC) curve. Moreover, the diagnostic value for NPC was decided by the area under the curves (AUCs). The Kaplan‐Meier methods and the log‐rank test were used to analyse overall survival (OS) and disease‐free survival (DFS). The independent prognostic risk factors for survival and influencing factors of side effects after treatment were analysed by Cox and logistic regression analysis, respectively. Most haematological indexes of NPC and rhinitis were significantly different between the two groups, and PLR was optimal predictive indicators of diagnosis. In the multivariable Cox regression analysis, PLR, WBC, RDW, M stage and age were independent prognostic risk factors. Many inflammation indicators that affected various side effects were evaluated by logistic regression analysis. In conclusion, the combined inflammation indicators were superior to single haematological indicator in the diagnosis and prognosis of NPC. These inflammation indicators can be used to supply the current evaluation system of the TNM staging system to help predict the prognosis in NPC patients.

DW-MRI-Guided Dose Escalation Improves Local Control of Locally Advanced Nasopharyngeal Carcinoma Treated with Chemoradiotherapy

Background

Nasopharyngeal carcinoma (NPC) is one of the most highly radiosensitive malignancies; however, some locally advanced NPC patients experienced local recurrence even though they received aggressive treatment regimens. Defining the tumor volume precisely is important to escalate the total dose required for the primary tumor. In this study, we aimed to investigate the feasibility and efficacy of dose escalation guided by DW-MRI in patients with locally advanced NPC.

Patients and Methods

A total of 230 patients with locally advanced NPC treated with intensive modulated radiotherapy (IMRT) at Sichuan Cancer Hospital between January 2010 and January 2015 were enrolled in this retrospective study. All the patients were treated with all-course of simultaneous integrated boost-IMRT. DW-MRI-guided dose escalation with 2.2–2.5 Gy/F, qd for 1–3 days or 1.2–1.5 Gy/F, bid for 1–3 days were prescribed to 123 patients. Survival and complication of the patients were evaluated, and multivariate analysis was performed.

Results

The median follow-up of patients in the DW-MRI-guided dose-escalation group and the conventional group was 48 months (range 8–88 months) and 52 months (range 6–90 months), respectively. The 5-year overall survival rate, distant metastasis-free survival rate, progression-free survival, and local recurrence-free survival (LRFS) of patients in the dose-escalation group and the conventional group were 88% vs 82.5% (p = 0.244), 86.1% vs 83.3% (p = 0.741), 82.2% vs 76.6% (p = 0.286), and 89.1% vs 80.1% (p = 0.029), respectively. Multivariate analysis showed that dose escalation was independent prognostic factor for LRFS (HR 0.386, 95% CI 0.163–0.909, p = 0.03).

Conclusion

DW-MRI-guided dose escalation is a feasible strategy to improve local control of patients with locally advanced NPC. The treatment-related complications are tolerable.

Expression of miR-34a and Ki67 in nasopharyngeal carcinoma and the relationship with clinicopathological features and prognosis

Expression levels of miR-34a and Ki67 in nasopharyngeal carcinoma (NPC) and the relationship with clinicopathological features and prognosis were studied. A prospective study was performed on 56 cases of NPC tissues and 56 cases of adjacent tissues collected in Xiangyang No. 1 People's Hospital. The expression levels of miR-34a, Ki67 in NPC and adjacent tissues were detected by RT-qPCR. The association among the expression levels of miR-34a and Ki67, the clinicopathological features and prognosis of patients was analyzed. The relative expression levels of miR-34a in 56 cases of NPC were lower than those of the adjacent tissues. The expression of miR-34a in NPC was significantly associated with bone metastasis and TNM staging (P<0.001). The relative expression of Ki67 in 56 cases of NPC was higher than that of the adjacent tissues. The expression of Ki67 in NPC was significantly associated with lymphatic metastasis and TNM staging (P<0.001). The 5-year survival of patients with low expression of miR-34a was significantly lower than that of patients with high expression, and the survival of patients with high expression of Ki67 was significantly lower than that of patients with low expression. According to Pearson's correlation analysis, Ki67 expression was negatively correlated with miR-34a expression in NPC tissues. In conclusion, the expression of Ki67 in NPC was upregulated, while the expression of miR-34a in NPC was downregulated. miR-34a expression in NPC was significantly associated with bone metastasis and TNM staging, and Ki67 expression in NPC was significantly associated with lymphatic metastasis and TNM staging. In addition, there was a negative correlation between miR-34a and Ki67 expression levels, and the two can be used as predictors of NPC-associated mortality. The expression levels of miR-34a and Ki67, as well as TNM staging were associated with the prognosis of NPC patients.