Induction plus adjuvant chemotherapy, combined treatment with nimotuzumab, and intensity-modulated radiation therapy for N3 stage nasopharyngeal carcinoma: A pilot study

Adjuvant chemotherapy or no adjuvant chemotherapy? A prediction model for the risk stratification of recurrence or metastasis of nasopharyngeal carcinoma combining MRI radiomics with clinical factors

BACKGROUND

Dose adjuvant chemotherapy (AC) should be offered in nasopharyngeal carcinoma (NPC) patients? Different guidelines provided the different recommendations.

METHODS

In this retrospective study, a total of 140 patients were enrolled and followed for 3 years, with 24 clinical features being collected. The imaging features on the enhanced-MRI sequence were extracted by using PyRadiomics platform. The pearson correlation coefficient and the random forest was used to filter the features associated with recurrence or metastasis. A clinical-radiomics model (CRM) was constructed by the Cox multivariable analysis in training cohort, and was validated in validation cohort. All patients were divided into high- and low-risk groups through the median Rad-score of the model. The Kaplan-Meier survival curves were used to compare the 3-year recurrence or metastasis free rate (RMFR) of patients with or without AC in high- and low-groups.

RESULTS

In total, 960 imaging features were extracted. A CRM was constructed from nine features (seven imaging features and two clinical factors). In the training cohort, the area under curve (AUC) of CRM for 3-year RMFR was 0.872 (P <0.001), and the sensitivity and specificity were 0.935 and 0.672, respectively; In the validation cohort, the AUC was 0.864 (P <0.001), and the sensitivity and specificity were 1.00 and 0.75, respectively. Kaplan-Meier curve showed that the 3-year RMFR and 3-year cancer specific survival (CSS) rate in the high-risk group were significantly lower than those in the low-risk group (P <0.001). In the high-risk group, patients who received AC had greater 3-year RMFR than those who did not receive AC (78.6% vs. 48.1%) (p = 0.03).

CONCLUSION

Considering increasing RMFR, a prediction model for NPC based on two clinical factors and seven imaging features suggested the AC needs to be added to patients in the high-risk group and not in the low-risk group.

Continuous cement leakage along the posterior longitudinal ligament of the intraspinal epidural during a percutaneous vesselplasty: A case report and literature review

Objective

This study aims to report one case of intraspinal epidural cement leakage caused by a novel percutaneous vesselplasty.

Methods

A clinical case report from the Orthopedic center of our hospital and a literature review. A 63-year-old woman with an L₂ osteoporotic compression fracture underwent novel kyphoplasty, percutaneous vesselplasty. This rare complication was evaluated through a literature search, and its special types are classified in more detail.

Results

The patient was hospitalized with low back pain two weeks after a fall. After auxiliary examination, a new type of percutaneous vesselplasty was performed. After the intraoperative injection of bone cement, bone cement leakage extended along the posterior longitudinal ligament and epidural space. There were no special compression symptoms of the spinal cord, and the prognosis of conservative treatment was good.

Conclusion

Although percutaneous vesselplasty is relatively safe and frequent, intraspinal leakage may occur, so sufficient preoperative evaluation, intraoperative continuous fluoroscopic monitoring, and timely evaluation of postoperative images are extremely necessary.

Comparison Efficacy and Safety of Gemcitabine plus Cisplatin and 5-Fluorouracil plus Cisplatin for Metastatic Nasopharyngeal Carcinoma: A Meta-Analysis and Systematic Review

Objective

To compare the efficacy and safety of gemcitabine plus cisplatin (GP) and 5-fluorouracil plus cisplatin (PF) for metastatic nasopharyngeal carcinoma.

Methods

The clinical trials of GP and PF in the treatment of metastatic nasopharyngeal carcinoma (NPC) were searched in PubMed, EMBASE, Cochrane Library, and Web of Science. The literature search met the inclusion and exclusion criteria. The software Revman 5.4 was used for data analysis, and STATA 15.0 was used for publication bias.

Results

10 studies were included in this meta-analysis. The results showed that the GP group had a higher clinical remission rate than the PF group (RR = 1.22, 95% CI (1.03–1.44), P=0.02, P=0.02). GP and PF groups in OS, PFS, and DMFS had the same effect at 1, 2, and 3 years (OS at 1 year: RR = 1.04, 95% CI (0.95–1.15), P=0.37, P=0.37; 2 years: RR = 1.08, 95% CI (0.94 1.23), P=0.28, P=0.28; 3 years: RR = 1.07, 95% CI (0.89 1.29), P=0.46; PFS at 1 year: RR = 1.98, 95% CI (0.29 13.44), P=0.49; 2 years: RR = 3.09, 95% CI (0.10 97.55), P=0.52; 3 years: RR = 0.95, 95% CI (0.73 1.24), P=0.71; DMFS at 1 year: RR = 1.01, 95% CI (0.90–1.14), P=0.83; 3 years: RR = 1.10, 95% CI (0.85–1.41), P=0.47. The number of hematological adverse reactions occurred in GP group was higher than the PF group.

Conclusion

The GP and PF groups had similar OS, PFS, and DMFS, but the GP group had a higher clinical remission rate. Therefore, GP may be the first choice for metastatic NPC.