Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Li-Rong Wu, Ya-Tian Liu, Ning Jiang, Yan-Xin Fan, Jing Wen, Sheng-Fu Huang, Wen-Jie Guo, Xiu-Hua Bian, Fei-Jiang Wang, Feng Li, Dan Song, Jian-Feng Wu, Xue-Song Jiang, Ju-Ying Liu, Xia He
ObjectivesIntensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT.Materials and methodsData on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared.ResultsThe median follow-up duration was 112.7months (range, 7.6–156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome.ConclusionIMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.



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Masseteric Nerve for Gracilis Muscle Re-Innervation in Unilateral Facial Palsy: Impact on Quality of Life

Unilateral established or congenital facial palsies are usually treated with neuromuscular transplantation to reanimate the impaired side of the face. One of the most debated points is the motor nerve to choose for the reinnervation of the transplant. Contra-lateral healthy facial nerve is usually preferred, but in selected cases motor nerve to masseter is considered a valuable option. However only a few clinical studies focused on quality of life in this subset of patients are available in literature.

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The effect of early fusion of the spheno-occipital synchondrosis on midface hypoplasia and obstructive sleep apnea in patients with Crouzon syndrome

he investigators hypothesized that patients with Crouzon syndrome and premature fusion of the spheno-occipital synchondrosis (SOS) more often have, or have more severe midface hypoplasia and obstructive sleep apnea (OSA).

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Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors?

Salivary gland tumors occur very infrequently. In the Western world they have an annual incidence of 2.5–3 cases per 100,000 people. 1They are divided into major gland (parotid, submandibular and sublingual) and minor gland neoplasms. Histologically, this is a heterogeneous group of tumors, with several different patterns that often overlap, making differentiation between benign and malignant nature difficult.2, 3

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Taking the endochondral route to craniomaxillofacial bone regeneration: A logical approach?

The current golden standard for treatment of craniomaxillofacial critical size bone defects, autologous bone grafting,is associated with several disadvantages which have prompted an increased demand for alternatives. New solutions are emerging in the form of bone tissue engineering. This involves harvesting of multipotent mesenchymal stromal cells (MSCs), after which they can be differentiated towards the osteogenic lineage mimicking intramembranous bone formation. However, translating this approach from laboratory to clinic has met with limited success.

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Proposal for a new bone marker for maxillofacial surgery

The use of ink or dye to outline surgical approaches on the skin is common in plastic and reconstructive operations.1 However, marking bone with ink or dye before an osteotomy is difficult because of the need for irrigation. Some surgeons use burs, which we do not recommend, because it could compromise thin bones, it is time consuming, and irreversible.2

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Viral Reactivations and Associated Outcomes in Context of Immune Reconstitution after Pediatric Hematopoietic Cell Transplantation

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Rick Admiraal, Coco de Koning, Caroline A. Lindemans, Marc B. Bierings, Annemarie M.J. Wensing, A. Birgitta Versluys, Tom F.W. Wolfs, Stefan Nierkens, Jaap Jan Boelens
BackgroundViral reactivations (VR) following hematopoietic cell transplantation (HCT) contribute to significant morbidity and mortality. Timely immune reconstitution (IR) is suggested to prevent VR.ObjectivesWe studied the relation between IR (as a continuous over-time-predictor) and VR (as time-varying-predictor), and the relation between VR and other clinical outcomes.MethodsIn this retrospective analysis, all patients receiving a first HCT between January-2004 and September-2014 were included. IR (CD3/CD4/CD8 T-cells, NK- and B-cells) was measured bi-weekly until 12 weeks, and monthly thereafter. Main outcomes of interest were VR of adenovirus (AdV), Epstein-Barr-virus (EBV), human-herpesvirus 6 (HHV6), cytomegalovirus (CMV), and BK-virus, screened weekly. Clinical outcomes included overall-survival (OS), event-free-survival, non-relapse-mortality (NRM), and graft-versus-host-disease (GvHD). Cox-proportional-hazard- and Fine-Gray-competing-risk-models were used.Results273 patients (0.1-22.7 years; median follow-up 58 months) were included. Delayed CD4-reconstitution predicted reactivation of AdV (HR 0.995; p=0.022), EBV (HR 0.994, p=0.029), and HHV6 (HR 0.991, p=0.012), but not CMV (p=0.31) and BK (p=0.27). Duration of AdV-reactivation was shorter with timely CD4-reconstitution, defined as ≥50*10⁶ cells/L within 100-days. AdV-reactivation predicted lower OS (HR 2.17, p=0.0039) and higher NRM (HR 2.96, p=0.0008). Concomitant CD4-reconstitution abolished this negative effect of AdV-reactivation: OS (p=0.67) and NRM (p=0.64). EBV- and HHV6-reactivations were predictors for occurrence of GvHD, while CMV- and BK-reactivations did not predict clinical outcomes.ConclusionThese results stress the importance of timely CD4-reconstitution. Strategies to improve CD4-reconstitution may improve HCT-outcomes, including survival, and reduce the need for toxic anti-viral therapies.



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