Treatment Of Nasopharyngeal Cancer Research Articles

Radiation-Induced Maxillary Osteosarcoma and Synchronous Oropharyngeal Squamous Cell Cancer: A Rare Case Report

Radiotherapy is a treatment option for nasopharyngeal cancer. However, ionizing radiation may lead to development of secondary malignancies. In this case report, we will present a case of radiation-induced osteosarcoma of the maxilla and synchronous oropharyngeal squamous cell cancer following treatment of nasopharyngeal cancer. History, latency period, physical examinations, computed tomography, magnetic resonance imaging and biopsy results are provided. Diagnosis was confirmed by excision biopsy. Radiation-induced tumors are possible long-term side effects of radiotherapy. Although rare and possible to confuse with recurrent disease, this possibility should be considered in any patient who has received radiation therapy. Diagnostic imaging plays a pivotal role in recognition of radiation induced neoplastic disease. Accurate identification and reporting of key imaging findings allows referring physicians to choose the most appropriate treatment options.

Gemcitabine monotherapy in patients with heavily treated nasopharyngeal cancer: a case series.

Although gemcitabine is thought to play a critical role in the treatment of nasopharyngeal cancer, no research to evaluate the efficacy and toxicity of gemcitabine monotherapy has been conducted in Japan. We retrospectively reviewed eight nasopharyngeal carcinoma patients treated with gemcitabine monotherapy at National Cancer Center Hospital East between May 2015 and August 2016. The main eligibility criteria were (1) histopathologically proven NPC; (2) tumor recurrence or an initial M1 TNM stage diagnosis; (3) at least two other types of systemic chemotherapy prior to gemcitabine; (4) no other active malignant tumor during treatment. All patients were administered gemcitabine 800-1000mg/m2 on days 1, 8, and 15, repeated every 4weeks. Gemcitabine was given as third-line systemic chemotherapy in six (74%) patients, as fourth-line in one (13%) and as fifth-line in one (13%). One patient had a complete response and one had a partial response, giving an overall response rate of 25%; four patients (50%) had stable disease and two (25%) experienced disease progression. The main toxicity was myelosuppression, with grade 3 leukopenia in three (38%) patients and neutropenia in four (50%). There were no treatment-related deaths. Median dose intensity and relative dose intensity of gemcitabine were 620mg/m2/week and 97.5%, respectively. Our findings suggest that GEM monotherapy is well tolerated and has potential as an active agent in Japanese patients with recurrent/metastatic NPC who have been heavily pretreated.

Effects of S-1 combined with radiotherapy in the treatment of nasopharyngeal cancer: a meta-analysis based on randomized controlled trials

The aim of this meta-analysis was to evaluate the effects and toxicity of S-1 combined with radiotherapy in the treatment of nasopharyngeal cancer (NPC). Through a search of the databases of PubMed, Embase, the Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang system and Chongqing VIP Information (CQVIP), the efficacy and side effects data of S-1 combined with radiotherapy in the treatment of NPC patients from open published randomized controlled trials (RCTs) were collected. The pooled complete response (CR), partial response (PR), objective response rate (ORR), 2-year survival rate and treatment related toxicity were analyzed by Stata12.0 software. Eight RCTs with 599 cases were included and analyzed in this meta-analysis. The general quality of the 8 studies were deemed as having moderate risk of bias. Adequate sequence generation was reported in 4 studies. Incomplete outcome data address was reported in 7 publications. Five studies indicated to be free of selective reporting. Seven studies reported the treatment complete response (CR) between S-1 combined with radiotherapy and radiotherapy alone. With significant heterogeneity, the data was pooled by random effect model. The pooled results indicated that S-1 combined with radiotherapy can significant increase the CR rate compared to radiotherapy alone (RR=1.52, 95%CI:1.33-1.74, P<0.05). Eight studies reported the partial response (PR) rate between the combined treatment and radiotherapy alone. The pooled results showed that there was no statistical difference for PR between combined treatment and radiotherapy alone (RR=0.85, 95%CI:0.62-1.16, P>0.05). For the effect size of objective response rate (ORR), pooled results indicated that S-1 combined with radiotherapy can significantly increased the ORR by random effect model (RR=1.39, 95%CI:1.23-1.57, P<0.05). The pooled results showed that S-1 combined with radiotherapy significant increase the risk of developing bone marrow suppression (RR=1.94, 95%CI:1.40-2.69, P<0.05) and gastrointestinal reaction (RR=1.81, 95%CI:1.38-2.38, P<0.05) with fixed effect model. However, the pooled oral mucositis (RR=1.22, 95%CI:0.99-1.50, P>0.05) and radiodermatitis (RR=0.93, 95%CI:0.77-1.12, P<0.05) were not statistically different. Two studies reported the 2-year survival rate between the two groups. The pooled results showed the combined treatment significantly increased the 2-year survival rate for patients with nasopharyngeal carcinoma (RR=1.14, 95%CI:1.01-1.28, P<0.05). The funnel plot demonstrated significant publication bias for complete response, partial response, objective response rate and oral mucositis. The egger’s line regression test indicated significant publication bias for complete response (t=5.98, P=0.002) and objective response rate(t=6.23, P=0.003). Conclusion S-1 combined with radiotherapy can significant improve the clinical efficacy with more treatment related toxicity compared to radiotherapy alone in the treatment of nasopharyngeal carcinoma.

PO-075: Treatment of nasopharyngeal cancer: a Serbian institututinal experience

PO-075: Treatment of nasopharyngeal cancer: a Serbian institututinal experience

Radiotherapy of nasopharyngeal cancer using Rapidarc: dosimetric study of military teaching hospital Mohamed V, Morocco

BackgroundThe aim of the present study is to assess efficacy and efficiency of Volumetric-modulated arc therapy (VMAT) technique in treatment of nasopharyngeal cancer in our institution and to report toxicity related to this technique.MethodsBetween June 2013 and January 2015, thirty-two patients with non metastatic nasopharyngeal cancer were curatively treated using VMAT Rapidarc. Dose prescription was performed using two different schedules, it consisted of either simultaneous integrated boost or simultaneous modulated accelerated radiation therapy delivering 70 Gy in 35 fractions and 69.96 in 33 fractions respectively. The choice was leaved at the discretion of the treating physician. The optimization process was performed by Eclipse software version 10.0 (Varian Medical Systems), using PRO algorithm (Progressive resolutive optimisation) version 3. Data was collected from dose-volume histograms for both planning target volumes (PTV) and organs at risk (OAR). We calculated the homogeneity index and the conformity index as well as the number of monitor units MU and the treatment delivery time. We also reported acute and late toxicity related to radiation therapy.ResultsFor the PTV high risk (HR), intermediate risk (PTV IR) and low risk (LR) the D95% was 97.21 ± 1.5, 97.5 ± 3.3 and 97.10 ± 6.86 respectively. Whereas, The D5% was 104.6 ± 2.16, 103.8 ± 2.1 and 100.89 ± 7.26. The CI for PTV HR was 0.98 ± 0.02 and the HI was 0.08 ± 0.02. The mean treatment delivery time was 2.3 ± 0.2, and the mean MU number was 527.6 ± 131.4. Grade 4 toxicity was not reported in any case. Grade 3 xerostomia was observed in only 3(9.4%) patients and no patients developed grade 3 hearing loss.ConclusionOur results confirmed the abilities of VMAT to provide excellent coverage of target volumes while sparing OAR especially the nervous structures and salivary glands.

CXCR4 knockdown inhibits the growth and invasion of nasopharyngeal cancer stem cells.

Nasopharyngeal cancer is a type of malignant tumor with a high rate of incidence. Cancer stem cells are regarded as one of the main causes for the formation and recurrence of nasopharyngeal cancer. CXC chemokine receptor type 4 (CXCR4) has been reported to perform an important role in cancer; however, the association between CXCR4 and nasopharyngeal cancer stem cells remains unclear. The present study explored the effect of CXCR4 on cellular viability, apoptosis and invasion of nasopharyngeal cancer stem cells. Results of the present study demonstrated that knockdown of CXCR4 inhibited the viability and invasion of nasopharyngeal cancer stem cells and promoted cellular apoptosis. Further studies have revealed that the anti-tumor effect of CXCR4 knockdown was associated with the inhibition of the protein kinase B signal. These results demonstrate that the knockdown of CXCR4 resulted in an anti-tumor effect in nasopharyngeal cancer stem cells. Therefore, CXCR4 may become a promising therapeutic target in the treatment of nasopharyngeal cancer.

Prognostic value of claudin-4, nm23-H1, and MIB-1 in undifferentiated nasopharyngeal carcinoma

Nasopharyngeal cancer (NPC) is a tumor of epithelial origin with complex etiology, and it is one of the most confusing, commonly misdiagnosed, and poorly understood diseases. Currently, the standard treatment for NPC is radiotherapy, but therapy failure is quite common, making radioresistance an important issue. Claudin-4 is a major tight junction protein that regulates the integrity and function of tight junctions. Aberrant expression of claudin-4 has been shown in various carcinomas with diverse prognostic implications. Ki-67 as a maker of cell proliferation and nm23-H1 as a metastasis marker have been widely used by many studies to indicate their close relationship with the progression and prognosis in many tumors. However, little is known about their prognostic values in undifferentiated NPC. The aim of this study was to evaluate the immunohistochemical staining of claudin-4, nm23-H1 protein, and Ki-67 in human undifferentiated NPC, and the relationship between claudin-4, nm23-H1, and Ki-67 expressions and both metastasis and prognosis of patients with undifferentiated NPC. The results were correlated with sex, age, extent of tumor, lymph node status, the presence or absence of distant metastasis, and patient survival. Low claudin-4 expression, low nm23-H1, and high Ki-67 expression were associated with distant metastasis and poor survival. Claudin-4 may be a novel biomarker for the prediction of distant metastasis and unfavorable prognosis in NPC, especially when combined with nm23-H1 and Ki-67.

AHNS Series - Do you know your guidelines? Principles of treatment for nasopharyngeal cancer: A review of the National Comprehensive Cancer Network guidelines.

This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for the management of nasopharyngeal cancer are reviewed here in a systematic fashion. These guidelines outline the workup, treatment and surveillance of patients with nasopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck 39: 201-205, 2017.

Evaluating environment radiations at Axesse linac undergoing NPC treatment of VMAT

Environment radiations in vault rooms resulting from Axesse linac use was assessed at Medical University Hospital using Thermoluminescent dosimeters (TLDs) during the use of the new radiation treatment known as volumetric modulated arc therapy (VMAT) in the treatment of nasopharyngeal cancer (NPC). The TLD-100H was calibrated using linac 6 MV photons. A total of 75 measurement points of the TLD-100H were utilized for environmental monitoring. The measured environment radiations were then visualized as three-dimensional graphical representations. Environment radiations were visualized using colored three-dimentional graphical representations. The radiations in NPC treatment of Rando phantom was found to reach levels up to 370 mSv/treatment. Many researchers consider TLD, which is the most cost-effective method to environment radiations. The minimum detectable dose (MDD) was also identified to demonstrate the reliability of the TLD approach. Quantitative results that provide practical guidance with regarded radiation protections. Potentially hazardous of secondary radiations from the operating linac is evaluated with regard to its potential health effects on both patients and the public.KEY POINTSThis work tried to evaluate the environment radiation and minimal detectable limit of TLD inside the LINAC maze.

Development of a Multi-Channel Concentric Tube Robotic System With Active Vision for Transnasal Nasopharyngeal Carcinoma Procedures

Minimally invasive surgery-based nasopharyngeal cancer treatment is promising, but currently, it is not a common treatment choice because of the absence of suitable tools. In this letter, a multi-channel concentric tube robot is proposed for the treatment of nasopharyngeal cancer based on natural orifice translumenal endoscopic surgery. The proposed system has three channels, i.e., two manipulation channels and one vision channel, and all the three channels are confined by a 10 mm active sheath. The robot is controlled by human-in-the-loop bimanual teleoperation under active endoscopic guidance. The reduced sheath diameter and the steerable vision channel improve the functionality of the system and distinguish our design from the prior art. The feasibility of the system has been evaluated through a series of simulations and experiments. Results show that the proposed system is capable to conduct cooperative tasks in a confined space and the miniaturized manipulator is suitable for transnasal procedures. Besides, comparisons with other types of flexible surgical robots are discussed to further demonstrate the superiority of the proposed system in the target clinical applications.

Treatment outcome of nimotuzumab plus chemotherapy in advanced cancer patients: a single institute experience.

Nimotuzumab is a humanized anti-EGFR IgG1 monoclonal antibody and demonstrates a better safety profile than other anti-EGFR antibodies due to its intermediate affinity. Since it was approved in China for the treatment of nasopharyngeal cancer (NPC), it has been widely used in NPC and in many clinical trials for other cancer types. However, the optimal dose and administration frequency of nimotuzumab that should be used and which kind of cancer patients will be more benefited from nimotuzumab is still unknown. In this retrospective study, 205 advanced cancer patients with colorectal cancer, esophageal cancer, head and neck cancer, gastric cancer, non-small cell lung cancer, or other cancers from mainland China, treated with nimotuzumab in combination with chemotherapy, were enrolled. Over 60% of these patients received nimotuzumab > 6 doses and ≥ 400 mg/week as maintenance therapy. It was well tolerated in real-life patients. This report demonstrates that age, sex and previous treatment might be potential predictive factors for survival, and patients received nimotuzumab > 6 doses and > 200 mg/week might benefit more from nimotuzumab therapy. Using these factors for stratification analysis may form a predictive differential clinical strategy for nimotuzumab to maximize the benefit in patients with different epithelial tumors.

Phase I/II Trial Evaluating Carbon Ion Radiotherapy for Salvaging Treatment of Locally Recurrent Nasopharyngeal Carcinoma.

Background: Radiation therapy is the mainstay strategy for the treatment of nasopharyngeal cancer (NPC). Intensity-modulated X-ray therapy (IMXT) alone is the current standard for stage I and II NPC. For stage III and IV A/B diseases, concurrent chemotherapy should be provided in addition to IMXT. However, optimal treatment for locally recurrent NPC after previous definitive dose of radiotherapy is lacking. Various techniques including brachytherapy, IMXT, stereotactic radiosurgery or radiotherapy (SRS or SBRT) have been used in the management of locally recurrent NPC. Due to the inherent limitation of these techniques, i.e., limited range of irradiation or over-irradiation to surrounding normal tissues, moderate efficacy has been observed at the cost of severe toxicities. Carbon ion radiotherapy (CIRT) offers potential physical and biological advantages over photon and proton radiotherapy. Due to the inverted dose profile of particle beams and their greater energy deposition within the Bragg peak, precise dose delivery to the target volume(s) without exposing the surrounding organs at risk to extra doses is possible. In addition, CIRT provides an increased relative biological effectiveness (RBE) as compared to photon and proton radiotherapy. Such advantages may translate to improved outcomes after irradiation in terms of disease control in radio-resistant and previously treated, recurrent malignancies. It is therefore reasonable to postulate that recurrent NPC after high-dose radiotherapy could be more resistant to re-irradiation using photons. Reports on the treatment of radio-resistant malignancies in the head and neck region such as melanoma, sarcoma, and adenoid cystic carcinoma (ACC) have demonstrated superior local control rates from CIRT as compared to photon irradiation. Thus patients with recurrent NPC are likely to benefit from the enhanced biological effectiveness of carbon ions. As effective retreatment strategy is lacking for locally recurrent NPC, carbon ion radiation therapy offers an ideal alternate to conventional X-ray irradiation.Methods and Design: The recommended dose of re-irradiation using CIRT for locally recurrent NPC will be determined in the dose-escalating phase (Phase I) of the study. Efficacy in terms of local progression-free survival (LPFS) and overall survival (OS) will be studied in the second phase of the study. Increasing doses of CIRT using raster scanning technology from 55GyE (22×2.5 GyE) to 65 GyE (26× 2.5 GyE) will be delivered in the Phase I part of the study. The primary endpoint of the Phase I part of the study is acute and sub-acute toxicities; the primary endpoint in the Phase II part is local progression-free survival and overall survival. Using the historical 2-year OS rate of 50% in locally recurrent NPC patients treated with photon or proton, we hypothesize that CIRT can improve the 2-year OS rate to 70%.Discussion: The utilization of conventional radiation techniques including IMXT, brachytherapy, or stereotactic radiation therapy provides moderate efficacy in the treatment of locally recurrent NPC due to the limitations in dose distribution and biological effectiveness. Improved outcome in terms of treatment-induced toxicity, LC, LPFS, and OS are expected using CIRT due to the physical and biological characteristics of carbon ion beam. However, the recommended dose of CIRT used in re-irradiation for the local NPC focus remain to be determined. The recommended dose as well as the efficacy of CIRT in the treatment of locally recurrent NPC will be evaluated in the present trial.

LONG-TERM RESULTS OF NASOPHARYNGEAL CARCINOMA TREATMENT (BASED ON THE ANALYSIS OF CASES FROM CANCER REGISTRY OF N.N. BLOKHIN RUSSIAN CANCER RESEARCH CENTER DURING 1980–2010)

Data on 573 patients with nasopharyngeal carcinoma registered for treatment in N.N. Blokhin Russian Cancer Research Center in 1980–2010 was used for the analysis. The study revealed high rate of late-stage diagnosis of nasopharyngeal carcinoma (82.9 %), low cancer suspicion, poor diagnostics in general practice (73.2 %). Active screening for nasopharyngeal carcinoma is virtually absent in Russia. According to the study results, combined radiotherapy is an optimal method for nasopharyngeal cancer treatment; chemoradiotherapy with platinum drugs, doxorubicin, bleomycin combined with hyperfractionated radiotherapy is preferable for treatment of locally advanced and reginal tumors.

P2-9-3 - Combined modality treatment of Nasopharyngeal cancer with IMRT& Concurrent/Adjuvant Chemotherapy-First report from Nepal

P2-9-3 - Combined modality treatment of Nasopharyngeal cancer with IMRT& Concurrent/Adjuvant Chemotherapy-First report from Nepal

Abstract 1734: Preclinical study of HSP-90 inhibitor drug, AUY922 showed good efficacy in treatment of nasopharyngeal cancer

Abstract Introduction: Prognosis of patients with metastatic or recurrent nasopharyngeal cancer (NPC) is usually poor. Despite some good response to chemotherapy by cisplatin-containing regimen, long term remission in NPC patients is not common. Response rate to second line drug after failing cisplatin is poor. Heat shock protein-90 (HSP-90) is a molecular chaperone essential to the folding of a wide variety of oncogenic client proteins. Inhibition of HSP-90 can lead to a combinatorial blockage of signal transduction leading to cancer cell death. Here, we reported a successful preclinical study showing good efficacy of an anti-HSP-90 drug, AUY922 in treating NPC in cell culture in vitro and xenograft model in vivo in nude mice. Experimental Design: WST assay was used to determine the growth inhibitory dose of AUY922 in 3 NPC cell lines (C666, HONE1 &amp; CNE2) and 2 cisplatin resistant NPC cell lines (HONE1-EBV-Cisp-Res &amp; HK1-LMP1-Cisp-Res). Subcutaneous NPC xenografts was treated by AUY922 i.p. to examine tumor growth inhibition. DNA flow cytometric analysis (DNA-FCM) and Yo-Pro staining were carried out to analyze the effect of AUY922 in cell cycle progression and apoptosis. RT-PCR and Western blotting were performed to examine the effects of AUY922 in regulating Epstein-Barr virus (EBV) gene transcripts and kinase pathway phosphorylation respectively. Results: AUY922 (at GI-50 of 22 nM for C666) could effectively induce tumor growth inhibition in all the 3 NPC cell lines with 300-900 and 180-2700 folds of higher sensitivity than cisplatin or 5-FU. NPC xenograft regression was accomplished by AUY922 treatment at 35-65 mg/kg alone with additive effect when combined with cisplatin. Importantly, AUY922 was also growth inhibitory in the 2 cisplatin resistant NPC cell lines in vitro or in vivo hinting its potential use in the clinical setting in patients refractory to cisplatin. By DNA-FCM, AUY922 could induce prominent G2 cell cycle phase arrest and sub-G1 apoptotic peak at 60 nM (with low level of early apoptosis by YoPro staining). &amp;gt;95% NPC patients in Hong Kong are EBV positive. AUY922 can dramatically induce the expression of 2 EBV transcripts - BZLF1 (for viral lytic cycle) and LMP2A (associated with cytotoxic T cell lysis) indicating its potential in facilitating tumor lysis through these processes. Western blot delineated substantial regulation of phosphorylation in AKT, mTOR, GSK-3-beta, NF-KappaB, IKK-alpha/beta and IKB-alpha pathways but not in CREB, p38 and PARP pathways. Conclusion: The findings of this preclinical study clearly showed the good potential of this HSP90 inhibitor drug, AUY922 in NPC treatment. Ethics approval is pending to initial clinical trials of AUY922 in patients with metastatic/locally recurrent NPC in Hong Kong. Citation Format: Timothy T.C. Yip, Roger K.C. Ngan, Wai-Tong Ng, Lewis T.C. Chan, William C.S. Tai, Wai-Wai Cheng, Victor W.S. Ma, Kwok-Wai Lo, Ya-Ping Li, Michael B.H. Yang, Eric C.H. Wong, Brigette B.Y. Ma, Nai-Ki Mak, George S.W. Tsao, Maria Li-Lung. Preclinical study of HSP-90 inhibitor drug, AUY922 showed good efficacy in treatment of nasopharyngeal cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1734. doi:10.1158/1538-7445.AM2015-1734

Abstract 3903: Differential transcript expression in nasopharyngeal carcinoma by cDNA microarray analysis

Abstract By cDNA microarray, gene expression profiling was carried out in 360 paired tumor &amp; normal biopsies from 60 nasopharyngeal cancer (NPC) patients at 3 time points, namely, at diagnosis of NPC, on treatment with an anti-inflammatory drug, Celecoxib (Celec) and on radiotherapy (RT). We found 1 cluster of 82 transcripts with statistically significant difference in expression between tumor &amp; normal tissues at diagnosis, a second cluster of 214 tumor versus normal transcripts on Celec treatment and finally a third cluster of 202 tumor versus normal transcripts on RT. Differential expression of selected tumor associated transcripts was confirmed by RT-PCR. These include 8 tumor up-regulated transcripts with 3 encoding for immunological/inflammatory molecules, IL8, CXCL9 &amp; CXCL10, 1 matrix metallopeptidase, MMP12, which breaks down extracellular matrix and thus is associated with cancer metastasis, 1 osteonectin protein which is involved in cell shape changes and thus related to cancer invasion, SPARC, 1 bone morphogenic protein with a role in tissue differentiation, GREM1, 1 GTPase-activating protein for phorbol ester receptor, CHN1 and a sorting nexin family member with a role in intracellular trafficking, SNX10. Genes which were prominently down-regulated in tumor were a variety of polymorphic xenobiotic detoxification enzyme genes or genes with antioxidant function (e.g. GSTA1, GSTA2, GSTA3, CYP4B1, ALDH1A1, ADHFE1, MAOB, NQO1 &amp; OAT). Many genes were also down-regulated by RT in tumor tissues and one notable example was TOP2A which encodes topoisomerase 2A involving in chromosome condensation &amp; chromatid separation during DNA replication, CLDN1 which has tight junction adhesion function, ANLN which is required for cytokinesis, and STMN1 which can regulate microtubule filament. These genes had good potential in applying for clinical applications in diagnosis or treatment of NPC in the future. Further exploration of the clinical applications of these genes is underway. Citation Format: Timothy T.C. Yip, Dora L.W. Kwong, Roger K.C. Ngan, Cadmon K.P. Lim, Wai-Wai Cheng, Victor W.S. Ma, Stephen C.K. Law, Loretta Tse. Differential transcript expression in nasopharyngeal carcinoma by cDNA microarray analysis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3903. doi:10.1158/1538-7445.AM2015-3903

Olfactory change after intensity-modulated radiotherapy for nasopharyngeal carcinoma.

Radiotherapy is the mainstay of treatment for nasopharyngeal cancer (NPC), but many side effects were reported in NPC patients receiving radiotherapy. This study was conducted to evaluate the long-term effects of intensity-modulated radiotherapy (IMRT) on olfactory function. The olfactory function of 41 NPC patients was assessed by a traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC). The patients also filled out a Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22) questionnaire and received imaging examinations of the sinuses before IMRT and 1 year after IMRT. The sinus imaging was scored according to the Lund-Mackay system. The mean UPSIT-TC scores were 30.6 before IMRT and 28.0 after IMRT and the decrease in UPSIT-TC scores was significant (p = 0.001). The mean TWSNOT-22 scores were 32.1 before IMRT and 28.8 after IMRT. The change in TWSNOT-22 scores was not significant, but the scores for item 5 "loss of smell or taste" significantly increased after IMRT (p = 0.035). The mean total computed tomography (CT) scores were 1.7 before IMRT and 3.2 after IMRT, and the mean ethmoid CT scores were 0.5 before IMRT and 1.2 after IMRT. The increase in total CT and ethmoid CT scores was both significant (p = 0.004 and 0.002). The decrease in UPSIT-TC scores was moderately negatively correlated with the increase in total CT and ethmoid CT scores (r = -0.348 and -0.423). Our results showed that the olfactory function of NPC patients was mildly impaired after IMRT, which can cause rhinosinusitis.

Nasal cytological changes as late effects of radiotherapy for nasopharyngeal cancer.

Radiation therapy is a cornerstone in nasopharyngeal cancer treatment. However, it can induce acute and long-term adverse effects, such as acute mucositis and late submucosal fibrosis. Late toxicities could not only affect submucosa but also mucosal cells, determining long-term cytological changes. Evaluation of delayed nasal cytological alterations in patients who underwent radiation therapy for nasopharyngeal carcinoma (NPC). In this case-control study, we analyzed 30 healthy subjects and 30 patients treated with chemotherapy and radiotherapy for NPC between 2003 and 2011, with a median follow-up of 59 months. All subjects underwent symptoms anamnestic evaluation (rhinorrea, nasal obstruction), endoscopic fiber optic nasal examination, skin-prick tests, and nasal scraping for cytological exam. A higher percentage of rhinorrhea, nasal obstruction, mucosal hyperemia, and presence of nasopharyngeal secretions at fiber optic endoscopic exam was found in radiated subjects (p < 0.05). Nasal cytology analysis demonstrated a higher percentage of neutrophilic inflammation and squamous cell metaplasia and mucous cell metaplasia in treated patients (p < 0.05). No cytological atypia was seen. No statistically significant correlation between nasal cytological changes and objective findings, patients' age, tobacco smoking, and gastroesophageal reflux has been found in the radiotherapy group (p > 0.05). Radiation therapy induces late nasal mucosal changes, which may be related to clinical consequences, such as abundant mucus production and its consequent endonasal stagnation. In the future, detailed knowledge of cytological changes in patients' nasal mucosa could represent a key prerequisite for the choice of effective interventions for late radiation-induced rhinitis.

Traditional herbal medicine as adjunctive therapy for nasopharyngeal cancer: a systematic review and meta-analysis.

The effectiveness of traditional herbal medicine (THM) as treatment for nasopharyngeal cancer (NPC) has not been clearly demonstrated. The aim of this study is to assess the effectiveness of THM as adjunctive therapies for NPC using the results of randomized controlled trials (RCTs). Five electronic databases, including English and Chinese databases, were systematically searched up to February 2014. All RCTs involving traditional herbal medicine in combination with conventional cancer therapy for NPC were included. Twenty-two RCTs involving 2,298 NPC patients were systematically reviewed. Of these 22 studies, 15 on 1482 patients reported a significant increase in the number surviving patients with survivals of more than 1, 3, or 5 years. Seven studies on 595 patients reported a significant increase in immediate tumor response, and three studies on 505 patients reported a significant decrease in distant metastasis. This meta-analysis of 22 studies suggests that THM combined with conventional therapy can provide an effective adjunctive therapy for NPC. More research and well-designed, rigorous, large clinical trials are required to address these issues.

PO-066: Impact of intensity-modulated radiotherapy in the treatment of nasopharyngeal cancer: single center experience

PO-066: Impact of intensity-modulated radiotherapy in the treatment of nasopharyngeal cancer: single center experience