Recurrent Nasopharyngeal Carcinoma Patients Research Articles

Radiation-induced nasopharyngeal ulcers after re-irradiation with intensity-modulated radiotherapy in locoregional recurrent nasopharyngeal carcinoma patients: a dose-volume-outcome analysis.

To analyze the interrelation between radiation dose and radiation-induced nasopharyngeal ulcer (RINU) in locoregional recurrent nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Clinical data were collected from 363 patients with locoregional recurrent NPC who received re-irradiated with definitive IMRT from 2009 to 2017. Twenty-nine patients were diagnosed with RINU. Univariate and multivariate analyses were used to re-evaluate the first and second radiotherapy plans and to identify predictive dosimetric factors. All dosimetric parameters were notably associated with the progression to RINU (p < 0.01) using paired samples Wilcoxon signed rank tests. Multivariate analysis showed that EQD2_ [Formula: see text]D80 (dose for 80 percent volume of the unilateral nasopharynx lesion) was an independent prognostic factor for RINU (p = 0.001). The area under the ROC curve for EQD2_ [Formula: see text]D80 was 0.846 (p < 0.001), and the cutoff point of 137.035Gy could potentially be the dose tolerance of the nasopharyngeal mucosa. The sum of equivalent dose in 2Gy fractions (EQD2) in the overlapping volumes between initial and re-irradiated nasopharyngeal mucosal tissue can be effective in predicting the hazard of developing RINU in NPC patients undergoing radical re‑irradiation with IMRT and we propose a EQD2_ [Formula: see text]D80 threshold of 137.035Gy for the nasopharynx.

Camrelizumab plus famitinib in patients with recurrent or metastatic nasopharyngeal carcinoma: Data from an open-label, multicenter phase II basket study.

e18031 Background: Immune-checkpoint inhibitor (ICI) in combination with antiangiogenic therapy have the potential for synergistic activity. We report the results of camrelizumab plus famitinib for the treatment of recurrent or metastatic, ICI-resistant nasopharyngeal carcinoma (NPC) from an open-label, multicenter, phase II basket trial. Methods: Patients (pts) with histologically confirmed recurrent or metastatic NPC (nonkeratinizing carcinoma, WHO type II-III), who had been treated with platinum-based chemotherapy and ICIs (≤2 lines of systemic treatment), were enrolled to receive camrelizumab (200 mg intravenously every 3 weeks) and famitinib (20 mg orally once daily). Primary endpoint was objective response rate (ORR) per RECIST version 1.1, and secondary endpoints included duration of response (DoR), disease control rate (DCR), time to response (TTR), progression-free survival (PFS), overall survival (OS) and safety. Results: Between Oct 23, 2020, and Sep 24, 2021, 15 recurrent or metastatic NPC pts were enrolled. Among them, 12 (80.0%) and 3 (20.0%) pts had received their prior 1st-line and 2nd-line treatment, respectively. All pts were pretreated with anti-PD-1/PD-L1 immunotherapy (toripalimab, n = 9; tislelizumab, n = 4; sintilimab, n = 1; pembrolizumab, n = 1). As of Nov 30, 2021, median time from enrollment to data cutoff was 6.3 months (range, 2.2-13.3). No pt had a complete response, 5 (33.3%) pts had a confirmed partial response, 7 (46.7%) pts had stable disease, 2 (13.3%) pts had progressive disease and 1 (6.7%) pt was not evaluable. The ORR was 33.3% (95% confidence interval [CI], 11.8-61.6), the DCR was 80.0% (95% CI, 51.9-95.7). Most pts (73.3%) experienced reduction in target lesion size from baseline, with a median change of -36.0%. The median DoR was 4.2 months (95% CI, 2.1-not reached [NR]), median PFS was 6.3 months (95% CI, 4.1-NR), and median OS has not been reached. Treatment-related adverse events (TRAEs) of grade 3 or higher were reported in 7 (46.7%) pts, mainly decreased platelet count (13.3%), decreased neutrophil count (13.3%) and palmar-plantar erythrodysaesthesia syndrome (13.3%). Treatment interruption and discontinuation due to TRAEs occurred in 11 (73.3%) and 1 (6.7%) pts, respectively. Five (33.3%) pts had serious TRAEs (grade 2 platelet count decreased, grade 2 pharyngeal necrosis, grade 2 pulmonary tuberculosis, grade 3 left ventricular dysfunction, grade 3 pharyngeal hemorrhage; n = 1 for each), and no treatment-related death was reported. Conclusions: Camrelizumab plus famitinib showed encouraging antitumor activity in recurrent or metastatic NPC patients who were resistant to ICI treatment, with an acceptable and manageable safety profile. This combination might provide a novel alternative treatment strategy in this challenging disease setting and support further investigation. Clinical trial information: NCT04346381.

Establishment and validation of a recursive partitioning analysis based prognostic model for guiding re-radiotherapy in locally recurrent nasopharyngeal carcinoma patients

ObjectiveIn this study, we aimed to establish and validate an integrated prognostic model for locally recurrent nasopharyngeal carcinoma (lrNPC) patients, and evaluate the benefit of re-radiotherapy (re-RT) in patients with different risk levels. Materials and methodsIn total, 531 patients with lrNPC were retrospectively reviewed in this study, including 271 patients from 2006 to 2012 as the training cohort and 260 patients from 2013 to 2016 as the validation cohort. Overall survival (OS) was the primary endpoint. Multivariate analysis was performed to select the significant prognostic factors (P < 0.05). A prognostic model for OS was derived by recursive partitioning analysis (RPA) combining independent predictors using the algorithm of optimized binary partition. ResultsThree independent prognostic factors (age, relapsed T [rT] stage, and Epstein-Barr virus [EBV] DNA) were identified from multivariate analysis. Five prognostic groups were derived from an RPA model that combined rT stage and EBV DNA. After further pair-wise comparisons of survival outcome in each group, three risk groups were generated. We investigated the role of re-RT in different risk groups, and found that re-RT could benefit patients in the low (P < 0.001) and intermediate-risk subgroups (P = 0.017), while no association between re-RT and survival benefit was found in the high-risk subgroup (P = 0.328). The results of risk stratification and re-RT efficacy were verified in the validation cohort. ConclusionAge, rT stage and EBV DNA were identified as independent predictors for lrNPC. We established an integrated RPA-based prognostic model for OS incorporating rT stage and EBV DNA, which could guide individual treatment for lrNPC.

Nasopharyngeal Carcinoma: Clinical Achievements and Considerations Among Treatment Options.

Nasopharyngeal carcinoma (NPC) is a severe malignancy arising from the nasopharyngeal epithelium and is southern China’s third most common cancer. With the advancement of treatment methods, early-stage NPC patients usually have a better prognosis and more prolonged survival period than those with other malignant tumors. Most treatment failures are due to distant metastasis or a locally advanced stage of NPC in the initial diagnosis. In addition, approximately 10% of patients develop local recurrence, and 10%–20% of patients experience distant metastasis after treatment. These patients have a poor prognosis, with a median survival of only approximately 10–15 months. In the rapid development of treatment options, the efficacy and safety of some treatments have been validated and approved for first-line treatment, while those of other treatments remain unclear. The present study aims to provide a comprehensive overview of recent advances in NPC treatment and explain the various therapeutic possibilities in treating locally advanced, recurrent, and metastatic NPC patients.

Clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion

BackgroundWe aimed to assess the clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion. MethodsA retrospective analysis was performed involving 51 patients either operated by bypass grafting (n = 22) or treated with repeated chemo-radiotherapy (n = 29). ResultsFour patients in the bypass grafting group died 3–5 months after the operation due to epistaxis and pulmonary infection (4/22, 18.2%), and three more patients exhibited a modified Rankin Scale (mRS) ≥ 2 during the follow-up (3/22, 13.6%). In the repeated chemo-radiotherapy group, 8 patients died (8/29, 27.6%), including seven patients dying within 2–3 months due to epistaxis and pulmonary infection (7/29, 24.1%). One more patient died of epistaxis after 9 months. The difference in mortality between the two treatment groups within 3 months of treatment was statistically significant (P = 0.038). ConclusionsCerebrovascular reconstruction after detailed collateral flow assessment is an effective treatment for recurrent NPC patients with internal carotid artery invasion.

Diagnostic and prognostic values of KLK11 in nasopharyngeal carcinoma.

This study aims to clarify potential diagnostic and prognostic values of KLK11 in nasopharyngeal carcinoma (NPC). KLK11 levels in 81 primary NPC tissues, 24 recurrent NPC tissues, and 60 nasopharyngeal tissues with chronic mucosal inflammation were determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Then, receiver operating characteristic (ROC) curves were depicted for assessing the diagnostic value of KLK11 in primary and recurrent NPC. Next, correlation between KLK11 level and pathological indexes of NPC patients was analyzed by Chi-square test. Enrolled NPC patients were followed up for 5 years, and the follow-up data were recorded to determine the potential influence of KLK11 on overall survival by Kaplan-Meier method. In addition, Cox regression model was applied for assessing factors that could affect prognosis of NPC patients. It was found that KLK11 level was higher in primary NPC tissues than that in nasopharyngeal tissues with chronic mucosal inflammation. In recurrent NPC tissues, KLK11 was upregulated relative to primary ones. In addition, ROC curves revealed a certain diagnostic value of KLK11 in NPC. Overall survival was worse in primary and recurrent NPC patients expressing a high level of KLK11. By analyzing the pathological indexes of NPC patients, KLK11 level was found to be correlated with age, T stage, and clinical stage of NPC patients. Furthermore, KLK11 level was found to be the risk factor influencing the survival of NPC patients. KLK11 is upregulated in NPC tissues, and unfavorable to the prognosis of NPC. Besides, it can be utilized as a potential hallmark for diagnosing NPC.

Chemotherapy and chemo-resistance in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is closely associated with Epstein-Barr virus (EBV) and occurs frequently in the south of China and Southeast Asian countries. Concurrent chemo-radiotherapy is one of the main treatments for NPC. Although, the combined treatment of chemo-radiotherapy produces a satisfying survival rate, the chemo-resistance arises as a big obstacle in curing recurrent NPC patients. The acquirement of chemo-resistance is usually along with a poor prognosis. So far, the mechanism of chemo-resistance in NPC has not been fully elucidated and there have not been a comprehensive review on this issue. Thus, it is of great significance to summarize the mechanisms involved in NPC chemo-resistance. In this review, the importance and limitations of chemotherapy and the mechanisms of chemo-resistances in NPC were discussed.

CHARACTERISTICS OF RECURRENCE NASOPHARYNGEAL CARCINOMA IN HASAN SADIKIN HOSPITAL PERIOD 2017-2019

Abstract Introduction: Nasopharyngeal carcinoma is a malignancy that occurs in the squamous epithelium in the nasopharynx region. Recurrent Nasopharyngeal carcinoma is defined as tumor recurrence after the complete remission. Patients with recurrent NPC always experience local, regional, or both failure, with or without distant metastases and can damage surrounding tissue.. Methods: This research method was a retrospective descriptive based on medical record data in patients with recurrent nasopharyngeal carcinoma at ORL-HNS outpatient ward subdivision of Head Neck Surgery, RSHS, Bandung from 2017 to 2019. Result: In RSHS Bandung, there was 1727 patient NPC period 2017-2019. There was 135 recurrent nasopharyngeal carcinoma patients (7,8 %) consist of 96 male and 39 female, aged over 40 years as many as 107 patients. More patients were found in T3-T4 (56%), N2-N3(56%), M0 (91%), stage III-IV (75%). The duration of the patient experienced a relapse after initial therapy for more than 24 months (52%). Conclusion: Characteristics of recurrent nasopharyngeal carcinoma most of them come with stage III-IV, T3-T4 without distant metastases, with a recurrence within less than 24 months. There was 7,8% recurrent nasopharyngeal carcinoma patients Keywords: Charactherisic, Nasopharyngeal Carcinoma, Recurrence

Recommendations for surgical management of recurrent nasopharyngeal carcinoma during COVID-19 pandemic.

Nasopharyngeal carcinoma is endemic in southern parts of China including Hong Kong. Primary treatment entails radiotherapy ± chemotherapy depending on disease stage at presentation. Surgery is offered as a means of salvage for persistent and recurrent disease. Comprehensive preoperative work‐up, careful patient selection, attention to details perioperation and multidisciplinary approach is essential in ensuring optimal outcomes after salvage surgery for recurrent nasopharyngeal carcinoma patients. Since the COVID‐19 outbreak, we are faced with unprecedented challenges with priorities of care and resources being shifted to combat the virus. These include patient selection and timing of treatment, while preventing disease transmission to heath care providers. Practices and recommendations made in this document are intended to support safe clinical practice and efficient use of resources during this challenging time.

Outcomes of recurrent nasopharyngeal carcinoma patients treated with endoscopic nasopharyngectomy: a meta-analysis.

Recurrent nasopharyngeal carcinoma (rNPC) is mainly managed with re-irradiation or salvage surgery. Endoscopic resection is generally considered as the preferred surgical treatment, whereas a standard treatment modality has yet to be established. This article is aimed to summarize the treatment outcomes of endoscopic rNPC resection. Major medical databases including PubMed, EMBASE, Cochrane Central Library, Web of Science, and 2 major Chinese databases, CNKI and Wanfang, were searched for studies on endoscopic rNPC resection. Main characteristics of study and outcomes of interest were retrieved from articles meeting the selection criteria for meta-analysis. A total of 761 articles were identified through the initial systematic research. The combined 1-year, 2-year, and 5-year overall survival (OS) rates were 97%, 92%, and 73% with random effect model, respectively. The combined 2-year and 5-year disease-free survival (DFS) rates were 81% and 62%, respectively. Meta-regression analysis showed that high recurrent tumor (rT) stage (rT3 to rT4) case proportion was a correlative factor of heterogeneity. Combined 2-year OS rate in rT1, rT2, rT3, and rT4 patients were 100%, 87%, 78%, and 38%, respectively. Combined 2-year DFS rate in rT1 and rT2 patients were and 96% and 86%, respectively. The combined OS and DFS rates of rNPC patients treated with endoscopic nasopharyngectomy were summarized and reported in our study. This meta-analysis indicated that endoscopic nasopharyngectomy has comparable and possibly better treatment outcomes than intensity-modulated radiotherapy (IMRT). Therefore, the result of our study indicated that randomized controlled trials (RCTs) are needed in rNPC patients to compare treatment outcomes of endoscopic nasopharyngectomy vs IMRT.

A 4-year review of surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy in salvaging locally recurrent nasopharyngeal carcinoma.

To study the surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy (EETN) in salvaging locally recurrent nasopharyngeal carcinoma (NPC). This was a retrospective clinical record review study carried out at a tertiary centre from June 2013 until May 2017. A total of 55 locally recurrent NPC patients (rT1-rT4) underwent EETN performed by single skull base surgeon with curative intention with postoperative adjuvant chemotherapy but without postoperative radiotherapy. There were 44 (80.0%) males and 11 (20.0%) females, with mean age of 52.5years. The mean operating time was 180min (range 150-280min). 85% (47/55) of patients achieved en bloc tumour resection. 93% (51/55) of patients obtained negative microscopic margin based on postoperative histopathological evaluation. Intraoperatively, one (1.8%) patient had internal carotid artery injury which was successfully stented and had recovered fully without neurological deficit. There were no major postoperative complications reported. During a mean follow-up period of 18-month (range 12-48months) postsurgery, five patients (9.1%) had residual or recurrence at the primary site. All five patients underwent re-surgery. One patient at rT3 passed away 6months after re-surgery due to distant metastasis complicated with septicaemia. The 1-year local disease-free rate was 93% and the 1-year overall survival rate was 98%. EETN is emerging treatment options for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. Long-term outcome is yet to be determined with longer follow-up and bigger cohort study. However, a successful surgical outcome required a very experienced team and highly specialised equipment.

Clinical results of proton therapy reirradiation for recurrent nasopharyngeal carcinoma

Background and purpose: Recurrent nasopharyngeal carcinoma (NPC) has limited curative treatment options. Reirradiation is the only potential definitive treatment in advanced stages at a cost of substantial severe and often life-threatening toxicity. Proton therapy (PT) reduces irradiated volume compared with X-ray radiotherapy and could be advantageous in terms of safety and efficacy in a population of heavily pretreated patients. We report the retrospective results of PT reirradiation in recurrent NPC patients treated at our InstitutionMethods: All recurrent NPC patients treated since the beginning of clinical activity entered the present analysis. Clinical target volume consisted of Gross Tumor volume plus a patient-specific margin depending on disease behavior, tumor location, proximity of organs at risk, previous radiation dose. No elective nodal irradiation was performed. Active scanning technique with the use of Single Field Optimization (SFO) or Multifield Optimization (MFO) was adopted. Cumulative X-ray -PT doses were calculated for all patients using a dose accumulation tool since 2016. Treatment toxicity was retrospectively collected.Results: Between February 2015, and October 2018, 17 recurrent NPC patients were treated. Median follow-up (FUP) was 10 months (range 2–41). Median PT reirradiation dose was 60 Gy RBE (range 30.6–66). The majority of patients (53%) underwent concomitant chemotherapy. Acute toxicity was low with no ≥ G3 adverse events. Late events ≥ G3 occurred in 23.5% of patients. Most frequent late toxicity was hearing impairment (17,6%). G2 soft tissue necrosis occurred in two patients. Fatal bleeding of uncertain cause (either tumor recurrence or G5 carotid blowout) occurred in one patient. Kaplan–Meier 18 months Overall Survival (OS) and Local control (LC) rates were 54.4% and 66.6%, respectively.Conclusions: Our initial results with the use of modern PT for reirradiation of recurrent NPC patients are encouraging. Favorable LC and OS rates were obtained at the cost of acceptable severe late toxicity.

Programmed Death-1 (PD-1) Antibody Combined With IMRT in Recurrent Nasopharyngeal Carcinoma Patients

Programmed Death-1 (PD-1) Antibody Combined With IMRT in Recurrent Nasopharyngeal Carcinoma Patients

Neutrophil-Lymphocyte Ratio in Locally Recurrent Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Carbon-Ion Radiation Therapy Versus Intensity-Modulated Radiation Therapy

Neutrophil-Lymphocyte Ratio in Locally Recurrent Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Carbon-Ion Radiation Therapy Versus Intensity-Modulated Radiation Therapy

PD-1 and PD-L1 expression in 132 recurrent nasopharyngeal carcinoma: the correlation with anemia and outcomes

The expression of Programmed death-1 (PD-1) / programmed death-ligand 1 (PD-L1) has been reported to be reliable prognostic factors in various malignances including primary nasopharyngeal carcinoma (NPC). However, the exact role of PD-1/PD-L1 in recurrent NPC remains unclear. In this study, we aimed to investigate the relationship between the expression of PD-1 / PD-L1 and the clinical-pathology as well the outcomes of recurrent NPC patients (n = 132). The expression of PD-1 and PD-L1 was measured by immunohistochemistry staining. The relationship between PD-1 / PD-L1 and factors involved in clinic-pathology and outcomes of patients with NPC was assessed by correlation analysis. To further explore the association between PD-L1 and anemia, immunofluorescence analysis was performed to investigate the correlation of PD-L1 with hypoxia inducible factor-1α (HIF-1α). We observed that advanced rT classification and anemia status before salvage treatment was associated with high level of PD-L1 in recurrent NPC patients, and PD-L1 and was co-located with HIF-1α in recurrent tumors by immunofluorescence analysis. Moreover, our result suggested that PD-L1 might be a negative indicator for recurrent NPC patients as well as age, rT classification, anemia and tumor necrosis at diagnose of recurrence. Taken together, our results revealed that PD-L1 might be a potential prognostic biomarker for recurrent NPC patients, and advanced re-stage, anemia might represent as candidate biomarkers for evaluating patients’ response to anti-PD-1 / PD-L1-treatment. However, further studies are needed to clarify the underlying mechanism of hypoxia in immunosuppression process induced by PD-1 / PD-L1 axis.

Efficacy and safety of recombinant human adenovirus p53 combined with chemoradiotherapy in the treatment of recurrent nasopharyngeal carcinoma.

This study aims to explore the efficacy and safety of recombinant human adenovirus p53 (rAd-p53) combined with chemoradiotherapy (CRT) in the treatment of recurrent nasopharyngeal carcinoma (NPC). A total of 162 recurrent NPC patients were selected and divided randomly into the rAd-p53+CRT, CRT, and rAd-p53 groups. An electrochemical luminescence immune analyzer was used to detect serum levels of tumor markers (carcinoembryonic antigen, cancer antigen 199, and cancer antigen 153). Efficacy evaluation was in accordance with Response Evaluation Criteria in Solid Tumor. Toxicity evaluation was performed according to the WHO grading standard. A 3-year follow-up was performed. A Kaplan-Meier curve was drawn to calculate progression-free survival and the 3-year survival rate. The complete response rate and effective rate (complete response+partial response) of recurrent NPC patients in the rAd-p53+CRT group were higher than those in the CRT and rAd-p53groups. After treatment, compared with the CRT and rAd-p53 groups, the rAd-p53+CRT group had lower serum levels of carcinoembryonic antigen, cancer antigen 199, and cancer antigen 153. The incidences of leukopenia and oral mucositis in the rAd-p53+CRT group were lower than those in the CRT group, but no differences were found between the rAd-p53+CRT and rAd-p53 groups. The progression-free survival and 3-year survival rate of recurrent NPC patients in the rAd-p53+CRT group were higher than the than those in the CRT and rAd-p53 groups. Our study supports that rAd-p53 combined with CRT may provide better efficacy and lower toxicity than rAd-p53 or CRT alone for the treatment of recurrent NPC patients.

Multi-institutional prospective study of nedaplatin plus S-1 chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-containing regimens.

In this multi-institutional prospective study, we aimed to assess the safety and efficacy of nedaplatin plus S-1 (NS) chemotherapy for patients with recurrent and metastatic nasopharyngeal carcinoma (NPC) when platinum-containing regimens failed. A total of 52 recurrent and metastatic NPC patients who previously received, but failed with platinum-containing chemotherapy, had oral S-1 chemotherapy (twice daily from the first day to the fourteenth day) and nedaplatin (80 mg/ m2, day 1) every 3 weeks. The body surface area (BSA) decided the dose of S-1: 40 mg twice a day when BSA < 1.25 m2; 50 mg twice daily when 1.25 m2 ⩽ BSA < 1.5 m2; and 60 mg twice daily when BSA ⩾ 1.5 m2. Treatment was well tolerated. The main hematological adverse event was neutropenia. Five patients (9.6%) had grade 3 neutropenia. Three patients were found with grade 3 anemia (5.8%). One patient was found with grade 3 thrombocytopenia (1.9%). No patient was found with grade 3 or 4 nonhematological toxicity. The rates of complete response, partial response and overall response were 3.8%, 38.5% and 42.3%, respectively. Median time to progression was 6.2 months and median survival was 14.6 months. The rates of 1-year survival and 2-year survival were 63% and 27%, respectively. NS chemotherapy provides a satisfactory and safe clinical activity for patients with recurrent and metastatic NPC after platinum-containing chemotherapy failed.

Phase II study of gemcitabine plus S-1 chemotherapy in recurrent and metastatic nasopharyngeal carcinoma patients after failure of platinum-based chemotherapy

No standard salvage regimen has been established for patients with recurrent and metastatic nasopharyngeal carcinoma (NPC) and disease progression after prior platinum-based chemotherapy. This phase II study was designed to evaluate the efficacy and safety of gemcitabine plus S-1 (GS) chemotherapy as a remedial regimen in this setting. In this multicenter phase II study, 49 patients with recurrent and metastatic NPC who failed previous platinum-based chemotherapy received gemcitabine (1.0 g/m(2) on days 1 and 8) plus oral S-1 chemotherapy (twice daily from day 1 to 14). Each cycle was repeated every 3 weeks for two cycles at least. The dose of S-1 was determined according to the body surface area (BSA): 40 mg twice a day for BSA <1.25 m(2); 50 mg twice a day for 1.25 m(2) ⩽ BSA <1.5 m(2); and 60 mg twice a day for BSA ⩾1.5 m(2). Treatment was generally well-tolerated. A total of seven patients (14.3%) had grade 3 toxicities and the main toxicity was myelosuppression, whereas the nonhematology adverse events were minimal. There were 3 complete responses (6.4%), 17 partial responses (36.2%), and the overall response rate was 42.6% (95% confidence interval: 27.3-61.2). Median time to progression was 5.8 months and median survival was 14.8 months. The 1- and 2-year survival rates were 64% and 30%, respectively. Gemcitabine plus S-1 offers a satisfactory clinical activity and an acceptable safety profile for recurrent and metastatic NPC patients after failure of platinum-based chemotherapy.

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 71 patients and analysis of the prognostic factors

To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors. Between January 2006 and March 2014, 71 patients who received endoscopic nasopharyngectomy for recurrent NPC were retrospectively reviewed. The sex and the age of the patients, T stage, and tumor necrosis were recorded. Correlation between clinicopathological features and survival time was analyzed. Kaplan-Meier analysis was used to calculate the disease overall survival, disease-specific survival, and disease-free survival rates. Cox multivariate regression analysis and ROC curve analysis were used to determine the predictive value of the parameters. The median age of 71 patients with recurrent nasopharyngeal carcinoma was 51.0 years old. Male to female ratio was 2.9:1 (male: 53, female: 18). The lesions were staged as follows (AJCC, 2010, seventh edition): rT1, 27; rT2, 10; rT3, 19 and rT4, 15. All patients underwent successful endoscopic nasopharyngectomy. No patient was transferred to open approach. The mean operative time was 155 minutes. The average blood loss was 450 ml. Three patients needed intraoperative blood transfusion. No serious postoperative complications occurred. Postoperative follow-up time was 5-96 months. During follow-up, 48 cases survived, including that 7 patients survived with disease, 1 patient had pulmonary metastases, and 1 case had cervical lymph node metastasis. Two-year overall survival and disease-free survival rates were 74.0% and 60.5%, respectively. Five-year overall survival and disease-free survival rates were 39.0% and 31.9%, respectively. Multivariate analysis showed that tumor necrosis was an independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients (P=0.001). Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.

An analysis of brachytherapy with computed tomography-guided permanent implantation of Iodine-125 seeds for recurrent nonkeratin nasopharyngeal carcinoma.

Background125I seed implantation is a new method in treatment of nasopharyngeal carcinoma (NPC), and it is worthwhile to evaluate its feasibility. In this study, we performed brachytherapy with computed tomography (CT)-guided permanent implantation of 125I seeds in the treatment of patients with the recurrence of NPC.MethodsA total 30 patients (20 male and ten female) at the median age of 55 (range 25–80) years were diagnosed with recurrent nonkeratin NPC, with a total 38 lesions and a short disease-free interval (mediañ11 months) after primary radiotherapy alone or combined with chemotherapy. Patients received CT scan, starting from 2 months after the treatment. Follow-up was conducted for ~2–38 months to observe the local control rate and overall survival rate. We also analyzed the possible correlation between survival periods and the status of recurrent tumors.ResultsThe local control rates at 6, 12, 24, 30, and 36 months after the procedure of 125I seed implantation were 86.8%, 73.7%, 26.3%, 15.8%, and 5.3%, respectively. The overall 1-, 2-, and 3-year survival rates were 80.0% (24/30), 30.0% (9/30), and 6.7% (2/30), respectively, with a median survival period of 18 months (17.6±8.6 months). Interestingly, the survival periods of the patients who had primary radiotherapy with or without chemotherapy were 15.8±7.9 and 24.3±7.9 months, respectively. Kaplan–Meier survival analysis demonstrated that χ2 (log rank) was 7.555, with very significant difference (P<0.01). The survival periods of patients in tumor stages I, II, III, and IV were 25.4±8.7, 19.8±9.4, 16.1±4.5, and 12.8±7.8 months, respectively, with significant differences (P<0.05).ConclusionOur data suggest that the survival period of recurrent NPC patients after 125I seed implantation is inversely related to the tumor stages of the recurrence but not to chemotherapy after the primary radiotherapy. Therefore, CT-guided 125I seed implantation can be set for treatment of recurrent NPC, for better survival rate with minimal damage.