Objectives
Nasopharyngeal cancer (NPC) is an endemic disease in Taiwan. Prognostic factors the anatomical TNM stage are important for its prognostic stratification. An elevated ...neutrophil‐to‐lymphocyte ratio (NLR) has been reported to be associated with poor prognosis in various solid tumours. In this study, we analysed the prognostic impact of the NLR in NPC in Taiwan.
Design
Single‐institution retrospective study.
Setting
Medical centre.
Participants
One hundred and eighty patients with NPC treated at the Far Eastern Memorial Hospital, Taiwan, from January 2007 to December 2013.
Main outcome measures
The association between the clinical or haematological presentations and the prognosis.
Results
The majority of the 180 patients included in this study were men (80%) and were <65 years old (91.7%). A neck mass (55.6%) was the most common clinical presentation, followed by nasal (39.4%) and aural (30.6%) symptoms. In addition, the majority (75.4%) of patients had advanced stage (III and IV) disease. Patients with a high NLR (≧3.6) had significantly lower progression‐free survival, overall survival and disease‐specific survival rates. The association between high NLR and poor prognosis was more pronounced in patients with advanced disease than in those with early‐stage NPC. The results of a multivariate analysis revealed that advanced age, clinical symptoms including headache, diplopia and facial numbness, advanced disease stage, and high NLR were independent prognostic factors.
Conclusion
A high NLR is an independent poor prognostic factor of NPC in Taiwan.
Objective
To establish a real‐time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation.
...Methods
One‐hundred forty‐four irradiation‐treated patients underwent ultrasonography and ultrasound‐guided fine‐needle aspirations (USgFNAs), and the resultant data were used to construct a real‐time and computerised predictive scoring model. This scoring system was further compared with our previously proposed prediction model.
Results
A predictive scoring model, 1.35 × (L axis) + 2.03 × (S axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c‐statistic) were 0.89 and 0.81, respectively (P < .05).
Conclusions
A real‐time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.
The effective treatment for hepatocellular carcinoma (HCC) with American Joint Committee on Cancer stage IIIB remains controversial and challenging because of the high recurrence rate after resection ...and low survival rate. The median survival of those with macroscopic portal vein tumor thrombus (PVTT) is short. We reported such a case which received liver transplantation (LT) after successful consecutive downstaging therapies. A 40-year-old man with alcohol related liver cirrhosis and repeated esophageal varices bleeding had HCC with tumor thrombi in right main portal vein and the second portal branch of segment VI (stage IIIB). The received percutaneous alcohol injection, radiofrequency ablation, 8 sessions of transcatheter hepatic arterial chemoembolization, radiotherapy, and target therapy with sorafenib. Computed tomography (CT) scan and magnetic resonance imaging after treatments showed no viable fragments in the tumor and revealed both the right main portal vein and V1 branch were patent. One month later, the patient received a deceased LT. The perioperative course was rather smooth. After discharge, the interval follow-up CT studies of the chest and liver and whole body bone scan showed no tumor recurrence or metastasis up to 20 months postoperation.
•The treatment of HCC portal vein tumor thrombus remains challenging.•Multimodal downstaging to meet the Milan criteria is successful.•The patient in the present case had received liver transplantation and presented tumor-free up to 20 months posttransplant.
Whole-brain radiotherapy (WBRT) with hippocampal avoidance improves neurocognitive function deterioration. To improve both planning and treatment efficiency, we investigated the feasibility of using ...the coplanar volumetric-modulated arc therapy (VMAT) technique with various head flexion angles for hippocampal avoidance during WBRT. Six patients with brain metastases were selected for the study. We rotated patient CT images by 90° and changed the couch angle to simulate different head flexion angles. The plan with a head angle of 0° had the lowest planning target volume (PTV) coverage and the highest normal organ dose (i.e., hippocampus and bilateral lenses). When the angle was equal to or greater than 15°, the maximum dose of the hippocampus and the PTV V30 met all dose constraints. The results obtained with head angles equal to or greater than 25° were better than those obtained at angles below 25° with the obviously decreased dose of the bilateral lenses. The VMAT treatment plans of each patient were computed under various head flexion angles using the Eclipse Treatment Planning System. The study demonstrated that 15° is the minimum head flexion angle that should be adopted in clinical practice. For better dose coverage and uniformity for whole-brain PTV and dose reduction of critical organs, the study results suggested utilizing a head angle equal to or greater than 25°, while ensuring that patient comfort is maintained with larger head flexion angles. Compared with non-coplanar linac-based techniques, a tilted head angle with the coplanar VMAT technique not only reduces plan complexity but also improves treatment efficiency.
•WBRT with hippocampal avoidance improves neurocognitive function deterioration.•The coplanar VMAT with various head flexion angles for HA-WBRT is investigated.•A tilted head angle with the VMAT technique improves treatment efficiency.
Treatment planning for patients with synchronous bilateral breast cancer (SBBC) is challenging due to the technical complexity of bilateral treatment. To minimize both high-dose and low-dose volumes ...of the heart and lungs being irradiated, we proposed an efficient and simple strategy for volumetric modulated arc therapy (VMAT) treatment planning in this study. Five SBBC patients were enrolled in this study. We utilized two pseudo block planning structures to minimize the high-dose volume of the whole lungs and heart and confine the low-dose areas in normal organs for VMAT planning. The prescription delivered was 45 Gy in 25 fractions to the whole breast. The VMAT treatment plan consisted of two partial arcs. In terms of the whole lungs, the average V5Gy, V10Gy and V20Gy in the VMAT-B plan (with two pseudo planning block structures) for the five patients were 34.8 ± 7.2%, 23.4 ± 5.0% and 14.8 ± 3.0%, respectively. For the VMAT-NB plan (without two pseudo planning block structures), the average V5Gy, V10Gy and V20Gy were 38.6 ± 6.8%, 27 ± 5.9% and 18.4 ± 4.0%, respectively. For the heart, the average V5Gy, V10Gy, V20Gy and V30Gy in the VMAT-B plan were 19.6 ± 3.1%, 7.0 ± 2.5%, 2.2 ± 1.2% and 0.7 ± 0.7%, respectively, while the mean values in the VMAT-NB plan were 26.2 ± 6.3%, 11.3 ± 3.9%, 3.9 ± 1.8% and 1.5 ± 1.1%, respectively. We designed an approach to reduce both the high-dose and low-dose volumes by utilizing pseudo planning structures in the VMAT treatment plan. The dosimetric results of this study showed that the pseudo block structures have the potential to reduce the risks of radiation pneumonitis and heart disease, while preserving the same tumor control rate.
•Treatment plan for SBBC patients is challenging due to complex treatment volumes.•Use of Pseudo planning structures can reduce OAR dose for VMAT treatment plans.•The risk of radiation pneumonitis and heart disease is reduced by using Ref_block.
Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage ...and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm(3). The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis.
To examine the effects of norcantharidin (NCTD) on development of human myeloid dendritic cells (DCs) in vitro and in skin allograft transplantation in vivo.
Human CD14(+) monocytes were isolated and ...triggered differentiation and maturation toward myeloid DCs with and without NCTD. The cell morphology, viability, cell death, expression of surface markers and co-stimulatory molecules, allostimulatory activity, and cytokine production were examined for characterization of DCs. The rejection of mice skin allograft model was used to translate the in vitro effect of cantharidin (CTD) and NCTD on DCs.
DCs developed in the presence of NCTD showed decreased viability, cell death with necrosis, and lower expression of CD1a and CD83. DCs triggered in the presence of NCTD possessed a greater allostimulatory activity in naive CD4(+)CD45RA(+) T cells. NCTD modulated DCs through calcineurin phosphatase but not through mammalian target of rapamycin or downstream molecule p70S6 kinase. In vivo, NCTD caused accumulation and co-localization of antigen-presenting cells and regulatory T cells in the interfollicular area of the recipients' spleens. CTD and NCTD prolonged skin allograft survival along with less severe histopathological inflammatory reactions. CTD, but not NCTD, treatment caused elevation of serum alanine aminotransferase and evident mortality of the recipients.
NCTD modulated the differentiation and maturation of human myeloid DCs and caused deviation of standard DC differentiation toward a tolerogenic phenotype through calcineurin phosphatase inhibition. In vivo, both drugs effectively prolonged skin allograft survival. NCTD was less toxic than CTD, and thus, has potential for development as an immunosuppressant for transplant rejection.
We report on a 63-year-old man with a history of hepatitis B virus-related hepatocellular carcinoma with a thrombus extending into the inferior vena cava, who received image-guided stereotactic body ...radiation therapy (SBRT) with helical tomotherapy, followed by sorafenib. A total tumor dose of 48 Gy was delivered by 6 fractions within 2 weeks. The tumor responded dramatically, and the patient tolerated the courses well. Ten days after SBRT, sorafenib (200 mg), at 1.5 tablets twice a day, was prescribed. One week later, grade 2 recall radiation dermatitis subsequently developed in the previous SBRT off-target area. SBRT followed by sorafenib for the treatment of a portal vein thrombosis provided effective results, but the potential risk of enhanced adverse effects between radiation and sorafenib should be considered with caution, especially under a SBRT scheme.
The purpose of this study was to compare the efficacy of intensity-modulated radiotherapy (IMRT) and helical tomotherapy for endometrial cancer.
Between November 1, 2006 and November 31, 2010, 31 ...patients with histologically confirmed endometrial cancer were enrolled. All enrolled patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant whole pelvic IMRT or helical tomotherapy.
The actuarial 3-year overall survival, disease-free survival, locoregional control, and distant metastasis-free rates for the IMRT and helical tomotherapy groups were 87.5% versus 100%, 91.7% versus 51.7%, 91.7% versus 83.3%, and 91.7% versus 51.7%, respectively. The conformal index and uniformity index for IMRT versus helical tomotherapy was 1.25 versus 1.17 (P = 0.04) and 1.08 versus 1.05 (P < 0.01), respectively. Two of 31 patients with cervical stump failure were noted, one in the IMRT group and the other in the helical tomotherapy group. No acute or late grade 3 or 4 toxicities were noted, including proctitis, or genitourinary or gastrointestinal disturbances.
Helical tomotherapy is as effective as IMRT and has better uniformity and conformal indices, and critical organ-sparing properties. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT versus helical tomotherapy.
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