Objectives: To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy. Methods: Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS). Results: Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% (P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status (HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy (HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not (P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions: The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.

Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.

Some breast cancer patients can achieve pathologic complete response (pCR) for breast and/or axillary lymph node after neoadjuvant systemic therapy (NST). If the breast achieved pCR confirmed by extensive biopsy, the necessity of breast surgery has been questioned. Whereas, the appropriate management of the axilla in breast pCR patients is rarely studied. This cohort study was designed to retrospectively evaluate the status of axillary lymph nodes in relation to breast pCR and identify patients who may be eligible for omission of axillary surgery. This study in a single institution concluded operable breast patients who received NST followed by standard breast and nodal surgery from 2015 to 2019. The rates of axillary pCR (ypN0) were compared between patients who did or did not achieve breast pCR (ypT0/is). Among 258 patients, 70 (27.1%) patients achieved ypT0/is, and there was no statistical difference according to patients’ age, menopausal status, clinical tumor size and lymph node status when compared with non-ypT0/is patients. Patients with HER2-positive and triple-negative (TN) subtypes have a higher incidence of ypT0/is than patients with luminal subtype (P<0.001). Overall, the rate of ypN0 in ypT0/is group was higher than in non-ypT0/is group (87.1% vs 34.6%, P<0.0001). For cN0 (clinically assessed negative lymph node before NST) patients, although there was no difference of ypN0 rates between ypT0/is group and non-ypT0/is group (100% vs. 85.7%, P=0.1534), the high value of ypN0 rate in ypT0/is group (100%) provided evidence of axillary surgery omission. In addition, for cN+ (clinically assessed positive lymph node before NST) patients, the ypT0/is group population was more likely to achieve ypN0 than non-ypT0/is population (82.7% vs 22.9%, P<0.0001). Moreover, more cN+ patients achieved ypN0 in ypT0 group than in ypTis group (94.3% vs 58.8%, P= 0.0034), and the high rate number (94.3%) also indicated possibility of axillary surgery omission. Evidence supported that, for cN0 patients who achieved ypT0/is, and cN+ patients who achieved ypT0, axillary surgery may be omitted.

Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.

To retrospectively analyze the long—term efficacy and prognostic factors of preoperative chemotherapy or chemoradiotherapy combined with total mesorectal excision (TME) in locally advanced rectal cancer. A total of 305 patients who were consecutively admitted to our hospital and diagnosed with locally advanced rectal adenocarcinoma by pelvic magnetic resonance imaging or computed tomography from January 2006 to November 2018 were enrolled as subjects. 59 patients received preoperative chemotherapy with oxaliplatin + fluorouracil ± irinotecan ± leucovorin for 2-6 cycles, and then TME(R0 excision) at 2-8weeks (median time=3.75 weeks), 246 patients received preoperative radiotherapy with dose ranging from 42.0 to 50.4Gy (median dose =50Gy) and concurrent chemotherapy with capecitabine ± oxaliplatin and then TME (R0 excision) at 4-15 weeks (median time=7 weeks). Postoperative radiotherapy or chemotherapy were given according to the individual pathological stages and recovery. Disease free survival (DFS), locoregional recurrence (LRR), overall survival (OS), and distant metastasis (DM) rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. In all, 305 patients aged 18-82 (median age 55).Other basic information of the patients is as shown in the table , The median follow-up time was 38 months and the 3-year LRR, DM, DFS and OS were 4.5%, 23.3%, 77% and 87.3% respectively. In the preoperative chemotherapy group, 3-year LRR, DM, DFS, and OS were 5%, 16.7%, 86.3%, and 89.1%, respectively meanwhile, the 3-year LRR, DM, DFS and OS in the preoperative chemoradiotherapy group were 4.4%, 24.8%, 75.6%, and 85.7%, with no statistical significance between two groups (P > 0.05). R0 resection rate and pCR rate in Preoperative chemotherapy group and chemoradiotherapy group were: 96.7% and 100%, 3.4% and 13.7% respectively, There were significant differences in PCR rates. Similar efficacy was acquired by preoperative chemotherapy and chemoradiotherapy LARC, when patients received preoperative chemotherapy with tumor mainly located in the middle and upper. Besides, the other critical factors in the strategy design for rectal cancer such as MRF, EMVI should be further evaluated between these two arms.Abstract 2409; Table 1The baseline information of the patientsIn totalPreoperative chemotherapyPreoperative chemoradiotherapyP valueAge>6566 (21.6%)12 (22%)53 (21.5%)0.93≤65239 (78.4%)46 (78%)193 (78.5%)SexMale207 (67.8%)37 (62.7%)170 (69.1%)0.10Female98 (32.2%)22 (37.3%)76 (30.9%)Tumor locationUpper Rectum20 (6.6%)20 (34%)0<0.001Middle Rectum96 (31.4%)25 (42.4%)71 (28%)Lower Rectum189 (62%)14 (23.7%)175 (72%)StageII (T3-4N0-1)53 (17.4%)7 (11.9%)46 (18.7%)0.052III251 (82.3%)51 (86.4%)200 (81.3%)IV1 (0.3%)1 (1.7%)0 Open table in a new tab

Objective To analyze the clinical treatment modalities and clinical prognosis of patients diagnosed with primary nasopharyngeal adenoid cystic carcinoma (NACC).Methods The medical records of 46 patients with NACC between March 1971 and November 2015 were retrospectively analyzed.Among them,22 patients were male and 24 female.The median age of all patients was 47 years (range:23-74 years).Among them,34 patients received radiotherapy alone including 25 patients treated with conventional radiotherapy and 9 receiving intensity-modulated radiation therapy (IMRT).Five patients underwent salvage surgery for the residual tumors after radiotherapy.Twelve patients were treated with a comprehensive treatment modality (surgery combined with radiotherapy).Results The median follow-up time was 66.0 months (range:11.0-270.6 months).The 5-and 10-year overall survival,locoregional failure-free survival,and distant metastasis failure-free survival rates were 70％ and 40％,64％ and 47％,70％ and 62％,respectively.In the radiotherapy alone group,12(35％) cases obtained complete response,13 had partial response and 9 remained stable after radiotherapy.The 5-year overall survival and locoregional failure-free survival rates in the radiotherapy alone and combined therapy groups were 69％ and 74％,63％ and 66％,respectively (all P＞ 0.05).Conclusion The course of NACC is relatively slow.Radiotherapy is recommended for patients with high sensitivity towards radiotherapy.Salvage surgery is feasible for those who are insensitive to radiotherapy or with residual tumor after radiotherapy.

Objective To explore the risk factors influencing the outcomes of radiation brain injury after intensity-modulated radiotherapy (IMRT) in patients diagnosed with nasopharyngeal carcinoma.Methods Clinical data of 1 300 nasopharyngeal carcinoma patients treated with IMRT in our hospital during 2006 and 2013 were retrospectively analyzed.Fifty-eight patients presented with radiation brain injury after IMRT.MRI data of these patients during 3-24 months follow-up were collected.The clinical efficacy in the treatment of radiation brain injury was evaluated according to RECIST guidelines.Results Forty-six patients with intact follow-up data were enrolled.The median latency of radiation brain injury was 34 months.Patients were divided into the response (CR+PR) and non-response groups.The risk factors influencing the response rate during 10-12 months and 18-24 months were identified and analyzed.Univariate analysis demonstrated that gender,age,smoking history,T stage,and high-intensity treatment exerted no significant effect upon the objective remission rate during these two time intervals periods.Patients treated with gangliosides obtained high response rate.The response rate was 68.8％ in 10-12 months (P=0.000),and 81.8％ in 18-24 months (P=0.008).Multivariate analysis revealed that use of gangliosides was a favorable factor for mitigating radiation brain injury in two time intervals (OR=19.8 and 13.5;P=0.001 and 0.005).Conclusions Use of gangliosides probably accelerates the healing of radiation brain injury,whereas the clinical efficacy remains to be elucidated by prospective clinical trials.

To evaluate the value of postmastectomy radiotherapy (PMRT) for pathological T3N0 breast cancers. From 11,288 breast cancer patients treated with mastectomy from 1997 to 2014, 78 (0.7%) women who had pathological T3N0 diseases and didn't receive neoadjuvant systemic therapy were included in this analysis. Kaplan-Meier method was used to calculate the Overall survival (OS), disease-free survival (DFS), distant metastasis (DM) and local recurrence (LRR) and the difference was tested by the Log-rank test. The median age was 47 years (range, 23-88 years). The median tumor size was 6cm (5-15cm). Forty (51.3%) patients received PMRT. The use of PMRT decreased with time, 61.7% before 2007 and 43.2% after 2007. Sixty-seven (85.9%) received chemotherapy, and 35 (44.9%) received hormone therapy. The clinical variables were well balanced between patients with and without PMRT, except that PMRT group had more patients with younger age and more received chemotherapy. With a median follow-up time of 79 months (range, 6-232months), the 8-year OS, DFS, LRR, DM for all patients was 88.6%, 88.0%, 2.0% and 8.6%. There were no significant differences in OS (83.8% vs. 95.5%, p=0.126), DFS (84.4% vs. 92.1%, p=0.531) and LRR (0% vs. 4.5%) between PMRT and non-PMRT group. The only patient with LRR in non-PMRT group had chest wall recurrence at 51 months after surgery. ER and PR status were the only prognostic factors for DFS. The 8-year DFS was 96.9% and 82.9% for ER positive and ER negative patients (p<0.001), 97.1% and 81.9% for PR positive and PR negative patients (p<0.001). Pathological T3N0 breast cancers have excellent locoregional control despite of PMRT, therefore PMRT might not be required for all. Further study is warranted to identify high-risk patients for individualized PMRT.

To analyze the clinic outcomes of preoperative chemoradiotherapy (CRT) combined with surgery on rectal cancer patients with mesorectal fascia (MRF) involved by tumor infiltration or T4b. From January 2007 to November 2014, patients of rectal adenocarcinoma, who were diagnosed involved MRF by tumor infiltration (MRF+) or T4b based on pelvic MRI and undergone preoperative CRT, were in analysis. CRT followed by radical resection 6-8 weeks later was planned for all the patients, and adjuvant chemotherapy was delivered depending on postoperative recovery of patient and oncologist’s suggestion. A total of 111 eligible patients were enrolled in this study, with the median age 55 years (range: 24-82 years) and median distances 4 cm (range: 1-12 cm) from tumor edge to anal verge. Diagnosed by MRI, 48 patients (43.2%) were staged T4b and 63 cases (56.8%) with MRF+. Radiotherapy dose ranged from 44 to 50.4Gy (Median 50Gy), and concurrent capecitabine with or without oxaliplatin was administrated. In all, 74 patients (66.7%) received surgery after CRT (R0: 70, R1: 1, R2: 3). Among 37 cases who didn’t undergo surgery, 15 patients (13.5%) remained unresectable disease after CRT, 2 patients worried about high surgery risk, 14 patients refused to surgery because of private reasons, and 6 were found distant metastases before surgery. R0 resection rate was 63.1% for all the patients (T3 and MRF+: 73.0% vs. T4b: 50.0%, p=0.013).The median follow-up time was 45 months, 15 patients met local recurrences or progress, 36 patients undergone distant metastases. The 3-year OS and DM of all patients were 62.5% (R0: 76.7% vs. Non-R0: 37.8%, p<0.01) and 36.1% (R0: 28.6% vs. Non-R0: 50.9%, p=0.08), respectively. 57 patients died and the main cause of death was due to distant metastasis (76.9%). One third of rectal cancer patients with MRF+ or T4b still could not be resected radically even after chemoradiation, however patients with R0 resection would resulted in better survival. We should explore more effective treatment regimen for those patients, especially for cases of T4b.

Objective To investigate the influencing factors for postradiation nasopharyngeal necrosis (PRNN) by analyzing clinical characteristics,prognosis,and dosimetry of PRNN after initial intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods A retrospective analysis was performed among 1217 patients with NPC who received initial IMRT from 2001 to 2013.Twentyone patients were diagnosed with PRNN by clinical symptoms,endoscopy,magnetic resonance imaging,and pathological evidence (not including local recurrence).The clinical characteristics and prognosis were summarized and the radiotherapy plans were reassessed for dosimetric evaluation.Results In the 21 patients with PRNN,17 were male and 4 female;one patient was in stage T2,3 in stage T3,and 17 in stage T4.The median volume of gross tumor was 83 cm3.All patients received radiotherapy with a prescribed dose of 73.92 Gy except one patient with stage T2 disease who received a prescribed dose of 69.96 Gy.The time to PRNN after radiotherapy ranged between 1.8 and 21.9 months (median time =6.2 months).The incidence of massive nasopharyngeal bleeding was 48％ (10/21).In the 21 patients,6 recovered form PRNN,15 remained ill,and 8 patients died,consisting of 4 who died of massive nasopharyngeal bleeding,3 of cachexia with multiple organ failure,and 1 of multiple bone metastases.Conclusions PRNN is one of the severe adverse reactions after IMRT for NPC.The development of PRNN is related to advanced T stage,large tumor volume,poor nutritional status,infection,radiotherapy dose,and intense treatment.Massive nasopharyngeal bleeding and cachexia are the primary causes of death in patients with PRNN.

Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma.

The host immune response is important in the natural history of nasopharyngeal cancer. The aim of this study was to evaluate the prognostic significance of peripheral blood lymphocyte subpopulation in nasopharyngeal cancer (NPC) treated with intensity-modulated radiation therapy (IMRT). From January in 2014 to July in 2015, 251 cases of nasopharyngeal carcinoma patients treated by definitive intensity-modulated radiation therapy (IMRT) in our hospital were analyzed retrospectively. There were 3 patients with stage I disease, 25 patients with stage II disease, 117 patients with stage III disease, and 106 patients with stage IV disease. Treatment options depended on the TNM stage. Overall, 97 patients (38.6%) were treated with radiation therapy alone and 154 patients received concurrent chemoradiation therapy. The median follow-up period was 11 months for surviving patients. The level and the dynamic change of lymphocyte subpopulation during treatment were measured to evaluate prognosis significance. Progression-free survival rate was estimated by using the Kaplan-Meier method, and the differences between survival curves were calculated by using the log-rank test. Cox regression model was applied to determine the independent prognostic factors. The actuarial 1-year PFS rate for all patients was 89.2%. Univariate factor analyses showed that the TNM stage, the CD4/CD8 ratio after treatment, and patterns of CD4/CD8 ratio dynamic changes during treatment were significantly associated with PFS. Patients with CD4/CD8 ratio less than 0.435 after treatment had significantly unfavorable outcome (1-year PFS 79% vs. 95%, P = 0.004). Using multivariate analysis, only CD4/CD8 ratio after treatment was an independently significant factor for PFS (HR 1.121, P = 0.004). TNM staging system did not predict PFS. Peripheral blood CD4/CD8 ratio is a novel, independent predictor of prognosis in NPC patients treated with IMRT. The host immune response might play an important role in the progression of NPC.

PurposeThis study was conducted is to identify the prognostic value and staging categories of magnetic resonance imaging (MRI)-detected intracranial extension in nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) to determine whether it is necessary to subclassify the T4 classification NPC.Materials and MethodsA total of 335 nonmetastatic T4 classification NPC patients with MRI treated between March 2004 and June 2011 by radical IMRT were included. The T4 classification patients were sub-classified into two grades (T4a, without intracranial extension vs. T4b, with intracranial extension) according to the site of invasion.ResultsThe frequency of intracranial extension was 40.9% (137 of 335 patients). Multivariate analysis identified subclassification (T4a vs. T4b) as an independent prognostic factor for local failure-free survival (p=0.049; hazard ratio [HR], 0.498) and overall survival (p=0.004; HR, 0.572); however, it had no effect on regional failure-free survival or distant failure-free survival (p > 0.050).ConclusionFor patients with T4 classification NPC, those with MRI-detected intracranial extension are more likely to experience local failure and death after IMRT than patients without intracranial extension. According to the site of invasion, subclassification of T4 patients as T4a or T4b has prognostic value in NPC.

To present initial results of an interim analysis of a phase III trial of Short Term chemoradiotherapy (SCRT) (experimental group) versus Long-term chemoradiotherapy (LCRT) (control group) in Locally Advanced Rectal cancer (LARC)(STELLAR trial). Patients with distal or middle third, T3-T4 and/or N+ rectal adenocarcinomas diagnosed by magnetic resonance imaging, were randomly assigned to experimental group or control group. In experimental group, patients received SCRT (25 Gy/ 5 fractions/ 5 days), followed by 4 courses of CAPOX. In control group, patients received LCRT (50 Gy/ 25 fractions/35 days with concurrent capecitabine). TME surgery was performed 4 and 6 or 8 weeks in experimental group and control group, respectively, and 2 or 6 courses of CAPOX was prescribed as the postoperative adjuvant chemotherapy in experimental group and control group, respectively. An interim analysis of the first 100 patients was planned as little is known about toxicity of short-term radiation combined with sequential chemotherapy except Polish study, the primary endpoint of this interim analysis were pCR and acute toxicities. The primary endpoint for the phase III study was 3-year disease-free survival (DFS) and the hypothesis is 3-year DFS in experimental group was non-inferior to that in control group. The estimated enrolled number of patients is 552. Until February 14, 2016, 97 eligible patients from 7 Chinese hospitals were enrolled: 52 in experimental group and 45 in control group, with median distances from tumor edge to anal verge were 3 cm and 5 cm, respectively. Sixty-four patients, who had finished neoadjuvant treatment, were eligible for toxicity analysis. Grade 3+ acute toxicity was observed 26.6% of patients in experimental group and 5.9% in control group. As to 35 patients who had received TME surgery (15 in experimental group and 20 in control group), R0 resection rates and pathological complete response (pCR) rates were 93.3%, 46.7% (7/15) and 90.0%, 10.0% (2/20), respectively in experimental group and in control group. There were only 3 in experimental group and 3 in control group finished adjuvant chemotherapy. Others are waiting for either surgery (12 in the experimental group and 9 in the control group) or adjuvant chemotherapy (12 in the experimental group and 17 in the control group). The initial analysis revealed the acute toxicity was tolerable in both groups, and the experimental group showed a surprising pCR rate (ClinicalTrials.gov No.: NCT02533271)

To investigate the potential risk factors for parotid gland failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods The clinical data of 1096 NPC patients who underwent IMRT in our hospital from January 2005 to December 2012 were analyzed retrospectively. Among these patients, 13 patients experienced parotid gland recurrence, and the recurrence in 12 patients was analyzed. A case-control study was performed with the side of the parotid gland with recurrence as the case group and the side of the parotid gland without recurrence as the control group. The association of parotid gland failure with the extent of tumor invasion, IMRT dose distribution, and local recurrence was analyzed. The differences between groups were analyzed with χ2 test or Fisher's the exact probability test. Results Among the 12 patients, 11 had stage III-IV primary NPC; after definitive IMRT, 9 had local tumor residues. The median time of parotid gland recurrence was 16(8-43) months. Of all the patients who experienced recurrence, 8 had recurrence in the superficial lobe of the parotid gland, 1 in the deep lobe, and 3 in both superficial and deep lobes. Recurrence was in the same side of primary tumor (P<0.001). Compared with the controls, the side of the parotid gland with recurrence had higher rate of cervical puncture/surgery (P=0.025). Parotid gland recurrence was often complicated by ipsilateral lymph node recurrence (67% vs. 8%, P=0.003), as well as the tendency of ipsilateral primary lesion recurrence (42% vs. 8%; P=0.059). Conclusions For NPC patients, the recurrence rate in the parotid gland is very low. Parotid gland recurrence may be related to locally advanced NPC, residues after treatment, the history of cervical puncture/surgery, and locoregional recurrence. The low radiotherapy dose in the parotid gland caused by IMRT may be an important reason for parotid gland recurrence. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Periparotid failure; Failure analysis

The objective of the study was to evaluate long-term survival outcomes and toxicity of T4 classification nasopharyngeal carcinoma (NPC) with intracranial extension (IE group) or without intracranial extension (non-IE group) after intensity-modulated radiotherapy (IMRT) using the propensity score matching method. After generating propensity scores given the covariates of age, sex, N classification, and concurrent chemotherapy, 132 patients in each group were matched. The 5-year local failure-free survival rate and the 5-year overall survival rate in the IE group were lower than the patients in the non-IE group (74.6 vs. 88.9 %, p = .008; 51.1 vs. 71.9 %, p = .005). Grade 2 hypothyroidism was more common in the IE group (13.2 vs. 3.4 %, p = .029). For patients with T4 classification NPC after IMRT, patients with intracranial extension need more attention to the thyroid gland function and are more likely to experience local failure and death than patients without intracranial extension.