e18068 Background: to summarize the characteristics of local extension of the eccentric and central nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) and to improve clinical target volume (CTV) delineation. Methods: MRIs of 870 newly diagnosed NPC patients were reviewed. According to the tumor distribution feature, the NPCs were divided into eccentric and central lesions. Results: All local invasions presented as continuous invasion from gross lesions and structures adjacent to the nasopharynx are more likely to be invaded. There were 240 (27.6%) and 630 (72.4%) cases with central and eccentric lesions, respectively. The spread of eccentric lesions centered on the ipsilateral Rosenmüller’s fossa; and most anatomic sites had significantly higher invasion rates in ipsilateral side than the contralateral side ( P < 0.05); however, they were at low risk of concurrent bilateral tumor invasion ( < 10%) except the prevertebral muscle (15.4%) and nasal cavity (13.8%). The extension of central NPCs centered on the nasopharyngeal superior-posterior wall and was more common in superior-posterior direction; furthermore, the bilateral tumor invasion into the anatomical sites was common. Conclusions: Local invasion of NPC was characterized by continuous invasion from proximal to distal sites. The eccentric and central lesions showed different invasion features. Individual CTV delineation should be based on the distribution characteristics of tumors. The eccentric lesion had very low probability of invasion into the contralateral tissue, thus routine prophylactic radiation of contralateral parapharyngeal space and skull base foramina may not be necessary.

Objectives: The optimal treatment and associated clinical outcomes for lymphoepithelial carcinoma of the major salivary gland (LECSG) are currently unclear. As such, the purpose of this study was to assess the survival rates of LECSG patients who received either upfront surgery or upfront chemoradiotherapy (CRT). Materials and methods: In this retrospective study, we analyzed cases of LECSG patients treated at our center from January 2010 to April 2021. The cumulative incidences of overall survival rate (OS) and locoregional failure-free survival rate (LRFFS) were evaluated using the Kaplan-Meier method. In order to balance potential risk factors between the treatment groups, we conducted propensity score matching (PSM) at a 1:1 ratio. Results: The study enrolled a total of 107 patients, among whom 24 received surgery alone, 56 underwent surgery combined with postoperative radiotherapy, and 27 underwent definitive radiotherapy. The 5-year LRFFS rate and 5-year OS rate for the entire cohort were 86.6% and 84.4%, respectively. Following PSM, the 5-year LRFFS and OS rates for the upfront CRT cases were comparable to those of upfront surgery, both before and after matching. However, the upfront surgery group showed a tendency toward more de novo facial nerve injury and post-treatment facial nerve injury. Conclusion: The results of this study suggest that upfront CRT is as effective as upfront surgery in terms of locoregional control and overall survival for LECSG patients. Therefore, upfront CRT could be considered a viable treatment option, potentially avoiding the risks associated with surgical intervention.

AbstractBackgroundThis study presents a summary of the clinical characteristics of non‐nasopharyngeal lymphoepithelial carcinoma (NNPLEC), effects of combined modality treatment and prognostic value of plasma Epstein–Barr virus (EBV) deoxyribonucleic acid (DNA) load, with the aim of providing a reference framework for optimizing treatment practices and outcomes.MethodsPatients with NNPLEC treated by our center between January 2000 and December 2020 were retrospectively reviewed.ResultsIn total, 728 patients were included. The lung was identified as the most common primary tumor site (64.0%), followed by the salivary gland (19.2%). A total of 539 (74.0%) patients underwent surgery, 459 (63.0%) received chemotherapy, and 361 (49.6%) were subjected to radiotherapy. The median follow‐up time was 45 months (range, 6–212 months) and 5‐year overall survival (OS) was 79.1%. Increased plasma EBV‐DNA load of >513.5 copies/mL was predictive of disease progression, with a specificity of 98.1% and a sensitivity of 98.9%. In multivariate Cox analysis, N stage, surgery, and radiotherapy were independent prognostic factors for both OS and PFS. Radiotherapy significantly improves OS in comparison with no radiotherapy group for salivary LEC, while surgery significantly improves OS for pulmonary LEC.ConclusionBased on our analysis, surgery and radiotherapy are associated with better OS and PFS for NNPLEC. Radiotherapy could be recommended for salivary LEC, while surgery remains the primary treatment strategy for pulmonary LEC patients. An increased plasma EBV‐DNA load of >513.5 copies/mL is strongly predictive of disease progression, supporting the importance of regular evaluation of plasma EBV‐DNA as part of the diagnostic routine.

Abstract Purpose To address the regional lymph node (RLN) distribution and the long‐term efficacy in unilateral nasopharyngeal carcinoma (NPC), providing elective irradiation for RLN with intensity‐modulated radiotherapy (IMRT). Methods The involvement of clinical data of 136 patients with unilateral NPC, who underwent IMRT from November 2003 to December 2020 were analyzed retrospectively. The therapeutic effect and failure pattern of RLN metastasis were evaluated. Results Of 57.1% patients have bilateral RLN metastasis. The rate of contralateral RLNs metastasis is lower than that of ipsilateral RLNs. Contralateral RLN metastasis mainly occurs in level VIIa (39.0%) and II (38.2%). While level IVa is only 0.7%, and none of RLN metastasis was found in level IVb and Va. The median follow‐up was 70 months, and the 3‐, 5‐and 10‐year regional recurrence‐free survival (RRFS) were 94.1%, 93.1%, and 93.1%, respectively. Conclusion Routine prophylactic irradiation may not include contralateral lower neck LN and level Va for N0‐1 unilateral NPC.

Most nasopharyngeal carcinoma (NPC) protocols define primary gross tumor volume (GTVnx) plus a range from 2 to 5 mm as the high‐dose clinical target volume (hd‐CTV). However, in China, hd‐CTV is defined as GTVnx plus 0 mm.

Purpose To evaluate the long-term local control, failure patterns, and toxicities after individualized clinical target volume (CTV) delineation in unilateral nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Methods Unilateral NPC was defined as a nasopharyngeal mass confined to one side of the nasopharynx and did not exceed the midline. From November 2003 to December 2017, 95 patients were retrospectively included. All patients received IMRT. The CTVs were determined based on the distance from the gross tumor. The contralateral para-pharyngeal space and skull base orifices were spared from irradiation. Results There were three local recurrences and eight regional recurrences in 10 patients during an 84-month follow-up. All local recurrences were within PGTVnx, and all in-field recurrences. No recurrences were found in traditional high-risk areas including contralateral the para-pharyngeal space and skull base orifices. The 10-year local-recurrence-free survival, regional-recurrence-free survival and overall survival were 96.2%, 90.5% and 84.7%, respectively. The dosimetry parameters of the tumor-contralateral organs were all lower than the values of the tumor-ipsilateral side (P < 0.05). The late toxicities occurred mainly in the tumor-ipsilateral organs, including radiation-induced temporal lobe injury, impaired visuality, hearing loss and subcutaneous fibrosis. Conclusion Individualized CTV delineation in unilateral NPC could yield excellent long-term local control with limited out-of-field recurrences, reduced dose to tumor- contralateral organs and mild late toxicities, which is worthy of further exploration.

Background The present study aimed to determine a treatment strategy and Intensity-Modulated Radiotherapy (IMRT) target volume for major salivary gland carcinoma (SGC). Methods Patients with SGC treated at our cancer center between August 2009 and August 2020 were retrospectively reviewed. Results The following primary tumor sites were identified: parotid gland in 61 (69.3%) patients, submandibular gland in 21 (23.9%) patients, and sublingual gland in six (6.8%) patients. Lymphoepithelial carcinoma (LEC) was the most common tumor subtype that accounted for 23.9% of cases. A total of 80 (90.9%) patients received radical surgery combined with postoperative radiotherapy. Eight patients (9.1%) received definitive radiotherapy: six patients with advanced-stage disease received induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT), and two patients with early-stage disease received CCRT. Complete response was observed in these eight patients after treatment completion. The median follow-up time of all patients was 42 months (range: 4–129 months). No patient developed local recurrence. The 5-year overall survival, regional failure-free survival, distant metastasis-free survival, and progression-free survival probabilities were 84.1%, 95.6%, 75.3%, and 75.7%, respectively. Distant metastasis was observed in 18 (20.5%) patients, followed by regional 2 (2.3%) recurrence. Permanent facial nerve injury was confirmed in 31 patients by follow-up. None of the patients experienced facial nerve paralysis in the definitive radiotherapy group. Conclusions LECs may be sensitive to chemoradiotherapy, which may achieve a radical effect and avoid unnecessary surgical injury. IC combined with CCRT is expected to become a new treatment strategy for advanced LECs. The IMRT target volume delineation according to the surgical principles may be a more promising method with good clinical efficacy that is worthy of further study.

Purpose To evaluate the efficacy of concurrent chemoradiotherapy (CCRT) in subgroups of stage III nasopharyngeal carcinoma (NPC) in the context of intensity-modulated radiotherapy (IMRT). Methods A total of 272 patients with stage III NPC who underwent IMRT with or without concurrent chemotherapy were retrospectively reviewed. Clinicopathological features were evaluated by a Cox regression model to identify independent prognostic factors. Survival outcomes were assessed using the Kaplan–Meier method and log-rank test. Results The median follow-up time was 108 months. The 10-year locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 87.8%, 80.7%, 68.8%, and 74.9%, respectively. Multivariate analysis showed that the N classification was significantly associated with DMFS (hazard ratio [HR] 3.616, 95% confidence interval [CI] 1.387–9.428, P = 0.009), DFS (HR 2.417, 95% CI 1.291–4.423, P = 0.006), and OS (HR 3.024, 95% CI 1.385–6.602, P = 0.005). In patients with T1-3N2 disease, CCRT was associated with improved 10-year LRFS (89.6% vs. 65.4%, P = 0.005), DFS (71.9% vs. 39.4% P = 0.001) and OS (80.0% vs. 50.5%, P = 0.004) compared with IMRT alone. However, in patients with T3N0-1 disease, no significant survival differences were observed between patients treated with IMRT alone and CCRT ( P > 0.05). Conclusions CCRT is an effective therapy in stage III NPC, especially for patients with N2 disease, but IMRT alone may be adequate for N0-1 disease. Individualized treatment strategies are essential for patients with varying disease risks.

Purpose To characterize the pattern of post-mastectomy supraclavicular lymph node (LN) metastases in patients with breast cancer (BC) and to provide insights for individualized clinical target volume delineation for radiotherapy. Methods We retrospectively analyzed 88 patients with BC who developed post-mastectomy regional LN metastases. The affected regional LNs were categorized as the ipsilateral medial supraclavicular LN area (IMSC-LN), ipsilateral lateral supraclavicular LN area (ILSC-LN), ipsilateral infraclavicular LN area (IIC-LN), and ≥2 groups in the ipsilateral clavicular LN area (MMIC-LN). Clinical characteristics were included in a multivariate analysis to identify risk factors for clavicular LN metastases. Results The ILSC-LNs (68.2%) were the most common metastatic site. IMSC-LN metastases showed a significant association with estrogen-receptor (ER) negative status, left-sided BC, and positive axillary LNs. Tumor size ≥2.4 cm and Her2 type were predictors of ILSC-LN metastases. Additionally, tumor size ≥2.4 cm, and level I ipsilateral axillary metastases were associated with MMIC-LN metastasis. Conclusion ILSC-LN was the most frequently affected group of supraclavicular lymph nodes. ER-negative status, left-sided BC, tumor size, and positive ipsilateral axillary LNs are potentially associated with the pattern of supraclavicular LN metastatic involvement.

To evaluate whether high biologically effective dose (BED) radiotherapy improves local control and survival outcomes for patients with brain metastases (BMs) from small-cell lung cancer (SCLC) and to determine possible prognostic factors. From January 1998 to June 2018, 250 patients with BM from SCLC were retrospectively analyzed. The Cutoff Finder program was used to classify patients by BED. Overall survival (OS) and BM progression-free survival (BM-PFS) were analyzed using the Kaplan-Meier method and log-rank test. A Cox regression model was used to calculate the hazard ratio and 95% CI for prognostic factors for OS among the study population and propensity score (PS)–matched patients. A BED of 47.4 was taken as the optimal cutoff value. Both OS and BM-PFS were significantly improved in the high-BED (>47.4 Gy) than in the low-BED (≤47.4 Gy) group (median OS: 17.5 months vs 9.5 months, P < .001, median BM-PFS: 14.4 months vs 8.3 months, P < .001). Biologically effective dose ( P < .001), Eastern Cooperative Oncology Group performance status ( P = .047), smoking ( P = .005), and pleural effusion ( P = .004) were independent prognostic factors for OS. Propensity score matching with a ratio of 1:2 resulted in 57 patients in the high-BED group and 106 patients in the low-BED group. In the PS-matched cohort, OS and BM-PFS were significantly prolonged in the high-BED group compared with the low-BED group ( P < .001). Biologically effective dose >47.4 Gy improves survival among patients with BM from SCLC. Eastern Cooperative Oncology Group score, smoking, and pleural effusion independently affect OS of SCLC patients with BM.

Objective The prediction of survival of gastric neuroendocrine tumours (g-NETs) is controversial. Prognostic effects of the metastatic lymph node ratio (LNR) in patients with g-NET were explored, and a nomogram was plotted to predict the survival rates of patients. Methods A longitudinal study conducted on the basis of the Surveillance, Epidemiology, and End Results database. The association between LNR and survival were investigated by using Pearson correlation and Cox regression. Overall survival (OS) and cancer-specific survival (CSS) rates were predicted with the help of nomograms. Results A total of 315 patients with g-NET diagnosed from 2004 to 2015 were included in this study. LNR was discovered to have a negative correlation with OS and CSS (Pearson correlation coefficients: 0.343 (p<0.001) and 0.389 (p<0.001), respectively). The multivariate analyses indicated age, tumour site, differentiation, T staging, M staging, chemotherapy and LNR to be independent prognostic factors for both OS and CSS. Surgery was also a prognostic determinant for CSS (p=0.003). Concordance indices of the nomograms for OS and CSS were higher than those of the TNM classification (0.772 vs 0.730 and 0.807 vs 0.768, respectively). As per the area under the receiver operating characteristic curve, predictive ability of the nomograms for survival of 1, 3 and 5 years was all better than that of TNM classification. Conclusions LNR is an independent predictor of g-NETs. The nomograms plotted in this study have a satisfying predictive ability of survival risks and are capable of guiding tailored treatment strategies for patients with g-NET.

Vascular depression can respond poorly to antidepressants. This study aimed to explore the efficacy and safety of tandospirone plus escitalopram for treating vascular depression with anxiety. This pilot randomized controlled trial included consecutive inpatients/outpatients with vascular depression/anxiety at the Department of Neurology, Fujian Medical University Union Hospital, China (January 2014 to December 2016). Among 157 patients screened, 100 were randomly divided into the tandospirone + escitalopram (combination therapy) and escitalopram (monotherapy) groups equally, and then followed for 8 weeks. Efficacy was evaluated using the Hamilton Depression (HAMD), Hamilton Anxiety (HAMA), Clinical Global Impression (CGI) and Mini-Mental State examination (MMSE) scales. Adverse events (AEs) were assessed with the Treatment Emergent Symptom Scale (TESS). HAMD and HAMA scores decreased progressively, showing reductions versus baseline at 1, 2, 4 and 8 weeks in both groups (P < 0.001). HAMD and HAMA scores were lower in the tandospirone + escitalopram group than those in the escitalopram group at 1 and 2 weeks (P < 0.001), but not at 4 and 8 weeks. Improvements in CGI scores (severity, improvement and efficacy indexes) were greater in the tandospirone + escitalopram group than that in the escitalopram group at 1 and 2 weeks (P < 0.01), but not at 4 and 8 weeks. The tandospirone + escitalopram group had higher MMSE scores than that in the escitalopram group at 4 and 8 weeks (P < 0.01). All AEs were mild, and the rates were comparable between groups. Augmentation of escitalopram with tandospirone accelerates the onset of anti-depressive and anxiolytic effects and improves cognitive function in patients with vascular depression and anxiety.

The impact of adjuvant radiotherapy in pT3N0 rectal cancer is controversial. We aimed to determine the risk factors for cancer‐specific survival (CSS) among these patients and to develop a risk‐stratification system to identify which of these patients would benefit from adjuvant radiotherapy. In this review of the Surveillance, Epidemiology, and End Results database (2010‐2014), we analyzed the data of pT3N0 rectal cancer patients who had not undergone neoadjuvant radiotherapy. Prognostic factors were identified using the Cox proportional hazards model, and risk scores were derived according to the β regression coefficient. A total of 1021 patients were identified from the database search. The overall 5‐year CSS was 86.31%. Multivariate analysis showed that age ( P < 0.001), tumor differentiation ( P = 0.044), number of nodes resected ( P = 0.032), marital status ( P = 0.005), and radiotherapy ( P = 0.006) were independent prognostic factors for CSS. A risk‐stratification system composed of age, tumor differentiation, and number of nodes resected was generated. Low‐risk patients had better CSS than high‐risk patients (92.13% vs 72.55%, P < 0.001). The addition of radiotherapy to surgery doubled the CSS among the high‐risk patients (42.06% vs 91.26%, P = 0.001) but produced no survival benefit among the low‐risk patients (93.36% vs 96.38%, P = 0.182). Our risk‐stratification model based on age, tumor differentiation, and number of nodes resected predicted the outcomes of pT3N0 rectal cancer patients. This model could help identify patients who may benefit from adjuvant radiotherapy.

目的 在大脑中动脉狭窄/闭塞的高血压脑梗死患者中,探讨血压成分与基底节区扩大的血管周围间隙之间的相关性.方法 回顾性纳入自2014年1月到2018年12月在福建医科大学附属协和医院经临床、颅脑计算机断层扫描血管造影(CTA)及头颅核磁共振成像(MRI)确诊为大脑中动脉狭窄/闭塞的高血压脑梗死患者49例,根据脑小血管病评估量表对患者头颅MRI上基底节区扩大的血管周围间隙(BG-EPVS)进行评估,将患者分为＞10BG-EPVS和≤10 BG-EPVS组,比较两组患者年龄、性别、收缩压、舒张压、脉压、平均动脉压(MAP)及其他血管相关因素等基线特征.采用Logistic回归分析法,评估血压成分与＞10 BG-EPVS之间的相关性.采用受试者工作特征曲线(ROC曲线)分析法计算收缩压、舒张压、脉压和MAP判断＞10 BG-EPVS的曲线下面积(AUC).结果 自2014年1月到2018年12月,共纳入49例符合入选标准的大脑中动脉狭窄/闭塞的高血压脑梗死患者[年龄(65.1±10.5)岁,男性30例(61.2％)].与≤10 BG-EPVS组患者比较,＞10 BG-EPVS组患者年龄更大[(67.7±8.1)比(60.4±12.7)岁],收缩压[(146.5±12.7)比(137.7±13.2) mm Hg]和MAP[(103.2±9.4)比(97.5±9.6)mm Hg,均P＜0.05]更高.Logistic回归分析显示,在调整年龄因素后,收缩压(OR=1.08,95％ CI 1.01～1.15,P=0.025)和MAP(OR=1.19,95％ CI 1.06～1.34,P=0.003)与＞10 BG-EPVS存在显著相关性.ROC曲线分析显示:收缩压和MAP的AUC分别为0.711(95％ CI 0.551～0.870,P=0.015)和0.710(95％ CI 0.553～0.867,P=0.015);舒张压和脉压的AUC分别为0.629(95％ CI 0.463～0.795,P=0.135)和0.575(95％ CI 0.391～0.759,P=0.384).结论 在大脑中动脉狭窄/闭塞的高血压脑梗死患者中,收缩压和MAP与＞10BG-EPVS存在显著相关性,是判断＞10 BG-EPVS的良好指标,可视为＞10 BG-EPVS的标志物.

This study aimed to evaluate the role of postoperative radiotherapy (RT) in dermatofibrosarcoma protuberans (DFSP) and identify the prognostic factors influencing the disease-free survival (DFS). A total of 184 patients with DFSP were analyzed from 2000 to 2016. The regression model was used to examine the prognostic factors for DFS. Baseline covariates were balanced using a propensity score model. The role of RT was assessed by comparing the DFS of the surgery + RT group with that of the surgery group. The median follow-up was 58 months (range, 6–203 months). The 5-year DFS rate was 89.8%. The univariate analysis showed that age ≥ 50 years, presence of fibrosarcoma, margins < 2 cm, and tumor size ≥5 cm were associated with worse DFS (P = 0.002, P <  0.001, P = 0.030, and P = 0.032, respectively). The multivariate Cox regression model revealed that age, margin width, lesion number, and histological subtype independently affected DFS. The Ki-67 expression was related to age and histological subtype. Patients with Ki-67 ≥ 17% showed a worse DFS than those with Ki-67 < 17% (35.8% vs 87.8%, P = 0.002). In the matched cohort, DFS was significantly higher in the S + RT group than in the S group (5-year DFS, 88.1% vs 56.2%, P = 0.044). Age, margin width, lesion number, and histological subtype were independent risk factors for DFS in patients with DFSP. The high expression of Ki-67 could predict a poor prognosis. Postoperative RT could improve DFS for patients with DFSP.

PURPOSE:The inflammatory status of patients with cancer appears to affect cancer progression and patient prognosis. We examined the characteristics of cancer-associated systemic and local inflammation and its impact on the overall survival (OS) of patients with locally advanced rectal cancer (LARC) who received neoadjuvant radiotherapy (nRT). PATIENTS AND METHODS:Seventy-six consecutive LARC patients who received nRT from February 2012 to September 2015 were retrospectively analyzed. The peripheral neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, and the CD8+ T-cell count was determined from surgical specimens. Factors associated with OS were identified by univariate and multivariate Cox regression. RESULTS:The median follow-up time was 23.0 months (range: 2-59), and the overall 5-year OS rate was 68.6% (95% CI =46.06-91.14). Patients with a high NLR (≥2.0) and a low CD8+ T-cell count (<9%) had a significantly worse 5-year OS than those with a low NLR and a high CD8+ T-cell count (P=0.005). NLR was also associated with lymphovascular invasion (P=0.014) and T stage (P=0.047), and the CD8+ T-cell count was associated with mucinous adenocarcinoma (P=0.005) and T stage (P=0.049). An NLR <2.0 was associated with pathological complete regression after nRT (P=0.039). Multivariate Cox regression indicated that NLR (P=0.025), CD8+ T-cell count (P=0.018), age (P=0.020), lymphovascular invasion (P=0.038), and T stage (P=0.011) were independently associated with OS. CONCLUSION:A high NLR and a low CD8+ T-cell count were significantly associated with poor survival in our population of patients with LARC. Measurement of markers of systemic and local inflammation might help to predict the prognosis of patients with LARC after nRT.