目的:探讨鼻咽癌延误诊断的原因。从而提高鼻咽癌患者的早期诊断率,改善治疗效果。方法: 回顾性分析324例在我科接诊前因各种因素而延误诊断的鼻咽癌患者首发症状、首诊误诊科室、误诊疾病。结果: 本组病例首发症状分别为颈部包块138例(42.5%)、鼻部症状148例(45.6%)、耳部症状66例(20.3%)、头痛46例(14.2%)、其他17例(5.2%),有两种首发症状的病例为91例。首诊误诊的疾病有颈部淋巴结炎、慢性鼻鼻窦炎、鼻出血、分泌性中耳炎、脑动脉硬化等27种疾病。涉及普外科、耳鼻咽喉科、神经内科、骨科、呼吸内科、口腔科、烧伤科、眼科、中医科等9个科室。结论: 加强鼻咽癌知识普及,完善继续医学教育及住院医师培训,积极寻找鼻咽癌的早期诊断方法能减少鼻咽癌的延误诊断。
【摘要】目的探讨鼓膜置管对鼻咽癌(NPC)患者放疗前后分泌性中耳炎(SOM)的疗效。方法2005年3月2010年1月将60例(84耳)NPC并发SOM患者分为两组:A组30例行鼓膜切开鼓膜置管;B组30例保守治疗为对照组,并行随访,对两组患者有效率和并发症发生率进行统计。结果60例中58例存活,1例死于全身衰竭,1例死于大出血。存活患者中治疗SOM有效率为:A组85.4%(35/41),B组为30.2%(13/43),两组差异有统计学意义(Plt;0.05);并发症发生率A组为14.6%(6/41),B组为69.8%(30/43),B组并发症高于A组,差异有统计学意义(Plt;0.05)。结论NPC患者在放疗后,咽鼓管功能受到严重损害,是不可逆的病变,鼓膜置管治疗NPC并发SOM较保守治疗效果好,并发症的发生率低。
Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
Intensity-modulated radiotherapy planning for nasopharyngeal carcinoma is very complex. The quality of plan is often closely linked to the experience of the treatment planner. In this study, 10 nasopharyngeal carcinoma patients at different stages were enrolled. Based on the scripting of Pinnacle3 9.2 treatment planning system, the computer program was used to set the basic parameters and objective parameters of the plans. At last, the nasopharyngeal carcinoma intensity-modulated radiotherapy plans were completed automatically. Then, the automatical and manual intensity-modulated radiotherapy plans were statistically compared and clinically evaluated. The results showed that there were no significant differences between those two kinds of plans with respect to the dosimetry parameters of most targets and organs at risk. The automatical nasopharyngeal carcinoma intensity-modulated radiotherapy plans can meet the requirements of clinical radiotherapy, significantly reduce planning time, and avoid the influence of human factors such as lack of experience to the quality of plan.
【摘要】 目的 探讨SPECT及CT对鼻咽癌颅底骨侵犯的检测能力。 方法 2006年5月-2009年12月对159例经病理确诊的初治鼻咽癌患者行颅底SPECT断层显像，同期行CT检查，分别计算颅底受侵的阳性率。 结果 ①159例鼻咽癌SPECT颅底断层阳性率46.5%（74/159），CT阳性率25.2%（40/159），SPECT检测敏感性高于CT（Plt;0.001）。 ②鼻咽癌伴颅神经损害SPECT检测敏感性高于CT（P=0.004）。 结论 SPECT对鼻咽癌颅底骨侵犯的检测敏感性优于CT。【Abstract】 Objective To compare the results of single-photon emission computed tomography (SPECT) and CT in skull base invasion in nasopharyngeal carcinoma (NPC). Methods A total of 159 patients with nasopharyngeal carcinoma were examined by SPECT and CT of nasopharynx and skull base from May 2006 to December 2009. The positive rates were compared by McNemar test. Results The positive rate of skull base invasion detected by SPECT and CT were 46.5% and 25.2% respectively (Plt;0.001). SPECT appeared to be superior to CT in the detection of skull base invasion in NPC with cranial nerve palsy (P=0.004). ConclusionsThe detection ability of SPECT in skull base invasion is superior to that of CT.
【摘要】 目的 观察时辰化学疗法联合放射治疗对比常规化学疗法联合放射治疗对鼻咽癌的近期疗效及其不良反应。 方法 2006年2月-2010年3月经病理学证实未接受过化学疗法的38例晚期鼻咽癌患者随机分为常规化学疗法联合放射治疗组（A组，n=20）和时辰化学疗法联合放射治疗组（B组，n=18）。两组均采用常规二维放射治疗。A组化学疗法方案为顺铂（DDP）80 mg/m2，采用完全水化方案，第1天静脉滴注；氟尿嘧啶800 mg/（m2•d），第2~6天120 h连续静脉滴注。B组时辰化学疗法采用Melodies多通道编程输液泵进行正弦曲线式时间调节给药。两组均为DDP 80 mg/m2，于10:00~22:00给药，浓度高峰设定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00给药，浓度高峰设定在凌晨4:00。每21天重复1次，行2~6疗程。 结果 A组3程化学疗法后有效率（PR）为95%（19/20），全程结束完全缓解率（complete remission，CR）达75%（15/20）；B组在2程化学疗法后PR达100%，全程治疗结束CR达94.4%（17/18）。两组不良反应主要为迟发性血小板减少，发生率分别为35%（7/20）和22.2%（4/18），其他不良反应两组间无明显差别。 结论 时辰化学疗法联合放射治疗对晚期鼻咽癌在减轻化学疗法造成的血小板减少方面有明显的优势，值得临床推广应用以及进一步发掘时辰化学疗法在临床治疗的价值。【Abstract】 Objective To investigate the efficacy and the adverse effects of routine chemotherapy and chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal cancer patients. Methods From March 2006 to March 2010, 38 patients diagnosed pathologically to have advanced nasopharyngeal cancer were randomly divided to the routine chemotherapy and radiotherapy group (group A, n=20) and the chrono-chemotherapy and radiotherapy group (group B, n=18). Patients in both groups received bi-dimensional radiotherapy. Patients in group A received a full hydration method, cisplatin (DDP) 80 mg/m2 intravenous infusion was also carried out on day 1; fluorouracil 800 mg/(m2•d) chemotherapy, and 120 hours of continuous intravenous infusion from day 2 to day 6. For patients in group B, Melodies multi-channel infusion pump programming to adjust the time of drug administering with a sinusoidal style was adopted; DDP 80 mg/m2 was administered intravenously on day 1 between 10:00 and 22:00 with the peak concentration set at 16:00; fluorouracil 800 mg/m2 was administered between 22:00 and 10:00 on the next day from day 2 to day 6 with the concentration peak set at 4:00. The treatments in both groups were repeated every 21 days, which was repeated for two to six courses of tremtment. Results After three courses of treatment for group A, partial response (PR) rate was 95% (19/20), and after six courses of treatment, the complete remission (CR) rate was 75% (15/20); After two courses of treatment for group B, the PR rate was 100%, and after six courses of treatment, the CR rate was 94.4% (17/18). The main adverse effect was thrombocytopenia at an incidence rate of 35% (7/20) and 22.4% (4/18) in the two groups respectively. There was no obvious difference in other adverse effects between the two groups. Conclusion Chrono-chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma has obvious advantages in reducing thrombocytopenia caused by chemotherapy, and it is worth further exploring the clinical applications and values of chrono-chemotherapy.
ObjectiveTo comprehensively analyze the disease burden of respiratory cancers in China from 1990 to 2021, and predict the trend of disease burden changes from 2022 to 2031, in order to improve its prevention and treatment strategies. MethodsData from the Global Burden of Disease (GBD) 2021 database were extracted and analyzed for the disease burden of nasopharyngeal cancer, laryngeal cancer, and tracheal, bronchial and lung cancers (hereinafter referred to as lung cancer) in China from 1990 to 2021. The Joinpoint 4.9.1.0 software was utilized to analyze the corresponding trends. The grey prediction model [GM (1,1)] was employed to forecast the disease burden of respiratory cancers in China from 2022 to 2031. ResultsThe disease burden of respiratory cancers attributed to tobacco and occupational carcinogens in China raised from 1990 to 2021. Among the respiratory cancers, lung cancer led in terms of incidence, mortality, and disability-adjusted life years (DALY) and their respective age-standardized rates from 1990 to 2021, followed by nasopharyngeal cancer, with laryngeal cancer being the lowest. Analysis via the Joinpoint regression model indicated that, overall, the disease burden of nasopharyngeal and laryngeal cancers in China decreased during this time period, while that of lung cancer increased. From a gender perspective, the disease burden of male patients was significantly higher than that of female patients from 1990 to 2021. Compared to the global average, the disease burden of respiratory cancers in China from 1990 to 2021 was still relatively heavy. As of 2021, the middle-aged and elderly population above 50 years old was the primary group suffering from the disease burden of respiratory cancers in China. The prediction model showed that the age-standardized rate of nasopharyngeal cancer in China would decline from 2022 to 2031; the age-standardized incidence rate of laryngeal cancer in China would increase, while its age-standardized mortality rate and DALY rate would both decrease; the age-standardized rates of lung cancer in China would increase. ConclusionIn the past 30 years, the disease burden of nasopharyngeal and laryngeal cancers in China has lightened, but the overall disease burden of lung cancer is still on the rise. Compared to the global average, the disease burden of respiratory cancers in China is still relatively heavy. The disease burden in male patients is significantly higher than that in female patients, and the population above 50 years old is the main group suffering from the disease burden. In the next 10 years, the disease burden of respiratory cancers in China will still tend to increase. Therefore, targeted prevention and treatment strategies for men and the middle-aged and elderly populations remain key challenges that urgently need to be addressed in China's response to respiratory cancers.
【摘要】 目的 评价中药复方（益气养阴、清热活血方Yiqi Yangyin Qingre Huoxue decoction，YYQHD）联合放射疗法治疗鼻咽癌在减毒增效方面的疗效。 方法 采用Cochrane系统评价方法，电子检索Cochrane图书馆临床对照试验资料库（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（CNKI）和中国期刊全文数据库（VIP）以及万方数据库等数据库2010年3月前所发表的相关文献。同时互联网检索Current Controlled Trial、Clinical Trials和中国临床试验注册网。手工检索部分肿瘤类核心期刊。采用Cochrane协作网推荐的 “偏倚风险评估”工具，评估纳入研究的质量，使用RevMan 5.0.23.0软件对纳入的研究进行定量系统评价。 结果 最终纳入符合标准的中文文献9篇共795例患者。定量分析结果显示:与单纯常规放射治疗相比较，中药复方（YYQHD）联合常规放射治疗能显著提高肿瘤近期疗效、生存率，并且能显著减少放射治疗常见毒副反应的发生，从而提高放射治疗按时完成率确保放射治疗疗效、改善患者生存质量。 结论 虽现有研究尚不能得出可以将中药复方（YYQHD）作为标准治疗手段辅助放射治疗的结论，但提示益气养阴、清热活血类中药联合放射治疗治疗鼻咽癌是值得继续探索的研究方向，期待设计科学合理、高质量的多中心、大样本、双盲、随机对照临床试验以进一步验证其疗效。【Abstract】 Objective To compare the efficacy of traditional Chinese medicine (TCM) plus radiotherapy (RT) with RT alone on nasopharyngeal carcinoma (NPC) by Yiqi Yangyin Qingre Huoxue decoction (YYQHD) through a meta-analysis of all available randomized controlled trials. Methods Literature retrieval was conducted using the Cochrane Library, PubMed, EMBASE, CBMdisk, CNKI, VIP, and Wanfang Database electronically. Relevant journals and conference proceedings were also hand-searched until March 31, 2010. The quality of included studies was assessed according to the criteria recommended by the Cochrane handbook, and the Meta-analysis was performed for homogeneous studies using RevMan 5.0.23.0 Software. Results Basing on our search criteria, we found nine trials (795 patients) which all published in Chinese. Our results showed that TCM (YYQHD) plus RT compared with RT alone, improved immediate tumor response, survival, completion rate of RT, quality of life, and alleviation of adverse effect of patients with NPC. Conclusions Considering the limitations related to this Meta-analysis, it nevertheless presents credible evidence that TCM (YYQHD) plus RT is worthy of additional study. Therefore, further large-scale, muti-center, randomized, and double-blind trials are warranted.
Objective To investigate the relationships between circulating tumor cells (CTCs), circulating tumor endothelial cells (CTECs) and treatment methods in patients with nasopharyngeal carcinoma (NPC) at different stages of treatment. Methods The data of NPC patients at different treatment periods in West China Hospital of Sichuan University from March 2016 to November 2019 were retrospectively collected. The patients received CTCs test and part of those patients received CTECs test, by subtraction enrichment-immunostaining-fluorescence in situ hybridization. The relationships of CTCs and CTECs with radiotherapy and chemotherapy, and the correlations between CTCs and CTECs in NPC patients were analyzed. Results A total of 191 patients were included. Among them, there were 66 cases before initial treatment, 38 cases after induction chemotherapy, and 87 cases after concurrent chemoradiotherapy. A total of 127 patients received CTECs test, including 41 cases before initial treatment, 29 cases after induction chemotherapy, and 57 cases after concurrent chemoradiotherapy. The positive rates of CTCs were 89.4%, 81.6% and 69.0% respectively in the three stages of treatment, and the difference was statistically significant only between the pre-treatment group and the post-concurrent chemoradiotherapy group (P=0.003). The number of CTCs in the post-concurrent chemoradiotherapy group was lower than that in the pre-treatment group and the post-induction chemotherapy group (P<0.001, P=0.002). The number of triploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group and the post-induction chemotherapy group (P=0.009, P=0.013). The number of tetraploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the post-induction chemotherapy group (P=0.007). The number of polyploidy (pentaploid or > 5 copies of chromosome 8) CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group (P<0.001). The positive rates of CTECs were 70.7%, 82.8% and 64.9% respectively in the three stages of treatment, and the difference was not statistically significant (P>0.05). The number of CTECs in the post-concurrent chemoradiotherapy group was only lower than that in the post-induction chemotherapy group (P=0.009). There was no significant difference in the number of triploid or tetraploid CTECs among the three groups (P=0.265, P=0.088). The number of polyploid CTECs was statistically different only between the post-concurrent chemoradiotherapy group and the post-induction chemotherapy group (P=0.007). Spearman correlation analysis showed that there was a significant positive correlation between CTCs and CTECs (rs=0.437, P<0.001). Conclusions Concurrent chemoradiotherapy plays a decisive role in reducing the number of CTCs in the blood of NPC patients, while induction chemotherapy does not appear to directly cause changes in the number of CTCs. In NPC patients, different types of CTCs have different responses to different treatments. There is a significant positive correlation between CTECs level and CTCs level in NPC.