【摘要】 目的 評價中藥復方（益氣養陰、清熱活血方Yiqi Yangyin Qingre Huoxue decoction，YYQHD）聯合放射療法治療鼻咽癌在減毒增效方面的療效。 方法 采用Cochrane系統評價方法，電子檢索Cochrane圖書館臨床對照試驗資料庫（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中國生物醫學文獻數據庫（CBM）、中文科技期刊全文數據庫（CNKI）和中國期刊全文數據庫（VIP）以及萬方數據庫等數據庫2010年3月前所發表的相關文獻。同時互聯網檢索Current Controlled Trial、Clinical Trials和中國臨床試驗注冊網。手工檢索部分腫瘤類核心期刊。采用Cochrane協作網推薦的 “偏倚風險評估”工具，評估納入研究的質量，使用RevMan 5.0.23.0軟件對納入的研究進行定量系統評價。 結果 最終納入符合標準的中文文獻9篇共795例患者。定量分析結果顯示:與單純常規放射治療相比較，中藥復方（YYQHD）聯合常規放射治療能顯著提高腫瘤近期療效、生存率，并且能顯著減少放射治療常見毒副反應的發生，從而提高放射治療按時完成率確保放射治療療效、改善患者生存質量。 結論 雖現有研究尚不能得出可以將中藥復方（YYQHD）作為標準治療手段輔助放射治療的結論，但提示益氣養陰、清熱活血類中藥聯合放射治療治療鼻咽癌是值得繼續探索的研究方向，期待設計科學合理、高質量的多中心、大樣本、雙盲、隨機對照臨床試驗以進一步驗證其療效。【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.
【摘要】 目的 觀察時辰化學療法聯合放射治療對比常規化學療法聯合放射治療對鼻咽癌的近期療效及其不良反應。 方法 2006年2月-2010年3月經病理學證實未接受過化學療法的38例晚期鼻咽癌患者隨機分為常規化學療法聯合放射治療組（A組，n=20）和時辰化學療法聯合放射治療組（B組，n=18）。兩組均采用常規二維放射治療。A組化學療法方案為順鉑（DDP）80 mg/m2，采用完全水化方案，第1天靜脈滴注；氟尿嘧啶800 mg/（m2?d），第2~6天120 h連續靜脈滴注。B組時辰化學療法采用Melodies多通道編程輸液泵進行正弦曲線式時間調節給藥。兩組均為DDP 80 mg/m2，于10:00~22:00給藥，濃度高峰設定在16:00；氟尿嘧啶800 mg/m2，于22:00~次日10:00給藥，濃度高峰設定在凌晨4:00。每21天重復1次，行2~6療程。 結果 A組3程化學療法后有效率（PR）為95%（19/20），全程結束完全緩解率（complete remission，CR）達75%（15/20）；B組在2程化學療法后PR達100%，全程治療結束CR達94.4%（17/18）。兩組不良反應主要為遲發性血小板減少，發生率分別為35%（7/20）和22.2%（4/18），其他不良反應兩組間無明顯差別。 結論 時辰化學療法聯合放射治療對晚期鼻咽癌在減輕化學療法造成的血小板減少方面有明顯的優勢，值得臨床推廣應用以及進一步發掘時辰化學療法在臨床治療的價值。【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.
Epstein-Barr (EB) virus infection is associated with various tumors of lymphoid and epithelial origin. EB virus exists in most humans as a latent infection. EB virus latent infection-related genes play a key role in the EB virus latent infection, and also play an important role in promoting the occurrence and development of related tumors. This article will briefly introduce the characteristics of EB virus latent infection, the protein coding genes and non-coding genes related to EB virus latent infection (including EB virus nuclear antigen genes, EB virus latent membrane protein genes, EB virus encoded small RNA genes and EB virus microRNA genes), and the main functional mechanism of these EB virus latent infection-related genes in EB virus latent infection and subsequent tumorigenesis. The purpose is to providea theoretical basis for a comprehensive understanding of the EB virus latent infection and the mechanism of tumors caused by EB virus.
摘要:目的:探討鼻咽癌放療后程同步輔以小劑量順鉑增敏的近期療效,并與常規治療和后程加速超分割放射治療進行比較。方法:選取98例Ⅱ～Ⅳ期鼻咽癌患者,隨機分為常規治療組(簡稱T1組,32例)、后程加速超分割治療組(簡稱T2組,32例)和順鉑加后程加速超分割治療組(簡稱T3組,34例),并對治療效果進行比較。 結果:1組鼻咽部腫瘤消除率為75.0%(24／32),頸部淋巴結消除率為87.5%(28/32);T2組鼻咽部腫瘤消除率為87.5%(28／32),頸部淋巴結消除率為84.4%(27/32);T3組鼻咽部腫瘤消除率為97.1%(33／34),頸部淋巴結消除率為91.2%(31/34)。進行兩兩比較,均為P＜0.05,有統計學意義,療效:T3 組＞T2 組＞T1組。治療副作用有增加(P＞0.05),但無統計學意義。 結論:小劑量順鉑加后程加速超分割治療鼻咽癌,可以達到較常規治療更好的近期治療效果。Abstract: Objective: To study the later therapeutic efficacy of nasopharyngeal carcinoma in late course accelerated fractionation (LCAF) radiotherapy and low dose cisplatin, at same time compare with conventional fractionation and LCAF. Methods: Ninetyeight cases with stage ⅡⅣ of nasopharyngeal carcinoma were randomly assigned to three groups: conventional fractionation (T1), LCAF (T2), LCAF and low dose cisplatin (T3). At the end of treatment, therapeutic efficacy was compared with each other. Results: The survey periods was 3 months. Comlete response rate (CR) for groups T1, T2 and T3 was 75.0% (24／32), 87.5% (28／32) and 97.1% (33／34), respectively; the group treated with LCAF and cisplatin had highest effective later therapeutic efficacy than other groups. Lymph node of neck of group T3 got better control, although its side effects were more serious, but no significant difference was found among three group. Conclusion: Combined treatment of LCAF radiotherapy and low dose cisplatin has better later therapeutic efficacy on tumor control in patients with nasopharyngeal carcinoma
The aim of this study is to compare the planning quality and delivery efficiency between dynamic intensity modulated radiation therapy (d-IMRT) and dual arc volumetric modulated arc therapy (VMAT) systematically for nasopharyngeal carcinoma (NPC) patients with multi-prescribed dose levels, and to analyze the correlations between target volumes and plan qualities. A total of 20 patients of NPC with 4–5 prescribed dose levels to achieve simultaneous integrated boost (SIB) treated by sliding window d-IMRT in our department from 2014 to 2015 were re-planned with dual arc VMAT. All optimization objectives for each VMAT plan were as the same as the corresponding d-IMRT plan. The dose parameters for targets and organ at risk (OAR), the delivery time and monitor units (MU) in two sets of plans were compared respectively. The treatment accuracy was tested by three dimensional dose validation system. Finally, the correlations between the difference of planning quality and the volume of targets were discussed. The conform indexes (CIs) of planning target volumes (PTVs) in VMAT plans were obviously high than those in d-IMRT plans (P < 0.05), but no significant correlations between the difference of CIs and the volume of targets were discovered ( P > 0.05). The target coverage and heterogeneity indexes (HIs) of PTV 1 and PGTVnd and PTV3 in two sets of plans were consistent. The doses of PTV2 decreased and HIs were worse in VMAT plans. VMAT could provide better spinal cord and brainstem sparing, but increase mean dose of parotids. The average number of MUs and delivery time for d-IMRT were 3.32 and 2.19 times of that for VMAT. The γ-index (3 mm, 3%) analysis for each plans was more than 97% in COMPASS? measurement for quality assurance (QA). The results show that target dose coverages in d-IMRT and VMAT plans are similar for NPC with multi-prescribed dose levels. VMAT could improve the the CIs of targets, but reduce the dose to the target volume in neck except for PGTVnd. The biggest advantages of VMAT over d-IMRT are delivery efficiency and QA.
ObjectiveTo explore the application value of plasma Epstein-Barr virus (EBV) DNA test in the clinical diagnosis of patients with nasopharyngeal carcinoma in non-high-incidence areas of Southwest China and its significance for monitoring patients after treatment. MethodsA total of 235 patients diagnosed with non-keratinized nasopharyngeal carcinoma between January 2014 and December 2015 were retrospectively collected. The plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment, the positive rates of the plasma EBV-DNA test before treatment and within 6 months of treatment, and the relationship between the positivity of plasma EBV-DNA within 6 months of treatment and the prognosis of nasopharyngeal carcinoma were analyzed. ResultsThe plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment was 69.79% (164/235), with a positive rate of 90.85% (149/164). A total of 131 patients were tested for EBV-DNA within 6 months of treatment, whose positive rate was 89.31% (117/131) before treatment and 21.37% (28/131) within 6 months of treatment, respectively, with a statistically significant difference (P<0.001). Comparing the prognosis of EBV-DNA positive patients and negative patients within 6 months of treatment, the difference in 3-year recurrence rate between the two groups was not statistically significant (10.71% vs. 3.88%, P=0.341); however, the 3-year metastasis rate (21.43% vs. 4.85%, P=0.016) and the 3-year disease progression rate (32.14% vs. 6.80%, P=0.001) of the EBV-DNA positive patients were higher than those of the EBV-DNA negative patients, and the log-rank test slao showed that the 3-year progression-free survival rate (67.86% vs. 93.20%, P<0.001) and the 3-year metastasis-free survival rate (78.57% vs. 95.15%, P=0.004) of the EBV-DNA positive patients were lower than those of the EBV-DNA negative patients. There was no statistically significant between-group difference in the 3-year progression-free survival curve when grouped by age, gender, or TNM staging (P>0.05).ConclusionsFor patients with non-keratinized nasopharyngeal carcinoma in non-high-incidence areas of Southwest China, EBV-DNA detection is important for the screening and diagnosis of nasopharyngeal carcinoma, and the positivity of EBV-DNA test within half a year of treatment is an important factor affecting the prognosis and progression of patients. Plasma EBV-DNA levels should be monitored regularly before and after treatment.
