Survival nasopharyngeal cancer hpv,dimensions of ford edge 2014 3d,garden shears kmart - 2016 Feature

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Prognostication of survival from nasopharyngeal carcinoma by reduction of plasma Epstein-Barr viral DNA load at midpoint of radiotherapy course: A new paradigm of prognostication. A phase II clinical trial on combined axitinib and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC): Final results and evaluation of clinical predictor for response. A phase II study of axitinib in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC). Prognostication of survival from nasopharyngeal carcinoma by reduction of plasma Epstein-Barr viral DNA load at midpoint of radiotherapy course: A new paradigm of prognostication.
1Department of Stomatology, 2Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China; 3Department of Clinical Oncology, Conde S. Background: Nasopharyngeal carcinoma (NPC) is a common malignancy in Southeast Asia, however, a full consensus has not yet been reached as to the value of comprehensive treatment for NPC. Patients and methods: A total of 248 patients, with different stages of NPC, were included in this study. Clinical data was collected from all histologically confirmed, new cases of NPC, which occurred between 2005 and 2009, at Macao Conde S.
The 5-year OS and PFS rates were significantly better in the radiotherapy-only group compared with the group that received a combination of radiotherapy and chemotherapy. Therefore, in clinical practice, it is recommended that chemotherapy be added to radiotherapy for patients with stage IV NPC.
We thank David Lopes, Pinho Pereira, Jianfeng Zhou from the Department of Haemato-oncology, Conde S. The rounded border between the tip and the root along with the adjoining area is known as the dorsum of the nose.Inferior surface of the external nose presents a pair of piriform apertures, the nostrils or nares.
This study was designed to evaluate the epidemiological characteristics of NPC and their prognostic value, as well as the long-term efficacy of NPC treatment. However, NPC is a much more common malignancy in Southeast Asia, especially in the southern coastal area of Mainland China and in Hong Kong, Macao and Taiwan.
The 5-year survival rate for all patients that underwent follow-up was 68.70%, however, the median survival (5-year) was not reached and could not be calculated. The effect of treatment modality on long-term survival was further examined via subgroup analysis of the demographic characteristics, pathological type and stage of NPC in these two patient groups (Table 4). Age was also found to be an independent prognostic factor affecting the long-term survival of patients with NPC.
Treatment modalities may include induction chemotherapy, concurrent chemoradiotherapy, and adjuvant or palliative chemotherapy treatment after radiotherapy.
Nasopharyngeal carcinoma in childhood and adolescence: analysis of a series of 32 patients treated with combined chemotherapy and radiotherapy.
The National Cancer Data Base report on the relationship of race and national origin to the histology of nasopharyngeal carcinoma.
Paradigm of polyendocrine therapy in endocrine responsive breast cancer: the role of fulvestrant. Clinical antiangiogenic effect of recombinant adenovirus-p53 combined with hyperthermia for advanced cancer. Assessment of clinical and therapeutic factors in patients with nasopharyngeal undifferentiated carcinoma. Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two Phase III trials.
Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials. Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Penang General Hospital from 2001-2005. A multi-institutional survey of the effectiveness of chemotherapy combined with radiotherapy for patients with nasopharyngeal carcinoma. Lung metastasis alone in nasopharyngeal carcinoma: a relatively favorable prognostic group. Alternating chemoradiotherapy in patients with nasopharyngeal cancer: prognostic factors and proposal for individualization of therapy.
Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of distant metastasis and survival.
Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience.
Significant prognosticators after primary radiotherapy in 903 nondisseminated nasopharyngeal carcinoma evaluated by computer tomography. Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: overall survival and patterns of failure.
Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma. Split-course radiationtherapy of carcinoma of the nasopharynx: results of a national collaborative clinical trial of the Radiation Therapy Oncology Group. Concurrent chemoradiation followed by adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma in Korea. Concurrent chemotherapy-radiotherapy compared with Radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. Progress report of a randomized trial comparing long-term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. Each nostril is bounded medially by the mobile part of nasal septum and laterally by the ala of the nose.The framework of the external nose is formed by bones and cartilages. Adding chemotherapy to radiotherapy was not advantageous for patients with stage I or II NPC, however the addition of chemotherapy to radiotherapy significantly improved OS and PFS in patients with stage IV NPC. Patients that had been previously diagnosed with NPC and treated, but who had relapsed during this period, were excluded. The age of disease onset was similar to normal distribution, with a median age of 49.0 years (Table 1).
The group treated with a combination of chemotherapy and radiotherapy was at a significantly later stage of NPC, on average, than the group that was treated with radiotherapy alone, indicating that the patients were not randomly assigned to each group and that more late-stage patients received radiotherapy combined with chemotherapy. The upper part is supported by bones which are as follows: nasal, frontal processes of the maxillae and nasal notch of the frontal bone.
The incidence of NPC gradually increases with age, peaking at 50-59 years of age, and then tends to decrease (2).
However, the study did include patients that had been diagnosed with NPC outside of Macao between 2005 and 2009, who then underwent subsequent treatment and follow-up at Conde S. There was a significant difference in the survival curves among patients in different clinical stages (P=0.000) (Figure 1).


Clinical stage was found to be a significant prognostic indicator for PFS (P=0.000) (Figure 2). Long-term survival was further analyzed according to different subgroups excluding interference due to unbalanced stage distribution between the two groups (Table 5).
The occurrence of NPC in males is 2-3 times that in females; this is similar to the results found in the current study (20,21). Chemotherapy may be considered for patients that are otherwise in good general health or for patients that have a relatively advanced stage of NPC.
Januario General Hospital.Data collected included patient demographics, NPC stage, histological type, treatment modalities, treatment efficacy, and survival time. The prognostic significances of age, gender, T stage, M stage, primary treatment modality, and therapeutic effect were evaluated by univariate analysis (Table 2). Univariate analysis showed that gender, T stage, M stage, primary treatment modality, and treatment efficacy were all prognostic factors for PFS in patients (Table 2).
Previous studies have reported slightly better, though not significant, long-term survival rates in women with NPC than in men (19). In patients with mid and early stages of NPC, such as stage II or lower, chemotherapy is not recommended.However, this study was a non-randomized, retrospective analysis and the clinical stage between the two groups was unbalanced, which may have led to bias in our results. There is a notable difference in the pathological types of NPC that occur within different regions.
However, in one Japanese retrospective study a significantly higher 5-year survival rate was reported for female patients compared to male patients (P=0.032), though multivariate analysis showed that gender was not an independent prognostic factor for survival in this study (20). The nares is kept patent by the U-shaped alar cartilage and is controlled by the compressor and dilator muscles.
The keratinizing type of NPC (WHO Type I) mainly occurs in Western countries with overall low incidences of NPC. Age data were divided into two groups: those younger than 50 years of age and those 50 years of age and older.
Age, gender, T stage, M stage, primary treatment modality and initial therapeutic effect were all independent prognostic factors for OS, as indicated by multivariate COX regression analysis (Table 3).
Age, gender, T stage, M stage, the primary treatment modality, and the efficacy of first-line therapy were all independent prognostic factors for PFS, as indicated by multivariate analysis (Table 3). Each choana is oblong in shape and made of bones.It is formed by the posterior free margin of the vomer, medial pterygoid plate and body of the sphenoid, and by the posterior margin of the hard palate. However, NPC tends to be of an undifferentiated, non-keratinizing subtype (WHO Type III) in South China and in Southeast Asian countries where the overall incidence of NPC is higher (4,5). The disease was restaged in accordance with the seventh edition of the American Joint Committee of Cancer (AJCC) TNM staging system (14) and the tumor pathological types were determined according to the WHO’s NPC classification (15).The treatment modalities were radiotherapy alone, neoadjuvant chemotherapy followed by radiotherapy, concurrent chemoradiotherapy plus adjuvant chemotherapy, or palliative treatment.
However, there is not yet enough evidence that supports the idea that patients with different pathological types of NPC require different treatment modalities (5,23). Patients with Type III have significantly better survival rates compared to those with Type I (6,7).Surgical resection is very difficult due to the fact that NPC is anatomically deep and occurs close to important neurovascular structures. The concurrent chemoradiotherapy and adjuvant chemotherapy treatments were the same as those used by Zhang et al. Thus, the mainstay strategies for the treatment of NPC are radiotherapy-based, comprehensive therapies, including concurrent chemoradiotherapy, as well as induction or adjuvant chemotherapy and palliative chemotherapy following radiotherapy (8). A retrospective study conducted in Malaysia showed that the risk of death was 1.97 times greater in patients with WHO Types I and II NPC than in patients with type III (19). The anterior or fronto-nasal part slopes downward and forward and is supported by the nasal cartilages, nasal and frontal bones. Prognosis is affected by treatment approach, race, histological type, and disease stage (7,9,10). Palliative treatment of advanced tumors included single-agent chemotherapy or combined chemotherapy and radiotherapy.All patients in the two groups had received intensity modulated radiation therapy (IMRT) as reported by Ma et al. Similarly, in a retrospective Japanese study, patients with the nonkeratinizing type of NPC (WHO Types III and II) were found to have higher 5-year OS and PFS rates than those with the keratinizing type (WHO Type I) (20). The intermediate or ethmoidal part is horizontal and formed by the cribriform plate of ethmoid bone which is perforated by the olfactory nerves and ethmoidal vessels; it is the highest part of the roof and about 2 to 3 mm wide.
Many factors that impact the long-term survival of NPC patients have not yet been fully clarified (11-13). Only one study, conducted in Brazil, reported results similar to the current study and concluded that there was no significant difference in the 5-year disease-specific survival rates among different histological types of NPC (24).Many studies have confirmed a clear association between long-term survival and NPC clinical stage (19,20,22,24,25). The posterior or sphenoidal part is formed by the anterior and inferior surfaces of the body of the sphenoid; it has a vertical and a sloping components which usually meet at an obtuse angle. In the current study, the clinical data from NPC patients in the Macao region was retrospectively analyzed in order to clarify epidemiological characteristics, influencing factors and patient survival. The split-field technique, consisting of two lateral-opposed facial fields, was used during the course of radiation for patients with tumors confined to the nasopharynx, and for some cases an anterior field was also used if necessary.
Results of the current study also demonstrated that, as the disease stage increased, the 5-year OS and PFS rates gradually and significantly decreased (P=0.000).
In cases of nasal or ethmoidal involvement, an additional anterior facial electron field was also involved. Multivariate analysis established AJCC staging as an independent prognostic indicator for OS and PFS. If the tumor remained in the primary site after 70 Gy was delivered, the total dose was boosted to 80 Gy with the cone-down technique. Further analysis demonstrated that tumor size (T) and distant metastases (M) are decisive factors for OS and PFS, but that lymph node metastasis (N) staging has no independent prognostic significance for OS or PFS. In patients with skull base involvement and intracranial extension, boost doses of 10 to 14 Gy in 5 to 7 fractions were given to the corresponding positions.
Most of the septum is lined on each side by the mucous membranes, except the mobile part which is covered by the skin. The total dosage for all palpable residual tumors could be boosted to 70 Gy with an electron field (9 to 12 Mev) at the 90% isodose level when all the external radiotherapy plans were completed.Patients were examined prior to treatment and during the follow-up period after treatment. Examinations included a complete medical history and physical examination, a craniofacial examination (including dental and cranial nerve exams), nasopharyngofiberscopy, a complete blood count, serum biochemistry, a chest X-ray, and a CT or MRI examination of the nasopharynx, skull base and any suspicious metastatic sites, including the paranasal sinuses.
After treatment, the patients were asked to return to the clinic once every three months, for two years and then every six months until relapse or death. Therefore, the initial treatment modality and its therapeutic efficacy are the major factors affecting the prognosis of patients in all stages of NPC. The follow-up period was defined as the period from the date of diagnosis until death or until the last follow-up time. All measures should be taken to achieve CR or PR during primary treatment as this will improve the long-term survival of patients in all stages of NPC.NPC is sensitive to radiotherapy and chemotherapy (26,27).
Patients with disease recurrence, progression, and those that were lost to follow-up were considered to have died on the day of their last follow-up.
Since surgical resection is difficult and the efficacy is poor, the primary treatment for NPC is radiotherapy and chemotherapy is used as an adjuvant option.
Sometimes a sphenoidal process extends back­ward for a variable distance between the perpendi­cular plate of ethmoid and the vomer.2. Local recurrence was confirmed by examination of the nasopharynx, head and neck and was verified by needle aspiration biopsy or MRI. Surgical resection is limited to cases in which there is residual tumor or can be used as a salvage therapy in cases of local recurrences.


Septal processes of lower nasal cartilages— Each process is connected by fibrous tissue with that of opposite cartilage, is covered with the skin and forms the mobile part of the septum.3.
Although NPC is relatively sensitive to radiotherapy, the long-term survival for patients with advanced NPC is not ideal (23,28,29).
Overall survival (OS) was defined as the time from diagnosis to the time of death from any cause. According to the literature, the five-year survival rate for patients with stage IV NPC, who received radiotherapy only, is between 28% and 35% (30,31).
Therefore, appropriate addition of chemotherapy is necessary to improve long-term survival in these patients.Many studies have shown that adding chemotherapy to radiotherapy can improve treatment efficacy and prolong OS in patients with intermediate or advanced NPC, though not all studies have had positive results (13,24,32-35). Each pouch extends blindly upward from the lateral incisive canal for a distance of about 2 to 6 mm. Progression-free survival (PFS) referred to the time from the start of treatment until recurrence, disease progression or death from any cause. The pouches are lined by the olfactory epithelium and are supplied by the olfactory nerves.
The cut-off time for the cases without disease progression was defined as the time of last visit.
The survival curves were analyzed using the Kaplan-Meier method and the survival curves of different groups of patients were compared using a log-rank test. The COX proportional hazard model was used for multivariate analysis of the prognostic factors, including the patient, tumor and treatment modalities. A phase III clinical trial conducted in patients with locally advanced NPC in China showed that adding adjuvant chemotherapy did not result in improved OS or relapse-free survival when compared with using concurrent chemoradiotherapy (36).
An infection from this part may extend into the cavernous sinus via deep facial vein and pterygoid venous plexus.
Hence, the mobile part belongs to the dangerous area of face.(d) Upper part of the septum—The veins accompany the olfactory nerves and drain into the inferior cerebral veins. The prolonged survival in the combined group was mainly attributed to a lower rate of distant metastases, however, restaging these patients according to the latest TNM classification system [2010] revealed that a considerable portion of the patients should have been categorized as stage III (14).The group that received combined chemotherapy and radiotherapy was compared with the group that received radiotherapy only to determine the effect of adding chemotherapy on patient survival in our study. The olfactory nerves pierce the cribriform plate of the ethmoid bone and make synaptic contacts with the mitral cells of the olfactory bulb (Fig. However, according to AJCC stage-based subgroup analysis, there was no difference between the two groups in the 5-year OS rate of patients with stages I, II and III NPC, although the 5-year OS rate of patients with stage IV NPC was significantly higher in the chemotherapy combined with radiotherapy group than in the radiotherapy only group. For patients with stage I or II NPC, the 5-year PFS rate was not significantly different in the combined group vs.
Bony wall is covered by mucous membrane and projects medially as curved plates of three nasal conchae (turbinate bones) (Figs. However, for patients with stage III NPC, adding chemotherapy can improve PFS to a certain degree though it may not improve OS and in patients with stage IV NPC, the addition of chemotherapy can significantly prolong both OS and PFS. The space under cover of the inferior concha is known as the inferior meatus, which receives the termination of naso-lacrimal duct in its anterior part.
A random trial from endemic regions of China also showed the addition of concurrent and adjuvant chemotherapy to RT provides survival benefits to patients with stage III through IVB NPC (35). The inferior meatus is continuous in front with the lateral wall of the vestibule of the nose.The middle and superior conchae are parts of ethmoidal labyrinth. The bulla ethmoidalis is bony bulging containing middle ethmoidal air sinuses which open into the middle meatus on or above the bulla. The hiatus semilunaris is a crescentic space between the bulla above and behind, and the uncinate process of ethmoid bone below and in front.The floor of the hiatus receives the opening of maxillary sinus immediately below the bulla. A mucous diverticulum, ethmoidal infundibulum, extends upward from the anterior part of the hiatus through the ethmoidal labyrinth. Anteriorly the middle meatus is continuous with a depression known as the atrium which lies above the vestibule. The atrium is limited above by a mucous ridge, the agger nasi, which slopes downward and forward. The junction between the artrium and the vestibule forms a curved muco-cutaneous ridge known as the limen nasi.The superior concha extends antero- posteriorly above the posterior half of the middle concha. The space under cover of the superior concha is known as the superior meatus into which posterior ethmoidal sinuses open.
The area intervening between the superior concha and the nasal roof is termed the supreme meatus which is sometimes traversed by the highest concha.
Sense of smell (special sensory)—from the olfactory zone is supplied by the olfactory nerves (Fig. The lateral wall of each vestibule is formed by the ala, and the medial wall by the mobile part of nasal septum. The coarse and stiff hairs filler foreign particles during inhalation.The respiratory region serves as the main air passage and is lined by the mucous membrane which is adherent to the underlying bones or cartilages.
The respiratory epithelium is lined by ciliated pseudo-stratified columnar cells resting on a basement membrane and is provided with goblet cells, and numerous mucous and serous glands.The mucus secretion by the goblet cells and mucous glands makes the surface sticky and entraps injurious inhaled particles and micro-organisms. The entrapped materials are swayed backward by the movements of cilia to the nasopharynx, where they are ejected by sneezing or coughing reflex. Thus the ciliated epithelium covered by a blanket of mucus helps in natural defensive mechanism by establishing ciliary rejection current.The lamina propria beneath the surface epithelium contains, in addition to glands, erectile vascular spaces which communicate with arterioles and venules.
Normally the vascular spaces remian collapsed; but in allergy these spaces are distended with blood due to vaso-dilatation and produces running from the nose (common cold).
The activity of the erectile cavernous tissue of nasal mucosa is presumably controlled in part by the circulating sex hormones.
This is sometimes manifested in a few females by nasal bleeding during menstruation (vicarious menstruation).The olfactory region occupies the roof and the adjoining septal and lateral walls of the nasal cavity above the superior conchae. The mucous membrane of the olfactory region is yellowish in colour and lined by the bipolar olfactory cells, tall columnar supporting cells and basal cell resting on a common basement membrane (Fig. Peripheral processes act as dendrites which are brought to the surface as knob-like elevations; the latter are provided with olfactory cilia which float in a blanket of serous fluid and respond to odorous stimuli in soluble form. Central processes form the axons which assemble to form bundles of olfactory nerves (about 20 in number on each side); the latter pierce the cribriform plate of the ethmoid bone and make synapses with the mitral cells of the olfactory bulb.
The olfactory cells act as first order of receptor neurons which are brought to the surface of the mucous membrane. To replenish the loss, some of the basal cells of olfactory epithelium proliferate and differentiate into olfactory cells. Ethmoidal sinuses are variable in number and are arranged in three groups— anterior, middle and posterior.
All sinuses are present in rudimentary form at birth, except the frontal sinuses which start development two or three years after birth. The contained air of the sinuses adds humidity and temperature to the inspired air, and serves as air-conditioning chamber.2. The sinuses are contained within the labyrinth of ethmoid and are completed by frontal, lacrimal, maxilla and sphenoid bones.



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