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W M Cai

Publications and source records attributed to W M Cai.

52 records · Page 3Linked to original sources
PubMed1989

Management of local residual primary lesion of nasopharyngeal carcinoma (NPC): are higher doses beneficial?

One hundred and eighty-two nasopharyngeal carcinoma (NPC) patients, treated from March 1958 through 1978, received 70 Gy or more and were left with gross residual lesion in the nasopharynx, were retrospectively analyzed. Ninety-two patients were given a boost by reduced portals to a total of 90-120 Gy (boost group) whereas for the other non-randomized 90 patients, the treatment was stopped at 70 Gy (observation group). The local recurrence, distant metastasis and 5-year survival rates of the two groups are: 35% (32/92) vs. 58% (52/90), 20% (18/92) vs. 43% (39/90), and 54% (50/92) vs. 21% (19/90), respectively. The benefit of boost is more apparent in patients with T1-2 than T3-4 lesions (p less than 0.001), at increased risk of radiation encephalo-myelitis from 5.5% to 17%. The authors believe that boost be given to patients with early Stage T or small residual lesion at the primary site of NPC.

Carcinoma↗
PubMed1989

[Influence of total parenteral nutrition on amikacin pharmacokinetics].

Six patients under total parenteral nutrition (TPN) and eight control patients received 200 mg of amikacin by iv infusion in 0.5 h. Amikacin concentrations of serum and urine were determined by fluorescence polarization immunoassay. At 6 h after the beginning of administration, the amikacin level in serum of TPN group (2.3 +/- 0.8 micrograms/ml) was significantly higher than control (1.3 +/- 0.8 microgram/ml). There was no significant difference between the 24-h urine output of 2 groups. Pharmacokinetic calculations were based on a two-compartment open-system model. The T1/2 beta and apparent volumes of distribution (Vc, Vdss, V2) of TPN group were significantly greater than those of control group. The body clearance of amikacin in TPN group was slower than control. It is suggested that serum amikacin concentrations should be monitored in clinical TPN patients to prevent toxic reactions.

Adult↗
PubMed1988

Long-term survival of 1035 cases of nasopharyngeal carcinoma.

Long-term results of 1035 previously untreated patients with nasopharyngeal carcinoma seen at Cancer Hospital, Chinese Academy of Medical Sciences, between March 14, 1958 and March 15, 1968 are presented. Of the 1035 patients, 715 were treated with radiation therapy; 281 patients did not receive radiation therapy; and 39 patients whose records were lost. The patients were further subdivided according to the dose of radiation therapy (greater than 4000 rad versus less than 4000 rad), the presence or absence of pathologic confirmation of diagnosis, whether or not follow-up was complete, and whether or not distant metastases developed during treatment. All patients are included in the analysis. The 5-year and 10-year absolute survival rates for the entire group of 1035 patients are 19.6% and 14.5%, respectively. The 5-year and 10-year relative survival rates for the 715 patients who received radiation therapy are 28.4% and 21.0%, respectively. The 5-year and 10-year relative survival rates of the 464 with a pathologically confirmed diagnosis, who were without evidence of distant metastases and who received at least 4000 rad were 34.7% and 25.4%, respectively. Details regarding our statistical methods as well as an exact breakdown of the patient population are presented.

Carcinoma↗
PubMed1988

Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation.

One thousand three hundred seventy-nine nasopharyngeal carcinoma (NPC) patients were treated from March 1958 to December 1978. Twenty-two percent had stage I or II and 78% Stage III or IV had lesions. Two hundred twenty-Kv radiographs were used before 1960; and telecobalt was used from 1961 to 1978. Factors influencing the 5-year survival rate favorably are youth of patient, being female, pathologic condition (poorly differentiated carcinoma, 45.1% versus adenocarcinoma, 13%), stage (Stage I, 86%, Stage II, 59.5%; Stage III, 45.8%; Stage IV, 29.2%), decade admitted for treatment in the past (31% in the 1950s, 48.6% in the 1970s), total dose delivered to the nasopharynx (40 to 49 Gy, 46%; 70 to 79 Gy, 54.1%; 90 Gy or more, 64%) and prophylactic radiation to the neck regions (with prophylactic irradiation, 53.8%, without prophylactic irradiation, 23%). This implies that prophylactic radiation of the neck is crucial even without positive clinical metastasis. For those who have a residual tumor in the primary site when 70 Gy has been delivered, the total dose may be boosted to more than 90 Gy with the cone-down technique or on basis of adding 20 Gy to the dose at which the primary lesion disappeared grossly. The common postirradiation complications are: radiation myelitis, trismus, and otitis media. Because disease recurred in some patients after the fifth year, NPC patients should be followed for at least 10 years.

Adenocarcinoma↗
PubMed1988

[Radiotherapy of nasopharyngeal carcinoma--analysis of 1379 patients].

This paper presents 1379 patients with nasopharyngeal carcinoma treated in our hospital from March 1958 to December 1978. The stage I and II lesions comprised 22% and stage III and IV lesions, 78%. 220 KV X-ray was used before 1960 and 60Co was predominant from 1961 through 1978. The overall 5 year survival rate was 41.4% (571/1379). Young adults and female patients gave better results. The 5 year survival rate was, according to pathological type, 45.1% for poorly differentiated squamous cell carcinoma and 13% for adenocarcinoma; according to clinical stage, 85.7% for stage I lesion, 59.5% for stage II, 45.8% and 29.2% for stages III and IV; according to period of treatment, 31.3% in the sixties and 48.6% in the seventies; according to tumor dose at the primary focus, 48.2% for 40-49 Gy, 55.6% for 60-69 Gy and 67.3% for 90 Gy or more; according to with or without prophylactic radiation in the neck region, 53.8% for the former and 23% for the latter. It implies that prophylactic radiation of the neck is necessary regardless of the presence of cervical lymph node metastasis or not. For those who had residual tumor at 70 Gy, the total dose may be boosted to more than 90 Gy with the cone down technic or the dose, at which the primary lesion disappears grossly, is added with 20 Gy. The common complications are radiation myelitis, trismus and otitis media. As in certain patients, the lesion would still recur 5 years after radiotherapy, the authors believe that the nasopharyngeal cancer patients should be followed for ten years at least.

Adenocarcinoma↗
PubMed1983

Influence of biopsy on the prognosis of nasopharyngeal carcinoma--a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients.

Most of the nasopharyngeal carcinomas (NPC) are histopathologically either poorly differentiated or undifferentiated. After radiotherapy, hematogenous spread is the chief cause of failure for these patients. Biopsies taken from the nasopharynx or the enlarged neck nodes should be performed to establish diagnosis before radiotherapy. The present study was done to ascertain whether the biopsy procedure would affect the final outcome of this malignancy, and to establish certain criteria for clinicians as they endeavor to correctly diagnose and prepare the patients for treatment. Six hundred and forty-nine of 702 NPC patients treated in our hospital from March 1958 through 1972 were analyzed for this purpose and the results are as follows: For patients with fixed and partially fixed neck nodes, the interval between the first biopsy and radiotherapy, the number of times or frequency of biopsy either taken from the nasopharynx or the lymph node and the type of biopsy done on the lymph node did not influence the prognosis. For patients with or without only movable neck nodes, the interval between the first biopsy from the nasopharynx and radiotherapy influenced the final outcome. Patients who received radiotherapy within 14 days after biopsy had a five year survival of 61% (42/69), which is better than that of the patients who started their treatment beyond the 15th day (47.5%-58/122). This is statistically significant (p less than 0.05). The number of times or frequency of biopsy taken from the nasopharynx before radiotherapy did not influence the result of treatment. The interval, therefore, and not the frequency, is important in the biopsy from the nasopharynx. For patients with movable lymph nodes, partial excision of the node gave a poorer five year survival (22%-2/9) than that of patients on whom complete excision was done (50%-9/18). Therefore, complete excision of the node is advised for patients with movable neck node metastasis.

Biopsy, Needle↗
PubMed1983

Lymph node metastases in the neck from an unknown primary. Report on 113 patients.

A series of 113 patients with cervical lymph node metastases from an unknown primary tumour is reported. The 5-year survival was 5 per cent after chemotherapy and 37 per cent after irradiation. The factors relevant to the prognosis after irradiation were the location of the mass and the total dose given. The prognosis was better if the mass was located in the neck than in the supraclavicular fossa. It is recommended that most patients with metastases in the upper or middle part of the neck from an unknown primary be radically irradiated with extended fields including nasopharynx, oropharynx, hypopharynx, and the opposite upper part of the neck in addition to the side with metastases. The tumour dose should preferably be higher than 50 Gy. With this policy it was possible to obtain a 5-year survival in about 50 per cent in a series of Chinese patients, which is quite comparable with the result of surgery. In the series reported, the primary lesions were detected during follow-up in only 6 per cent of the cases.

Adolescent↗
PubMed1983

Serologic diagnosis of nasopharyngeal carcinoma. A double-blind study of four EB virus antibodies with evaluation by sequential discrimination.

It is generally known that a close relationship exists between Epstein-Barr Virus (EBV) and nasopharyngeal carcinoma (NPC). Recently, patients with early lesions of NPC have been detected in the general population by use of serologic mass survey. Using the double-blind method, we have studied the diagnostic value of the four EBV antibody titers, VCA-IgA, VCA-IgG, EA-IgA and EA-IgG, in four groups of subjects, each consisting of 50 persons: patients with nasopharyngeal carcinoma (NPC group), patients with cancers other than NPC in the head and neck regions (HNC group), patients with cancers outside of head and neck regions (OC group) and normal individuals (NS group). The results of these four antibodies were evaluated both singularly and together by multivariate sequential discrimination. Taking 1:10 as the criterion of being positive, in the NPC group, the positive rate of VCA-IgA is 88%, the VCA-IgG rate is 100%, the EA-IgA rate is 48% and the EA-IgG rate is 74%. In the non-NPC group, the positive rates of VCA-IgA are as high as 86%-92%, but those of the other antibodies are as low as 0-42%. The positive rates and the geometric mean titers of these four antibodies were all elevated as compared with those in the three non-NPC groups. These differences are statistically significant. VCA-IgG is unimportant in the diagnosis of NPC because of its low specificity. By treating the antibody titers of VCA-IgA, VCA-IgG, EA-IgA and EA-IgG with sequential discrimination, the correlation rate between the serology and pathology of NPC is 88% and the false positive rate is 7.3%.

Adolescent↗
PubMed1982

Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus.

A series of 50 patients with cancer of the maxillary sinus treated by either preoperative or postoperative radiation from February, 1958 to June, 1974 is presented. In the postoperative group the patients were either free from recurrence, of if there was recurrence, the tumor was less than 0.5 cm in diameter. In the preoperative group, 23 of 36 patients survived for more than five years (64%). In the postoperative group, 4 of 14 patients survived for more than five years (26%). There is an obvious superiority in the preoperative radiation group. The surgical complication rate in the preoperative group was 29% as compared to 14% in the postoperative group. Although the incidence of complications in the preoperative group is higher, we believe it is worth attempting in clinical practice because of the more favourable survival rates.

Adult↗