[en] Objective: To compare the efficacy of concurrent chemoradiotherapy versus radiotherapy alone for T_3-4 N_0-1 M₀ and T_1-4 N_2-3 M₀ nasopharyngeal carcinoma (NPC) after induction chemotherapy.Methods: From 2002 to 2005,400 patients with stage III and IV_a NPC were randomly divided into 2 groups :induction chemotherapy followed by concurrent chemoradiotherapy group (IC/CCRT, 201 patients), and induction chemotherapy followed by radiotherapy alone group (IC/RT, 199 patients). Subgroup analysis was conducted for 197 patients with stage T_3-4N_0-1M₀ NPC and 203 with stage T_1-4N_2-3M₀ NPC. Results: The follow-up rate were 96.2%, with a median followg-up time of 3.9 years. For T_3-4N_0-1 M₀ NPC patients in IC/CCRT group (104 patients) and IC/RT group (93 patients), the 3-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival rates were 84.0% and 85.9% (χ²=0.08, P =0.780), 77.0% and 72.0% (χ²=0.44, P =0.510), 89.5% and 92.3% (χ²=0.65, P = 0.420), and 84.9% and 77.0% (χ²= 1.59, P = 0.210), respectively; For T_1-4 N_2-3 M₀ NPC patients in IC/CCRT group (97 patients) and IC/RT group (106 patients), the corresponding rates were 67.4% and 82.2% (χ²=3.48, P=0.060), 61.5% and 68.0% (χ²= 1.86, P=0.170), 86.2% and 87.0% (χ²=0.57, P =0.450) and 66.2% and 75.6% (χ²=2.07, P =0.150), respectively. Acute side effects were similar except more leucocytopenia in IC/CCRT group than IC/RT group. Conclusions: Compared with IC/RT, IC/CCRT dose not improve the overall survival in patients with T_3-4N_0-1 M₀ and T_1-4 N_2-3 M₀ NPC. (authors)

[en] Objective: To evaluate the impact of chemotherapy compliance on the therapeutic efficacy of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy alone for patients with locally advanced nasopharyngeal carcinoma (NPC). Methods: Based on intention to treat analysis (ITT) for 400 patients, 314 patients were analyzed by per protocol (PP) analysis. The patients were divided into induction chemotherapy plus concurrent chemoradiotherapy group (IC/CCRT, 127 patients) or induction chemotherapy plus radiotherapy group (IC/RT, 187 patients). The patients who completed 2 cycles of induction chemotherapy and at least 2 cycles of concurrent chemotherapy in the IC/CCRT group and the patients who completed 2 cycles of induction chemotherapy in the IC/RT group were analyzed. Radiotherapy was given by two-dimensional technique with γ-ray, X-ray and electron beams. The chemotherapy regimen was FUDR plus carboplatin for induction chemotherapy and carboplatin alone for concurrent chemotherapy. Results: The follow-up rate was 96.2%. 295 patients were followed to at 3 years. Based on PP analysis, Grade 3/4 toxicity was found in 23.6% of the patients in IC/CCRT group and 13.4% in the IC/RT group (χ² =5,50,P=0.019). No grade 4 toxicity was found in the IC/RT group. The median follow-up time was 3.9 years, and no significant difference was found between the two groups in 3-year overall survival (78.1% : 84.6% ; χ² = 0. 61, P =0. 435), disease-free survival (74.3 % : 70.1% ; χ²= 0. 12, P= 0.731), locoregional relapse-free survival (89.7% : 89.5% ; χ²= 0. 10, P= 0.748), or distant metastasis-free survival (78.9%:76.5% ; χ²=0.05,P=0.825). Conclusions: With more severe toxicities, the IC/CCRT regimen does not improve the overall survival in locally advanced NPC patients compared with the IC/RT regimen. (authors)

[en] To differentiate supratentorial single brain metastasis (MET) from glioblastoma (GBM) by using radiomic features derived from the peri-enhancing oedema region and multiple classifiers. One hundred and twenty single brain METs and GBMs were retrospectively reviewed and then randomly divided into a training data set (70%) and validation data set (30%). Quantitative radiomic features of each case were extracted from the peri-enhancing oedema region of conventional MR images. After feature selection, five classifiers were built. Additionally, the combined use of the classifiers was studied. Accuracy, sensitivity, and specificity were used to evaluate the classification performance. A total of 321 features were extracted, and 3 features were selected for each case. The 5 classifiers showed an accuracy of 0.70 to 0.76, sensitivity of 0.57 to 0.98, and specificity of 0.43 to 0.93 for the training data set, with an accuracy of 0.56 to 0.64, sensitivity of 0.39 to 0.78, and specificity of 0.50 to 0.89 for the validation data set. When combining the classifiers, the classification performance differed according to the combined mode and the agreement pattern of classifiers, and the greatest benefit was obtained when all the classifiers reached agreement using the same weight and simple majority vote method. Three features derived from the peri-enhancing oedema region had moderate value in differentiating supratentorial single brain MET from GBM with five single classifiers. Combined use of classifiers, like multi-disciplinary team (MDT) consultation, could confer extra benefits, especially for those cases when all classifiers reach agreement.

[en] Venous pathology could contribute to the development of parenchymal lesions in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aim to identify presumed periventricular venous infarction (PPVI) in CADASIL and analyze the associations between PPVI, white matter edema, and microstructural integrity within white matter hyperintensities (WMHs) regions. We included forty-nine patients with CADASIL from a prospectively enrolled cohort. PPVI was identified according to previously established MRI criteria. White matter edema was evaluated using the free water (FW) index derived from diffusion tensor imaging (DTI), and microstructural integrity was evaluated using FW-corrected DTI parameters. We compared the mean FW values and regional volumes with different levels of FW (ranging from 0.3 to 0.8) in WMHs regions between the PPVI and non-PPVI groups. We used intracranial volume to normalize each volume. We also analyzed the association between FW and microstructural integrity in fiber tracts connected with PPVI. We found 16 PPVIs in 10 of 49 CADASIL patients (20.4%). The PPVI group had larger WMHs volume (0.068 versus 0.046, p = 0.036) and higher FW in WMHs (0.55 versus 0.52, p = 0.032) than the non-PPVI group. Larger areas with high FW content were also found in the PPVI group (threshold: 0.7, 0.47 versus 0.37, p = 0.015; threshold: 0.8, 0.33 versus 0.25, p = 0.003). Furthermore, higher FW correlated with decreased microstructural integrity (p = 0.009) in fiber tracts connected with PPVI. PPVI was associated with increased FW content and white matter degeneration in CADASIL patients. PPVI is an important factor related with WMHs, and therefore, preventing the occurrence of PPVI would be beneficial for patients with CADASIL.

[en] To test the hypothesis that abnormal corpus callosum (CC) induced by diabetes may impair inter-hemispheric sensorimotor functional connectivity (FC) that is associated with poor clinical outcome after stroke. Forty-five patients with acute ischaemic stroke in the middle cerebral artery territory and 14 normal controls participated in the study. CC was divided into five subregions on three-dimensional T1-weighted image. The microstructural integrity of each subregion of CC was analysed by DTI and the inter-hemispheric FCs in primary motor cortex (M1-M1 FC) and primary sensory cortex (S1-S1 FC) were examined by resting-state functional magnetic resonance imaging. Diabetic patients (n = 26) had significantly lower fractional anisotropy (FA) in the isthmus of CC (CC_isthmus) when compared with non-diabetic patients (n = 19) and normal controls (p < 0.0001). In addition, diabetic patients had the lowest M1-M1 FC (p = 0.015) and S1-S1 FC (p = 0.001). In diabetic patients, reduced FA of CC_isthmus correlated with decreased M1-M1 FC (r = 0.549, p = 0.004) and S1-S1 FC (r = 0.507, p = 0.008). Decreased M1-M1 FC was independently associated with poor outcome after stroke in patients with diabetes (odds ratio = 0.448, p = 0.017). CC degeneration induced by diabetes impairs sensorimotor connectivity and dysfunction of motor connectivity can contribute to poor recovery after stroke in patients with diabetes. (orig.)