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PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2020. Outcomes of interest included survival, distant and locoregional disease control, and quality of life. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 108 relevant studies to inform the evidence base for this guideline. Five overarching clinical questions were addressed, which included subquestions on radiotherapy (RT), chemotherapy sequence, and concurrent, induction, and adjuvant chemotherapy options. RECOMMENDATIONS Evidence-based recommendations were developed to address aspects of care related to chemotherapy in combination with RT for the definitive-intent treatment of stage II to IVA NPC. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa. To develop these comprehensive guidelines for the diagnosis and management of NPC, the Chinese Society of Clinical Oncology (CSCO) arranged a multi-disciplinary team comprising of experts from all sub-specialties of NPC to write, discuss, and revise the guidelines. Based on the findings of evidencebased medicine in China and abroad, domestic experts have iteratively developed these guidelines to provide proper management of NPC. Overall, the guidelines describe the screening, clinical and pathological diagnosis, staging and risk assessment, therapies, and follow-up of NPC, which aim to improve the management of NPC.

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A hypoxic microenvironment plays important roles in the progression of solid tumors, including oral squamous cell carcinoma (OSCC). Long noncoding RNAs (lncRNAs) have gained much attention in the past few years. However, it is not clear whether lncRNAs can regulate hypoxia adaptation of OSCC or which lncRNAs participate in this process. Using a lncRNA microarray, we analyzed the aberrant lncRNA expression profiles in OSCC tissues compared with paired normal oral mucosa and in hypoxic OSCC cells compared with normoxic OSCC cells. The top 10 lncRNAs that had more than threefold increase with P‐value <0.01 in both microarray data were validated by qRT‐PCR. Among the top 10 lncRNAs, hyaluronan synthase 2 antisense 1 (HAS2‐AS1) was the only one that has a hypoxia‐responsive element (HRE) on its promoter region and has been validated to increase in OSCC tissues and in cells cultured under hypoxia. Tumor HAS2‐AS1 levels were closely associated with lymph node metastasis and hypoxic tumor status in patients with OSCC. Moreover, the hypoxia‐induced HAS2‐AS1 expression is dependent on HIF‐1α which directly binds to and activates the transcription of HAS2‐AS1. In addition, HAS2‐AS1 mediates hypoxia‐induced epithelial mesenchymal transition of OSCC cells via stabilizing HAS2. In conclusion, our results suggest that hypoxia would induce an overexpression of HAS2‐AS1 in an HIF‐1α dependent manner. The increase of HAS2‐AS1 plays important roles mediating the hypoxia‐regulated EMT and invasiveness of OSCC.

Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated. Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy. Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively. Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.

OBJECTIVES: To describe the seriously injured adult population aged 65 and older; compare the differences in injury characteristics and outcomes in three subgroups aged 65 to 74, 75 to 84, and 85 and older; and identify predictors of death, complications, and hospital discharge destination. MEASUREMENTS: Outcome variables included mortality, complications, and discharge destination (usual residence, rehabilitation, nursing home, convalescence). Predictive factors incorporated demographic details, injury characteristics, and acute care factors.RESULTS: Hospital survival was 95.0%, with a median length of hospital stay of 8 days (interquartile range 5-15), and 33.8% of cases with a major injury developed a complication. Predictors of death included older age, male sex, admission to the intensive care unit (ICU), greater Injury Severity Score (ISS), injury caused by a fall, and two or more injuries; those who had surgery were less likely to die. Predictors of complications included ICU admission, older age, longer hospital stay, and two or more injuries. Predictors of discharge to a nursing home included older age, greater ISS, longer hospital stay, and injury caused by a fall, among others.CONCLUSION: Older adults with severe injuries are at risk of poor outcomes. These findings suggest opportunities for improving geriatric trauma care that could lead to better outcomes. AbstractObjectives: The aims were to: 1) describe the seriously injured older adult; 2) characterize and compare

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