Purpose To analyze the long‐term outcome and pattern of failure for patients with nasopharyngeal carcinoma (NPC) after intensity‐modulated radiotherapy (IMRT). Methods and materials Patients with NPC after IMRT from 2001 to 2008 were recruited (n = 865). Clinical features, laboratory data, and treatments were collected. Results The 10‐year local recurrence‐free survival, distant metastasis‐free survival, and disease‐specific survival (DSS) were 92.0%, 83.4%, and 78.6%, respectively. A total of 209 patients died: 59% of whom died from distant metastasis. The 10‐year DSS was higher in patients who received chemoradiotherapy than those who received IMRT alone for patients with high‐risk stage III disease, while there was no survival difference for patients with stage II and low‐risk stage III disease. Conclusions IMRT provides satisfactory long‐term survival for patients with NPC. Distant metastasis has been the most common reason for failure. Adding chemotherapy did not improve survival in patients with stage II and low‐risk stage III disease.

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management. However, NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines, with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment. Conversely, the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines. Given they are frequently life-threatening conditions, all the involved clinicians, that is emergency physicians, diagnostic and interventional radiologists, surgeons, in addition obviously to gastroenterologists, should be aware of and familiar with their management. Indeed, they typically require a prompt diagnosis and treatment, engaging a dedicated, patient-tailored, multidisciplinary team approach. The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.

Purpose To define the clinical characteristics and prognostic value of pre‐retreatment plasma Epstein‐Barr virus (EBV) DNA, we investigated EBV status in locoregional recurrent nasopharyngeal carcinoma (lrNPC) patients. Methods Between April 2008 and August 2016, the data of patients with nonmetastatic lrNPC were retrospectively reviewed. The survival indexes of patients between different pre‐retreatment EBV status groups were compared. Results A total of 401 patients with nonmetastatic lrNPC were enrolled, and 197 (49.1%) patients had detectable pre‐retreatment plasma EBV DNA. Treatment included radiotherapy alone (n = 37 patients), surgery alone (n = 105), radiotherapy (n = 208), surgery combined with radiotherapy (n = 20), chemotherapy and targeted therapy (n = 31). Median follow‐up was 32 months. The 3‐year locoregional relapse‐free survival (LRRFS), distant metastasis‐free survival (DMFS), and overall survival (OS) rates for the entire cohort were 64.8%, 89.4%, and 58.8%, respectively. The estimated 3‐year LRRFS, DMFS, and OS rates for the pre EBV‐positive group vs the pre EBV‐negative group were 54.2% vs 75.0% ( P < 0.001), 86.6% vs 91.9% ( P = 0.05), 51.6% vs 65.9% ( P = 0.01), respectively. Among patients in the clinical stage rI/II, there were 17 patients in the radiotherapy alone group and 49 patients in the surgery alone group. And there was no significant difference in overall survival between radiotherapy and surgery, even among the different pre‐EBV statuses ( P > 0.05). In terms of long‐term toxic and side effects, the incidence of radioactive temporal lobe injury in the radiotherapy group was higher than that in the surgery group (35.3% vs 8.2%, P < 0.001), and no statistically significant difference was found in other long‐term toxic and side effects. Conclusions The positive rate of pre‐retreatment plasma EBV DNA in lrNPC is lower than primary NPC. The prognosis of EBV DNA negative group is better than positive group. For locally early‐stage lrNPC, regardless of EBV DNA status, radiotherapy and surgery are available options and both can achieve better long‐term survival.