The aim of this study is to explore non-medical factors that determine withdrawal from radiation therapy. Data from 2,643 patients who received radiotherapy in our Hospital from March 2010 to March 2012 were collected. Using gender, age, stage of the disease, Karnofsky score, aim of radiation therapy, therapy technique, vocation, medical insurance, and educational status as variables, 43 patients who terminated radiation therapy due to non-medical causes and 43 who completed the recommended course in the same period of time were, respectively, allocated to study and control groups. Univariate and 1:1 multivariate conditional logistic regression analyses were used to determine the risk facts for treatment withdrawal. Forty-three patients who withdrew from the therapy received at least one and maximally 26 therapy sessions (median of seven). A significant part of therapy withdrawals occurred during the first week and accounted for 37 % of therapy withdrawals. Univariate analysis showed that vocation, medical insurance, educational status, stage of the disease, Karnofsky score, aim, and technique of radiation therapy were significant determinants of therapy withdrawal. Furthermore, medical insurance status and stage of the disease were also found to be determinants in the multivariate regression analysis. Medical insurance and stage of the disease were found to be the major determinants that affect withdrawal from radiation therapy.
We report here a case of nasal natural killer/T-cell lymphoma with metastasization into the pancreas. A 43-year-old Chinese female patient presented with right nasal obstruction and purulent rhinorrhea that lasted for the past half year and worsened gradually despite antibiotic medical treatment. Physical examination revealed a mass in the right nasal cavity and an enlarged lymph node in the right submandibular region. A PET/CT scan and immunostaining of the resectate led to a diagnosis of nasal natural killer/T-cell lymphoma, clinical stage IIE, and the International Prognostic Index score of 1. The patient received radiotherapy followed by four cycles of the CHOP chemotherapy. A complete remission was achieved, and the patient was disease-free for 9 months. On a subsequent follow-up, abdominal ultrasound scan, enhanced abdominal CT scan, and ultrasound-guided fine-needle aspiration biopsy revealed pancreatic metastasis secondary to nasal lymphoma. Radiotherapy (40 Gy) to the whole pancreas was done, followed by two courses of the SMILE regime chemotherapy, leading to a complete remission. At the moment, the patient is undergoing subsequent chemotherapy.
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