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Background: Induction chemotherapy of docetaxel plus cisplatin (TP) is myelosuppressive, leading to severe neutropenia and febrile neutropenia (FN). Herein, we aimed to investigate the efficacy and safety of mecapegfilgrastim in the prevention of neutropenia in patients with locally advanced nasopharyngeal carcinoma who received the TP regimen. Methods: A total of 30 treatment‐naive patients with locally advanced nasopharyngeal carcinoma were included in this study. Mecapegfilgrastim 6 mg was injected 24–48 h after the completion of induction chemotherapy with the TP regimen. Results: The incidence of grade ≥3 neutropenia during the three induction chemotherapy cycles was 6.7% (95% CI, 0.8%–22.1%). In the first cycle of chemotherapy, the incidence of grade ≥3 neutropenia was 3.3% (95% CI, 0.1%–17.2%). No FN or antibiotic usage was reported. All 30 patients completed the induction chemotherapy cycles. Conclusion: Mecapegfilgrastim effectively reduced the incidence of chemotherapy‐induced neutropenia and FN in patients with locally advanced nasopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

Background: Compared with the conventional work‐up (CWU) including computed tomography (CT) of the chest and abdomen, MRI of the head and neck, and skeletal scintigraphy, positron emission tomography (PET)/MRI might improve diagnostic accuracy, shorten the work‐up time, and reduce false‐positive (FP) findings in patients with nasopharyngeal carcinoma (NPC). However, evidence of cost‐effectiveness is needed for the adoption of PET/MRI for the initial staging in NPC. Purpose: To evaluate the cost‐effectiveness and clinical value of PET/MRI as an initial staging procedure for NPC. Study Type: Retrospective cohort cost effectiveness study. Subjects: Three hundred forty‐three patients with a median age of 51 (13–81) years underwent PET/MRI before treatment (the PET/MRI group) and the remaining 677 patients with a median age of 55 (15–95) years only underwent CWU (the CWU group). There were 80 (23.3%) females and 193 (28.5%) females in the PET/MRI and CWU groups, respectively. Field Strength/Sequence: 3‐T integrated PET/MRI system, diffusion‐weighted echo‐planar imaging (b = 0 and 1000 s/mm2) and [18F] fluorodeoxyglucose PET. Assessment: The primary end point was the FP rate. Costs were determined as issued in 2021 by the Medical Insurance Administration Bureau of Zhejiang, China. Statistical Tests: Incremental cost effectiveness ratio (ICER) measured cost of using PET/MRI per percent of patients who avoided a FP. A P‐value <0.05 was considered statistically significant. Results: For the whole group, the de novo metastatic disease rate was 5.2% (53/1020). A total of 187 patients with FP results were observed. Significantly more patients with FP results were observed in the CWU group compared to the PET/MRI group (25.6% vs. 4.1%). The ICER was $54 for each percent of patients avoiding a FP finding. Data Conclusion: Compared with CWU, PET/MRI may reduce the FP risk. Furthermore, PET/MRI may be cost‐effective as an initial staging procedure for NPC. Evidence Level: 3 Technical Efficacy: Stage 6 [ABSTRACT FROM AUTHOR]

Background: To evaluate the impact of coronavirus disease 2019 (COVID‐19) pandemic on disease extent in patients with nasopharyngeal carcinoma (NPC) using 18 fuorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI). Methods: This retrospective cohort study included biopsy‐proven, newly diagnosed NPC patients using whole‐body FDG PET/MR staging in two selected intervals: 1 May 2017 to 31 January 2020 (Group A, the pre‐COVID‐19 period), and 1 February 2020 to 30 June 2021 (Group B, the COVID‐19 period). Results: Three‐hundred and ninety patients were included. No significant difference was observed in terms of T classification, N classification, overall stage, N stations, and M stations between the two groups (p > 0.05). For the involved neck node levels, more patients had developed level Vc metastasis in the group B (p = 0.044). Conclusion: Although the overall stage was not affected, more patients with NPC had developed level Vc metastasis in the era of COVID‐19. [ABSTRACT FROM AUTHOR]

Background and Aims: Malnutrition is a concern in patients with nasopharyngeal carcinoma (NPC) during chemoradiotherapy (CRT)/radiotherapy (RT), which is considered to be related with radiation–induced oral mucositis (ROM). The study aimed to evaluate the nutritional status of NPC patients during RT and investigate its association with ROM. Methods: A prospective study was conducted in NPC patients. Patients were divided into three subgroups (mild, moderate, and severe groups) based on the duration of severe ROM (≥ grade 3). Body weight, body mass index (BMI), albumin, prealbumin, NRS2002, and ROM grade were assessed on a weekly basis before and during CRT/RT. The statistical analysis was performed in the overall group and between three subgroups. Results: A total of 176 patients were included. In the overall group, body weight and BMI kept decreasing since week 1 of RT, and NRS2002 score and ROM grade increased (p < 0.001). NRS2002 score and prealbumin levels were significantly different between each subgroup (p ≤ 0.046). Significant differences were observed in the proportion of patients receiving enteral nutrition, duration of parenteral nutrition, and total calories provided by nutritional support among three subgroups (p = 0.045–0.001). Conclusions: Malnutrition occurred early in NPC patients and worsened continuously during RT. ROM was strongly associated with nutritional status. Nutritional support should be provided at the start of RT, especially in patients at high-risk of severe ROM. [ABSTRACT FROM AUTHOR]

• Proposing a two-stage segmentation framework for OAR segmentation for HaN CT images. • Segmenting large organs with multi-scale convolutional neural network, while first localizing and then segmenting small organs. • Adding adversarial shape constraint to regularize the estimated mask, which makes the prediction consistent with medical prior. • Testing our method on both large real data from hospitals and an open source dataset and shows superior performance. Radiotherapy is a treatment where radiation is used to eliminate cancer cells. The delineation of organs-at-risk (OARs) is a vital step in radiotherapy treatment planning to avoid damage to healthy organs. For nasopharyngeal cancer, more than 20 OARs are needed to be precisely segmented in advance. The challenge of this task lies in complex anatomical structure, low-contrast organ contours, and the extremely imbalanced size between large and small organs. Common segmentation methods that treat them equally would generally lead to inaccurate small-organ labeling. We propose a novel two-stage deep neural network, FocusNetv2, to solve this challenging problem by automatically locating, ROI-pooling, and segmenting small organs with specifically designed small-organ localization and segmentation sub-networks while maintaining the accuracy of large organ segmentation. In addition to our original FocusNet, we employ a novel adversarial shape constraint on small organs to ensure the consistency between estimated small-organ shapes and organ shape prior knowledge. Our proposed framework is extensively tested on both self-collected dataset of 1,164 CT scans and the MICCAI Head and Neck Auto Segmentation Challenge 2015 dataset, which shows superior performance compared with state-of-the-art head and neck OAR segmentation methods. [ABSTRACT FROM AUTHOR]