Detailed Treatment Process
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Male, 52 years old, with nasopharyngeal carcinoma. The following is an excerpt from the admission record of one hospitalization. Department: Radiotherapy Ward Admission time: January 4, 09:36 Recording time: January 4, 09:38 Attending physician’s first ward round diagnosis: Nasopharyngeal carcinoma Diagnosis date: January 4 Confirmed diagnosis: Nasopharyngeal carcinoma with cervical lymph node metastasis (cT3N3M0, stage III), ECOG performance status 1 Date of confirmation: January 4 Chief complaint: Diagnosed with “nasopharyngeal carcinoma” five months ago, after 23 sessions of radiotherapy. Present history: The patient developed discomfort in the right neck after tooth extraction last May, with a palpable small mass, accompanied by headache and a blocked sensation in the right ear. There was no obvious blood in the nasal discharge or sputum, and no dizziness or headache (as per original record). The patient later noticed the mass gradually enlarging and sought medical attention. A plain CT scan of the nasopharynx showed a soft tissue mass on the right posterolateral wall of the nasopharynx with multiple enlarged lymph nodes. Antibiotic treatment was given but proved ineffective. The patient then visited the ENT department at our hospital, where electronic nasopharyngoscopy revealed a nasopharyngeal mass. Postoperative pathology on July 25 last year showed the following immunohistochemistry results: CK(+), P63(+), CEA(-), Vim(-), CD20(partially +), CD79(partially +), CD3(partially +), CD5(partially +). Combined with the immunohistochemistry, the diagnosis was (nasopharynx) non-keratinizing carcinoma, undifferentiated type. PET/CT: Mass in the right nasopharynx with adjacent infiltration (disappearance of the right pharyngeal recess; the mass did not cross the midline to the left, infiltrated right parapharyngeal space, extended superiorly to the skull base, anteriorly to the right pterygopalatine fossa, and inferiorly to the oropharynx level, measuring 4.8 × 3.3 × 4.1 cm, SUVmax 13). Multiple enlarged lymph nodes in both sides of the neck (right deep cervical, right parapharyngeal space, right submandibular, and right posterior cervical regions, with the largest measuring 2.4 × 1.8 cm). All showed increased glucose metabolism, consistent with nasopharyngeal carcinoma with multiple lymph node metastases. Distant metastasis was ruled out. Induction chemotherapy with the TPF regimen was started on August 1 last year: docetaxel 120 mg on day 1 + cisplatin 120 mg on day 1 + capecitabine 1000 mg twice daily on days 1–10, with antiemetic, gastroprotective, and hydration supportive care. The neck mass shrank markedly after intravenous chemotherapy, and the patient was discharged. At home, he developed significant nausea, vomiting, high fever, and pain in the head and neck. Capecitabine was discontinued. Emergency blood work showed white blood cells 2.4 × 10⁹/L and neutrophils 21.83 × 10⁹/L, suggestive of infection. He improved after one week of anti-infective treatment. A second cycle of induction chemotherapy with the TPF regimen was given on August 28 last year: docetaxel 120 mg on day 1 + cisplatin 120 mg on day 1 + capecitabine 1000 mg twice daily on days 1–7. Induction chemotherapy with the DC regimen was administered on September 23 last year: docetaxel 120 mg on day 1 + cisplatin 120 mg on day 1, with aprepitant added for antiemetic coverage. The patient tolerated treatment well and began radical radiotherapy to the nasopharynx on September 26 last year. Radiation fields included the nasopharynx and bilateral cervical lymph node drainage areas, with DT 60 Gy/31 fractions (boost to the tumor up to 68 Gy) and prophylactic irradiation to the lower neck at DT 54 Gy/27 fractions. During radiotherapy, the patient experienced difficulty opening the mouth, fluctuating symptoms, nausea, and poor appetite. Supportive care included enteral nutrition, intravenous fluids, and fentanyl patches for pain. Nimotuzumab targeted therapy was given on October 9 and 15 last year. After 16 fractions of radiotherapy, food intake decreased with vomiting; nutritional support was provided. Three-in-one bag intravenous fluids and oral enteral nutrition were administered. After 23 fractions of radiotherapy, repeat nasopharyngeal MRI compared with the original planning images suggested metastasis outside the radiation field. Given the poor response, radiotherapy was paused after discussion with the family. Biological therapy was planned after immune modulation. After two weeks of thymopentin (TP-5) treatment, the patient received one cycle of immunotherapy at another hospital and reported improved energy, appetite, and mouth opening. He has now completed re-localization for radiotherapy and is admitted to our department for local radiotherapy to the nasopharynx. During the course of illness, the patient had poor appetite and reduced food intake, with normal bowel and bladder function and no significant recent weight change. Past history: Denied history of hypertension, diabetes, heart disease, or other chronic systemic illnesses. Denied history of hepatitis, typhoid, tuberculosis, or other infectious diseases. Denied history of trauma or surgery. Denied history of blood transfusion. Denied history of drug or food allergies. Physical examination T: 37°C P: 76 beats/min R: 16 breaths/min BP: 98/64 mmHg Height 178 cm, weight 55 kg, body surface area 1.7091, ECOG performance status 1, pain score 0. General condition good, clear consciousness, fair spirit, good nutrition, normal development. Walked into the ward, answered questions appropriately, cooperative with examination. No obvious jaundice of skin or mucous membranes. No enlarged superficial lymph nodes. Head normal in shape. No eyelid swelling. No obvious scleral icterus. Corneas clear. Conjunctiva not congested. Pupils equal and round, reactive to light. Mouth opening 3 cm. Lips not cyanotic. Tongue in midline. Bilateral auricles symmetric without deformity. External auditory canals patent. Bilateral tonsils not enlarged. Chest wall normal in shape. Respiratory movements normal. Tactile fremitus normal. No pleural friction rub. Percussion resonant. Breath sounds clear. No dry or wet rales or wheezes. Heart rate 76 beats/min, regular rhythm. No pathological murmurs in any valve area. Abdomen flat and soft, no tenderness or rebound. Liver and spleen not palpable below costal margin. Shifting dullness negative. Bowel sounds normal. Genitalia and anorectal examination not performed. Spine and limbs normal in shape. Babinski sign negative. Auxiliary examinations July 25 of last year postoperative pathology with immunohistochemistry: CK(+), P63(+), CEA(-), Vim(-), CD20(partially +), CD79(partially +), CD3(partially +), CD5(partially +). Combined with immunohistochemistry, diagnosed as (nasopharynx) non-keratinizing carcinoma, undifferentiated type.
After the patient was diagnosed with nasopharyngeal carcinoma, he received inpatient treatment at Hospital A. During this period, a doctor from Hospital A referred him to Hospital B for DCCIK infusion therapy, which was administered five times. This corresponds to the mention in the admission record of immunotherapy received at another hospital. The specific name of this immunotherapy is DCCIK (dendritic cell-cytokine-induced killer cell) reinfusion therapy. Each session carried a technical service fee of 24,000 dollars plus other costs of 7,000 dollars, for a total of 31,000 dollars per session. Five sessions totaled 155,000 dollars. In addition, blood collection was performed twice at 7,000 dollars each, bringing the total cost for the five DCCIK treatments to 169,000 dollars. The fifth DCCIK infusion occurred in April of the following year. In May of the following year, a mass appeared in front of the patient’s right ear. MRI in June showed progression of the lesion in the right lateral wall of the nasopharynx and right parapharyngeal space compared with the April images, along with enlarged lymph nodes in the right parapharyngeal space (newly appeared). The patient died in June of the third year, for a total disease course of exactly two years. Subsequent media reports indicated that the DCCIK treatment technique lacked professional qualification evaluation and certification.