Salvage radiotherapy for lymph node recurrence after radical surgery in cervical cancer

Objective

This study was to evaluate the treatment outcomes and prognostic factors of patients treated with salvage radiotherapy for the treatment of isolated lymph node recurrence of cervical cancer.

Methods

Between 1990 and 2009, 22 cervical cancer patients with lymph node recurrence who had previously undergone radical hysterectomy and pelvic lymph node dissection were treated with salvage radiotherapy with (n=18) or without (n=4) chemotherapy. Of the 22 patients, 10 had supraclavicular lymph node recurrence, 9 had para-aortic lymph node, and 3 had inguinal lymph node. The median total radiotherapy dose was 60 Gy (range, 40 to 70 Gy). Initial pathologic findings, latent period to lymph node recurrence and other clinical parameters such as squamous cell carcinoma antigen (SCC-Ag) level and concurrent chemotherapy were identified as prognostic factors for survival.

Results

The median follow-up period after salvage radiotherapy was 31.2 months (range, 12.1 to 148.9 months). The 5-year progression-free and overall survival rates of all patients were 32.7% and 30.7%, respectively. Concurrent chemoradiotherapy (p=0.009) and longer latent period to lymph node recurrence (>18 months vs. ≤18 months, p=0.019) were significant predictors of progression-free survival and SCC-Ag level at the time of recurrence (>8 ng/dL vs. ≤8 ng/dL, p=0.008) and longer latent period to lymph node recurrence (p=0.040) for overall survival. Treatment failure after salvage radiotherapy occurred in 14 (63.6%) for the 22 patients (in field, 2; out of field, 10; both in and out field, 2). Grade 3 acute skin (n=2) and hematologic toxicity (n=1) developed in 3 patients.

Conclusion

For isolated lymph node recurrence of cervical cancer, salvage radiotherapy with concurrent chemotherapy should be considered, especially in patients with a long-term progression-free period.     

Isolated paraaortic lymph node recurrence after definitive irradiation for cervical carcinoma

PURPOSE: To evaluate the clinical features of isolated paraaortic lymph node (PALN) recurrence after definitive radiotherapy, and analyze the prognostic factors and effect of salvage treatment. METHODS AND MATERIALS: Of a total 876 patients who received pelvic radiotherapy after the diagnosis of primary cervical carcinoma, 26 were found to have isolated PALN recurrence as the first recurrent site, and these patients enrolled in this study. Only those with primary-site carcinoma controlled and who were free of other distant metastases were eligible. Nineteen of the 26 patients accepted salvage therapy. Fourteen patients accepted concurrent chemoradiation (CCRT), 1 accepted radiation to the paraaortic region, and 4 accepted chemotherapy alone. Clinical parameters evaluated included tumor markers (SCC and CEA) and image studies. RESULTS: Seven of the 26 patients were alive and disease-free. All 7 survivors had salvage treatment with radiation to the paraaortic region and concurrent cisplatin-based chemotherapy. None of the patients receiving chemotherapy or radiation alone enjoyed long-term, disease-free survival. The 5-year survival rate for isolated PALN recurrence of the 14 patients who accepted salvage concurrent chemoradiation (CCRT) was 51.2%. The presence of a clinical symptom at the time of PALN recurrence was analyzed. Seven of the 12 asymptomatic patients and none of the 14 symptomatic patients survived without disease after salvage treatment. The SCC levels at recurrence showed a statistically significant relationship to disease-free survival. CONCLUSIONS: An SCC level of < or = 4 ng/ml and a lack of symptoms at the time of recurrence were good prognostic factors in isolated PALN recurrence after primary radiation therapy. In addition to concurrent CCRT, periodical surveillance with tumor markers and imaging studies allowed early detection and salvage of those patients.     

Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma

PURPOSE: To assess the efficacy and toxicity of salvage surgery for local or cervical nodal recurrence after accelerated radiotherapy for locally advanced head-and-neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS: We reviewed the medical records of the 136 patients with HNSCC who had been treated in three consecutive clinical trials at the Institut Gustave-Roussy using a very accelerated radiotherapy regimen (62 to 64 Gy with 2 daily fractions of 1.8 to 2 Gy over 3.5 weeks). Sixty-nine patients of the 136 initial patients (51%) had local or neck lymph nodes relapse, or both. RESULTS: Sixteen of these 69 patients (23%) had undergone salvage surgery for recurrence locally (n = 8) or in the cervical nodes (n = 8). All 16 had initially been diagnosed with locally advanced oropharyngeal carcinoma (T4, 11 patients; T3, 5 patients), and 13 had initially had cervical node involvement. After salvage surgery, 6 patients had had a local recurrence; 7, cervical node recurrence; and 3, distant metastasis. Thus, salvage surgery had been successful only in 3 patients. The 3- and 5-year overall actuarial survival rates were 20% and 11%, respectively. Eight patients had major postoperative wound complications, including carotid rupture in three cases. CONCLUSION: Salvage surgery for relapse after very accelerated radiotherapy for advanced HNSCC is infrequently feasible and is of limited survival benefit. It should be used only in carefully selected cases.     

ACR appropriateness criteria® adjuvant therapy for resected squamous cell carcinoma of the head and neck

Locoregional recurrence following surgical resection alone for stage III/IV head and neck cancer is common. Adjuvant radiotherapy has been shown to improve post-operative locoregional control when compared to pre-operative radiotherapy for head and neck cancers. Following surgical resection, adverse pathological features determine the need for adjuvant therapy. High-risk pathologic features include extranodal tumor spread and involved surgical margins. Other adverse pathologic features include T 3-4 tumors, perineural invasion, lymphovascular space invasion, low neck adenopathy, and multiple tumor involved cervical lymph nodes. The standard adjuvant therapies are post-operative radiation therapy or post-operative chemoradiotherapy. Post-operative chemoradiotherapy yields superior locoregional control, progression-free survival, and in some studies, overall survival compared to post-operative radiotherapy for high-risk patients in multiple randomized studies. Pooled analyses of randomized data demonstrate that post-operative concurrent chemoradiotherapy is associated with overall survival benefits for patients with involved surgical margins as well as those with extranodal tumor spread. Post-operative radiotherapy concurrent with cisplatin at 100 mg/m(2) every 21 days is the current standard chemoradiotherapy platform adjuvant head and neck cancer treatment. Post-operative radiotherapy and post-operative chemoradiotherapy radiation treatment volumes are not standardized and should be designed based on the risk of recurrence and clinically occult involvement of head and neck subsites and nodal regions. Evidence supports a post-operative radiotherapy and chemoradiotherapy radiation dose of at least 63 Gy for high-risk patients and at least 57 Gy for low risk patients.     

A pilot Phase II trial of concurrent radiotherapy,chemotherapy, and hyperthermia for locally advanced cervical carcinoma

BACKGROUND: Five randomized studies have demonstrated a benefit derived from adding cisplatin (CDDP)-based chemotherapy to radiotherapy (RT) for treatment of cervical carcinoma. The Dutch Phase III pelvic tumor trial demonstrated a survival and local control benefit due to the addition of hyperthermia (HT) to RT. The authors evaluated response and toxicity in patients with locally advanced cervical carcinoma (LACC) who were treated with concurrent weekly CDDP, HT, and RT (whole pelvis [n=7] and whole pelvis and paraaortic nodes [n=5]). METHODS: From August 1998 through December 2000, 12 patients with LACC or locally recurrent cervical carcinoma (LRCC) following hysterectomy were enrolled on a pilot study combining weekly CDDP, HT, and RT. RESULTS: Ten patients were treated at initial diagnosis. All achieved clinical complete response and durable local control. Two of the 10 experienced recurrence outside the pelvis; 1 of these patients had pulmonary metastasis, and the other had isolated paraaortic nodal involvement. Two patients treated for LRCC experienced local and systemic progression and died of disease within 6 months. CONCLUSIONS: In this small series, trimodality therapy resulted in an excellent clinical response and was well tolerated. The addition of HT to chemoradiotherapy represents a promising new strategy that warrants multiinstitutional collaborative efforts to confirm its efficacy.     

局部晚期宫颈癌同步放化疗临床观察

目的探讨同步放化疗治疗局部晚期宫颈癌的疗效和不良反应。方法 80例经病理确诊、临床分期为Ⅱb~Ⅲb期局部晚期宫颈癌患者随机分成两组,每组各40例,均予根治性放疗,体外放疗均采用直线加速器15 MV X射线,DT46~50 Gy,腔内治疗采用192Ir后装机,A点6 Gy/周,总剂量为36~42 Gy。两组放疗方法相同,同步放化疗组在放疗前每周日加用多西紫杉醇(希存)40 mg静滴,共6周。观察近期疗效、3年生存率及放化疗并发症。结果放疗后3个月同步放化疗组有效率(100%)明显高于单纯放疗组72.5%(P<0.05),局部复发率、远处转移率两组分别为5.0%、2.5%和17.5%、15.0%,差异有统计学意义(P<0.05);3年生存率分别为82.5%和55.0%(P<0.05),而毒副作用无明显增加(P>0.05)。结论同步放化疗能提高局部晚期宫颈癌患者的疗效及生存率,降低局部复发率及远处转移率。     

同步放化疗治疗局部晚期子宫颈鳞癌的临床研究

 目的 探讨同步放化疗治疗局部晚期子宫颈鳞癌的疗效及不良反应。方法 2001年至2002年收治121例60岁以下初治局部晚期子宫颈鳞癌患者，随机行同步放化疗（同步组）与单纯放疗（单放组）。所有患者均进行全盆野外照射4次／周， 2.0 Gy／次，量达30 Gy后，改为四野照射，放疗结束时B点剂量50 Gy；腔内治疗1次／周，A点剂量5 ~ 7 Gy／次，放疗结束时腔内治疗提供A点剂量40 ~ 45 Gy；同步组于腔内治疗前一天静脉滴注顺铂40 mg，1次／周，白细胞＜3.5×109／L时停止化疗。结果 同步组与单放组有效率分别为98.4 %、100 %，1、2、3年生存率分别为97.8 %和96.2 %、88.4 %和84.4 %、71.3 %和68.4 %，盆腔复发及远处转移率分别为21.0 %和16.9 %、11.3 %和15.3 %，差异均无统计学意义；恶心、呕吐以同步组程度略重、发生率高，差异有统计学意义。结论 同步放化疗较单纯放疗治疗60岁以下局部晚期子宫颈鳞癌，1、2、3年生存率未见显著提高，但生存质量有所改善，复发转移率未见改善，恶心、呕吐程度及发生率增高。     

宫颈腺癌同步放化疗疗效及残余病灶挽救性治疗分析

目的 评估宫颈腺癌根治性同步放化疗后疗效,分析同步放化疗后仍有残留病灶患者的治疗及预后。方法 回顾性分析2005-2016年间收治的109例局部进展期宫颈腺癌患者的临床资料。外照射临床靶体积处方剂量50.4Gy分28次,内照射A点剂量30~36Gy分5~7次。同步顺铂或紫杉醇周疗。放化疗后进行临床疗效评价。对部分缓解(PR)者进行挽救性治疗(手术和/或紫杉醇联合卡铂或顺铂化疗和/或放疗)。Kaplan-Meier法生存分析。结果 中位随访时间48个月,3、5年总生存率分别为74.1%、58.5%。放化疗后72例(66.1%)患者达完全缓解,31例(28.4%)患者达PR。PR患者挽救性治疗后3年总生存、无进展生存率分别为53%、41%。放化疗后仅4例(3.7%)和2例(1.8%)患者出现>3级泌尿系和胃肠道不良反应。结论 对于同步放化疗后仍有临床残余病灶的宫颈腺癌患者应积极采取挽救性治疗,以期更多的生存获益。     

Preliminary report of using FDG-PET to detect extrapelvic lesions in cervical cancer patients with enlarged pelvic lymph nodes on MRI/CT

PURPOSE: To evaluate, in a prospective study, the effects of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) on the detection of extrapelvic lesions, the design of whole pelvis or extended field radiotherapy, and subsequent failure patterns for patients with cervical cancer and enlarged pelvic lymph nodes (LNs) shown on MRI or CT. METHODS AND MATERIALS: Between April and December 2001, 19 consecutive patients underwent an additional FDG-PET examination before concurrent chemoradiotherapy. The inclusion criteria for the study were at least one enlarged pelvic LN > or =10 mm in its maximal dimension as shown on radiologic images and no extrapelvic tumors detected by conventional examination. The PET findings of the primary tumor, pelvic LNs, and extrapelvic lesions were investigated and compared with the MRI/CT findings. Tumor FDG uptake was quantitated with the maximal pixel standardized uptake value. RESULTS: Except for 1 patient with diabetes mellitus who was excluded from analysis, 18 cervical tumors had significant FDG uptake (maximal pixel standardized uptake value >8). A total of 39 pelvic LNs were reported, and the agreement of positive pelvic LNs between MRI/CT and PET was 79.5%. Five patients (28%) had positive paraaortic LNs on FDG-PET, and their treatment fields were extended to include the paraaortic region. In addition to the paraaortic LNs, 1 patient also had metastasis at the left supraclavicular node. After a minimum follow-up of 12 months (median 15.9), 4 patients (22.2%) developed new extrapelvic metastases. The disease-free survival rate was 78% at 12 months. CONCLUSION: FDG-PET is a useful tool to detect paraaortic LN metastasis and determine the appropriate treatment field for cervical cancer with enlarged pelvic LNs on MRI/CT. The preliminary data suggest that pretreatment FDG-PET can supplement conventional imaging studies, but still has limitations in the detection of microscopic disease.     

Long-term clinical outcomes of postoperative pelvic radiotherapy with or without prophylactic paraaortic irradiation for stage I-II cervical carcinoma with positive lymph nodes: retrospective analysis of predictive variables regarding survival and failure patterns

We performed retrospective analysis to classify the risk hazard of patients with stage I-II cervical cancer with lymph node metastases treated with postoperative radiotherapy. From 1981 to 1995, 106 patients with early stage cervical carcinoma who received adjuvant pelvic radiation were entered in the analysis. The median patient age was 53.0 years (range 21-73). The median dose of 45.3 Gy (range, 32.1-56.4 Gy) was delivered over the whole pelvis. Seventy patients also received prophylactic paraaortic radiation (median 44 Gy; range 22-46 Gy). The 5/10-year overall survival (OAS), disease-free survival (DFS), pelvic control, and distant metastasis-free survival rates were 69.1/63.5%, 62.4/58.1%, 85.7/84.3%, and 74.1/71.6%, respectively. In the uni-/multivariate analyses, the significant prognostic factors of OAS and DFS proved to be disease stage, duration period between operation and radiotherapy, histology, and presence or absence of common iliac lymph node metastasis. Using the results of these analyses, we devised a predictive model for DFS. In this model, the 5-year DFS rates of patients with low (N = 35), intermediate (N = 59), and high-risk factors (N = 12) were 88.1%, 56.7%, and 16.7%, respectively (p < 0.0001). The majority of analyzed patients did not have adequate DFS estimates in this series. High-risk patients should receive a more intensive strategy, such as concurrent chemoradiotherapy. On the other hand, the effort to reduce toxicity should be considered carefully.     

不能切除和复发的局部进展期胃癌放疗疗效分析

目的 回顾分析不能切除和复发的局部进展期胃癌行腹部放疗的疗效及影响因素。方法 回顾分析2009—2015年我院收治的57例患者,其中不能切除36例(包括局部晚期19例、术后肉眼残留17例),术后复发21例。接受3DCRT 17例、IMRT 40例,照射中位剂量50 Gy (42~60 Gy)。81%患者放疗同期口服氟尿嘧啶类药物化疗。结果 全组患者放疗后中位随访时间为16个月(3.9~77.5个月),放疗后缓解率65%。局部晚期、术后肉眼残留(R₂术后) 、术后复发组放疗后中位生存时间分别为13.9、13.9、19.0个月。全组放疗后2年的预期OS、PFS、LRRFS分别为50%、37%、50%。多因素分析显示病变分组是预后影响因素,而第3站淋巴结受侵并不是不良预后因素。结论 对不能切除及术后复发的局部进展期胃癌进行中等剂量放疗并结合化疗能取得较好的LC并改善患者生存,而术后复发和第3站淋巴结受侵病例均应被视为挽救性放化疗的良好适应征。     

早期宫颈腺鳞癌和腺癌术后同步放化疗疗效分析

目的 回顾分析早期宫颈腺癌、腺鳞癌术后同步放化疗的疗效。方法 收集2006—2012年Ⅰ_B—Ⅱ_A期宫颈腺鳞癌62例、腺癌149例、鳞癌2687例,部分术后盆腔±腹主动脉延伸野±后装放疗,行DDP、TP和FP化疗。一般临床资料χ²检验,Kaplan-Meier法生存分析并Logrank检验。结果 腺癌和腺鳞癌的临床病理特征相近(肿瘤大小、间质浸润、淋巴结转移、宫体受侵、病理分级、病变类型的P=0.639、0.107、0.522、0.956、0.204、0.182),高危腺癌即使辅助放(化)疗复发率仍高于低危患者(P=0.000)。手术+放疗中位生存期似乎腺鳞癌<腺癌<鳞癌(腺鳞癌比腺癌P=0.787;腺癌比鳞癌P=0.134;腺鳞癌比鳞癌P=0.582);手术+同步放化疗中位生存期似乎腺癌<腺鳞癌<鳞癌,腺癌与鳞癌间不同(腺癌比腺鳞癌P=0.131;腺鳞癌比鳞癌P=0.643;腺癌比鳞癌P=0.000)。腺鳞癌、腺癌术后同步放化疗比术后放疗的近期不良反应率均更高(P=0.037、0.003),远期不良反应相近(P=0.861、0.655)。腺鳞癌术后同步放化疗较术后放疗远处转移率低(P=0.003),中位OS、DFS期似乎延长了17个月(P=0.811、0.799);腺癌似乎分别减少了11个月和9个月(P=0.330、0.115)。结论 早期高危宫颈腺鳞癌术后同步放化疗较放疗可减少远处转移率,腺鳞癌和腺癌术后同步放化疗较放疗并不改善生存期。     

Effectiveness of chemoradiotherapy for three cases of squamous cell anal carcinoma

We report three patients with squamous cell anal carcinoma who were treated by chemoradiotherapy. Case 1: A 62-year-old female with squamous cell anal carcinoma invading the vagina underwent a posterior pelvic exenteration. She had paraaortic lymph node metastases. She was treated by chemoradiotherapy with 5-FU/CDDP and external irradiation (50 Gy) as an adjuvant therapy, and survived for 5 years. Case 2: A 74-year-old female with anal squamous cell carcinoma Stage II was treated by chemoradiotherapy with tegafur/uracil, external irradiation (30 Gy) and interstitial irradiation (24 Gy). She is currently living without any signs of recurrence for 3 years and 8 months. Case 3: A 53-year-old female with anal squamous cell carcinoma Stage IIIa was treated by chemoradiotherapy using 5'-DFUR and external irradiation (66 Gy). She is currently living without any signs of recurrence for 1 year and 9 months. The prognosis of anal squamous cell carcinoma that received Cur B or C resection was extremely poor with a median survival time (MST) of 7 or 6 months. Chemoradiotherapy seems to be effective as the first line treatment.     

Intensity-modulated radiotherapy with concurrent chemotherapy for previously irradiated, recurrent head and neck cancer

PURPOSE: Primary treatment fails in >70% of locally advanced head and neck cancer patients. Salvage therapy has a 30-40% response rate, but few long-term survivors. Intensity-modulated radiotherapy (IMRT) has recently emerged as a new modality for salvage therapy. This retrospective study evaluated our experience using every-other-week IMRT with concurrent chemotherapy. METHODS AND MATERIALS: Between 2001 and 2006, 41 patients underwent IMRT as repeat RT with concurrent chemotherapy. All but 6 patients received 60 Gy at 2 Gy/fraction. RT was delivered on an alternating week schedule. RESULTS: With a median follow-up time of 14 months, the overall response rate was 75.6%, with a complete response and partial response rate of 58.5% and 17.1%, respectively. The Kaplan-Meier estimate of overall survival, disease-free survival, and progression-free survival at 24 months was 48.7%, 48.1%, and 38%, respectively. Patients who underwent surgery as a part of their salvage therapy had a mean estimated survival of 30.9 months compared with 22.8 months for patients who received only chemoradiotherapy (p = 0.126). Grade 3 or 4 acute toxicities occurred in 31.7% of patients, but all had resolved within 2 months of therapy completion. No deaths occurred during treatment, except for 1 patient, who died shortly after discontinuing treatment early because of previously undiagnosed metastatic disease; 6 patients had long-term complications. CONCLUSIONS: Concurrent chemotherapy with repeat radiotherapy with IMRT given every other week appears to be both well tolerated and feasible in patients treated with previous radiotherapy for recurrent head and neck cancer. IMRT represents a reasonable modality for reducing treatment-related toxicities in a repeat RT setting.     

Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment

This study analyzes the results of 46 cases of biopsy-proven primary lymphoma of the thyroid, localized at diagnosis and treated at the Royal Marsden Hospital between 1948-1980. In all cases, disease was limited to the thyroid and cervical lymph nodes. There were 43 females and 3 males, with a mean age of 64.4 years (median 66 years; range 17-86). A short history (less than 3 months) of a neck mass and local compressive symptoms was the typical presentation. The majority of patients (91%) had adverse histologies, with diffuse histiocytic lymphomas being most common (78%). The overall crude 5-year survival rate was 40%, with 30% of patients surviving beyond 10 years. Disease-free and overall survival were virtually identical, indicating the ineffectiveness of salvage therapy. The important prognostic factors were: size of tumor, fixation, extra-capsular extension, and retrosternal involvement. Survival was not correlated with age, sex, histology, thyroid status, or stage of disease, as defined by the Ann Arbor classification. Patients who had total macroscopic removal of tumor had the highest rate of local control and long survival (p less than 0.005). No significant difference was seen between lobectomy, subtotal or total thyroidectomy, but 7 of 9 long-term survivors (58-129 months) have had total thyroidectomy. A radiotherapy dose to the tumor, of at least 40 Gy, was required to produce consistent local control in patients with unresected disease. The majority of patients who died had generalized disease. Only 52% of these patients were free of local recurrence. In view of the frequency of occult disseminated disease, adjuvant chemotherapy is one recommendation for patients with poor prognostic factors. For optimal local control, complete surgical eradication is recommended followed by high-dose local radiotherapy. The use of aggressive cytoreductive chemotherapy prior to radiotherapy is a possible alternative option which needs to be explored.     

食管癌同期放化疗后局部失败相关因素分析

背景和目的:目前同期放化疗是不能手术食管癌的标准治疗方法,局部未控和复发仍是治疗失败的主要原因。本文主要总结我科收治的食管癌同期放化疗后局部未控和复发情况,分析影响局部未控和复发的相关因素。方法:对132例食管癌患者行同期放化疗。第一周期化疗与放射治疗同时开始,第二周期化疗在放疗剂量达40Gy时给予。以二项分类logistic回归分析影响局部未控和复发的因素。结果:至随访截止时间,全组患者射野内未控和复发54例,射野内未控和复发并淋巴结或其他器官转移20例,射野外复发5例。logistic回归分析显示与局部未控和复发相关的因素为近期疗效和放疗剂量。放疗后病灶完全缓解和部分缓解者,局部未控和复发率分别为44.9%和79.6%(P<0.001),平均复发时间分别为12.9个月和6.1个月(P=0.002)。放疗剂量为50～60Gy、60.1～69.9Gy、≥70Gy时,局部未控和复发率分别为69%、61%、52%(P=0.027),平均局部失败时间分别为5.3个月、9.1个月、10.3个月(P=0.038)。结论:影响局部未控和复发的因素为近期疗效和放疗剂量。     

Cervical lymph node relapses of head-and-neck squamous cell carcinoma: is brachytherapy a therapeutic option?

Purpose: To report the results of interstitial brachytherapy (IBT) without salvage surgery for isolated cervical lymph node relapses.

Patients and Methods: From 1970 to 1989, 84 patients were treated; 76 patients had relapsed in sites of previous external beam radiation. In 72 patients, IBT was sole salvage treatment (mean, 56.5 Gy). In 12 patients IBT (mean, 38 Gy) was combined with further external beam radiotherapy (mean, 41 Gy).

Results: Local control in the neck was 49% at 1 year, 31% at 2 years, and 0% at 5 years. Overall survival was 33% at 1 year, 13% at 2 years, and 1% at 5 years. Significant toxicity occurred in 35% (7% fatal). Multivariate analysis shows survival after salvage was better for patients who had achieved initial control for ≥18 months before relapse (0% vs. 13% at 3 years, p < 0.0002). Lymph node control was better for patients who received total salvage dose ≥60 Gy (0% vs. 56% at 3 years, p = 0.0004).

Conclusion: Given its poor efficiency and its toxicity, IBT must be considered only when surgery is contraindicated and if lymph node relapse occurs after a minimal interval of 18 months.     

Prognostic factors affecting the outcome of nasopharyngeal carcinoma

BACKGROUND: The aim of the study is to evaluate patients with nasopharyngeal carcinoma treated with multisegmental intensity-modulated radiotherapy with or without chemotherapy and analyze patient, tumor and treatment characteristics, determining outcome. METHODS: From June 1999 through to April 2003, we treated in our institution 83 patients with nasopharyngeal carcinoma, 70 males and 13 females, their ages ranging from 25 to 85 years (median, 48 years). Nineteen patients had T1 tumors, 35 had T2 tumors, six had T3 tumors and 23 had T4 tumors. Sixty-four patients had cervical lymph node metastasis. Twenty patients were treated with radiation therapy alone and 63 patients with concurrent chemoradiotherapy. Cumulative radiation dose to primary tumor ranged from 70.2 to 77.4 Gy (median, 75.6 Gy). Follow-up ranged from 3 to 41.53 months (median, 17 months). RESULTS: Local complete response was achieved in 81 patients (97.5%). Local failure was observed in two patients, nodal failure in one patient and systemic failure in 14 patients. Overall survival, disease-free survival and disease-specific survival were 83, 84 and 93%, respectively, at 1 year, 82, 74 and 88%, respectively, at 2 years and 82, 61 and 88%, respectively, at 3 years. In univariate analysis, T stage of disease was a significant predictor of disease-free survival favoring those with early-stage (T1 + T2) disease (P = 0.040). Cumulative radiation dose to primary tumor was a significant predictor of disease-specific survival favoring those with >75.6 Gy (P = 0.010). Stage of disease (P = 0.007), N-classification (P = 0.046) and cumulative dose to primary tumor (P = 0.046) were significant prognostic factors for overall survival. CONCLUSIONS: High locoregional control for nasopharyngeal carcinoma was achieved with multisegmental intensity-modulated radiotherapy. Distant metastases are still the main impact on survival. More effective chemotherapy regimens and other systemic agents are needed to decrease the rate of distant metastasis.     

A case of advanced esophageal cancer invaded to the trachea with PCR after preoperative chemoradiotherapy, which relapsed at the time of three years and seven months after resection

A male in his 40s was diagnosed with type-3 advanced esophageal cancer in the upper thoracic and cervical esophagus, which invaded to the trachea. We administered a low-dose FP combination therapy (5-FU and CDDP) along with 40 Gy radiotherapy. This chemoradiotherapy reduced the esophageal tumor significantly, and then we performed subtotal esophagectomy. Histological examination of the resected specimens revealed no residual cancer cells in the primary lesion or regional lymph nodes. No recurrence had occurred for about three years and seven months after the operation. However, CT revealed that the patient had the signs of recurrence (bone and lung), and finally he died four years and eight months after the operation. Preoperative chemoradiotherapy is potentially effective for advanced esophageal cancer invaded to adjacent organs. Although chemoradiotherapy yielded a complete response in our case( an advanced esophageal cancer patient), a patient follow-up is necessary because a recurrence may occur along the way.