Present status and possibilities of radiotherapy in the interdisciplinary treatment of malignant tumors of the stomach, pancreas and bile ducts. III. Extrahepatic bile ducts and gallbladder

The malignant tumors of the gall bladder and the extrahepatic bile ducts belong to those having the most unfavorable prognosis. Similarly to the carcinomas of the pancreas, most of these tumors are in a very advanced stage when they are diagnosed. The survival times have not been improved by radical and ultraradical operation techniques, the operation mortality, however, has increased. In the meantime, the efficacy of radiotherapy has been proved for these tumors, too. So an additional application of radiotherapy seems indicated regarding the fact that most of these patients present postoperative locoregional recurrences. As for the carcinomas of the stomach and the pancreas, the best effect of radiotherapy can be expected in case of an intraoperative irradiation; furthermore direct percutaneous intraductal irradiation techniques have been developed for suitable cases. A possible efficacy of additional chemotherapy cannot be assessed yet; a locally adjuvant effect, as in patients with carcinoma of the pancreas, could be imagined. The authors present the surgical, radiotherapeutic, and chemotherapeutic results achieved hitherto in the treatment of the carcinomas of the extrahepatic bile ducts and the gall bladder and propose further possibilities for the future use of radiotherapy. After the failure of surgery alone an improvement of the bad prognosis of these carcinomas by cooperative therapy conceptions is a vital necessity, the more as the role of obstructive jaundice as fatal factor has been eliminated by the non-surgical percutaneous transhepatic drainage of bile ducts.     

Combined therapy of tumors in adults

A significant amelioration of treatment results is achieved by sequential chemotherapy and radiotherapy in patients with lymphogranulomatosis of stage IIb to IVb and in patients with non-Hodgkin's lymphomas in corresponding stages. Similar results will probably be obtained in patients with small cell bronchial carcinomas in a limited stage. Patients suffering from an initially inoperable ovarian cancer often reach an operable condition by sequential chemotherapy and radiotherapy. In the stages Dukes B2 and C of the rectum carcinoma, preoperative and/or postoperative irradiation significantly reduces the recurrence rates and increases the survival times. A considerable reduction of recurrence rates is obtained by postoperative radiotherapy in soft tissue sarcomas of the stages T1 to T3. Another improvement is anticipated by a neutron or neutron boost irradiation for stage T3 and by adjuvant chemotherapy for G3 tumors. In the osteosarcoma of adult persons, the results of the limb-sparing sequential therapy will not be worse than the results achieved by amputation. Retrospective analyses of the long-term results of radical mastectomy and conservative operation with postoperative irradiation in case of mammary carcinoma did not show any difference for the stages T1 to T3, N0 to N1.     

Current state and possibilities of radiotherapy in the inter- disciplinary treatment of malignancies of the stomach, pancreas and bile ducts. I. Stomach cancer

Surgery is undoubtedly the therapy of choice in case of the advanced carcinoma of the stomach. In spite of more and more radical and extended operation techniques, the extremely unfavorable prognosis could not be improved. Based on experiences gained with palliative irradiations, the efficacy of radiotherapy can be considered to be proved. Its difficulties and problems are due to the topographic position of the stomach and to the radiosensitivity of the stomach and the adjacent organs. An additional application of radiotherapy seems sensible regarding the high rate of local recurrences and regional lymph node metastases following surgery (about 90%). The greatest effect of radiotherapy is to be expected in case of intraoperative application - alone or combined with postoperative percutaneous irradiation. However, the therapeutic effect of fast neutrons, hyperthermia, radiosensitizers has not been explored yet. The occurrence of remote metastases besides local recurrences in about 25% of all cases and the available results of some smaller studies suggest a therapeutic advantage to be obtained by an additional systemic cytologic therapy. The authors present the surgical, radiotherapeutic, and chemotherapeutic results achieved hitherto in the treatment of the advanced carcinoma of the stomach. Further possibilities for the future use of radiotherapy are proposed in order to encourage the establishment and application of interdisciplinary therapy conceptions.     

Hyperfractionated Radiotherapy in Locally Advanced Nasopharyngeal Cancer

BACKGROUND: Despite numerous randomized trials suggesting a benefit of unconventional fractionation in locally advanced head and neck cancer, the role of this approach in nasopharyngeal carcinoma is debatable. Based on the current clinical experience, the authors introduced hyperfractionated irradiation in the treatment of locally advanced head and neck cancer, including nasopharyngeal tumors. The preliminary results of this treatment approach in nasopharyngeal cancer patients are presented, with special focus on the pattern of failure and toxicity. PATIENTS AND METHODS: 43 patients with nasopharyngeal cancer (stage II-IV, TNM 1997) underwent hyperfractionated irradiation. In 34 cases, radiotherapy was preceded by a median of three cycles of cisplatin-based induction chemotherapy. Irradiation was delivered using a shrinking-field technique up to a total dose of 74.4 Gy in 62 fractions of 1.2 Gy twice daily (minimum 6-h interval)/5 days/week. RESULTS: Acute toxicity of hyperfractionated radiotherapy was significant but tolerable. Mucositis proved the most common side effect (grade 3: 24 patients, grade 4: three patients). Severe late toxicity was not observed. 30 of 34 patients (88%) responded to induction chemotherapy. At 6 weeks after completion of radiotherapy, complete response was seen in 35 patients (81%), partial response in five (12%), stable disease in one, and progressive disease in two. After a median follow-up of 32 months, 18 patients (41%) developed progressive disease. Primary tumor progression was observed in three patients, and seven patients each showed regional lymph node progression and distant metastases. In one case both regional lymph node progression and distant metastases were diagnosed. The 2-year progression-free survival and overall survival rates were 58% and 84%, respectively. CONCLUSION: Hyperfractionated radiotherapy seems a feasible and active regimen in locally advanced nasopharyngeal carcinoma. Accompanying acute and late toxicity is acceptable and does not compromise delivery of the planned irradiation dose. This regimen is associated with a high local control rate; relatively high nodal and distant failure, however, call for further treatment modifications, e. g., optimization of irradiation technique and/or dose escalation as well as improved systemic therapies.     

Clinical results of thermoradiotherapy of locally advanced and recurrent breast cancers--comparison of results with radiotherapy alone

From August 1979 through January 1988, 23 breast cancer patients with 25 tumors supposed to be refractory to conventional treatment were treated by thermoradiotherapy. Of the 25 tumors, 10 were locally advanced primary tumors [Group 1], 4 locally advanced recurrent tumors after operation more than 5 cm in maximum diameter [Group 2], and 11 locally recurrent tumors after radiotherapy [Group 3]. The present study was not a formal randomised-trial, but a historical-controlled study. The results were compared with tumors which were treated by radiation therapy alone between July 1962 and August 1979. The historical control groups comprised 11 tumors for Group 1, 17 for Group 2 and 19 for Group 3. Employing 4 types of heating devices (8, 13.56 MHz capacitive RF, 430, 2450 MHz microwave), hyperthermia was administered once or twice a week after irradiation, for 30-60 minutes per session, up to a total sessions of 2-9. Radiotherapy was delivered in fractions of 180 to 200 cGy per day, 5 days per week, up to 28-74.4 Gy in total, or in fraction of 400 cGy, two times per week, up to 28-60 Gy. Tumor temperatures were measured by inserting thermocouples into the tumors. The tumors that did not recur during follow-up of more than 3 months were regarded as locally controlled tumors, and the local control rate was calculated. The local control rate in Group 2 and the local response rate (CR + PRa) in Group 1 were higher than those of the historically controlled tumors. In Group 3, hyperthermia combined with lower total doses of irradiation showed a high local response rate similar to that by radiation therapy alone. Thus local hyperthermia in combination with radiation therapy seems to be more effective than radiotherapy alone for locally advanced and recurrent breast cancers.     

Clinical results of thermoradiotherapy for recurrent lung cancers--comparison of results with radiotherapy alone

From October 1986 through December 1989, 18 patients with locally recurrent lung cancer were treated by local hyperthermia combined with radiotherapy at the Kawasaki Medical School Hospital. Nine patients were initially treated by radiotherapy for inoperable lung cancer or as adjunct postoperative therapy. The other 9 were initially treated by chemotherapy or operation. Local heat was applied with a 13.56 MHz radiofrequency (RF) capacitive heating equipment, twice a week after radiotherapy, for 45-60 minutes per session. The results were compared with 17 patients with locally recurrent tumors which were treated by radiation therapy alone between January 1981 and September 1986. Tumor temperatures of two patients were measured directly by thermocouples inserted into the tumors which partially attached to the chest wall. As we were unable to measure tumor temperatures in the other 16 because of the anatomical difficulty, we measured the temperatures of the esophagus as near as possible to these lesions. Based on thermometry results, it was estimated that the maximum tumor temperatures were about 40-41 degrees C. The local response rates (CR + PR) were 25% in patients treated with combined therapy and 7% in those with RT alone. The median survivals after onset of retreatment were 10.7 months and 5.0 months, a statistically significant difference being demonstrated. Severe complications were not seen in this treatment.     

博来霉素化疗的同期联合放疗治疗头颈部中晚期鳞癌

目的　观察使用博来霉素化疗的同期给予放疗治疗头颈部中晚期鳞癌的疗效。方法　 62例头颈部中晚期鳞癌患者随机分为观察组和对照组。观察组 3 2例 ,每天用博来霉素 8mg加地塞米松 5 mg,静滴 ,1次 / d,化疗后采用直线加速器放疗。5次 /周 ,2 Gy/次 ,照射总量 60～ 70 Gy,博来霉素总量 1 60～ 2 0 0 mg。对照组 3 0例 ,给予单纯放疗治疗 ,剂量同观察组。结果　观察组和对照组在放疗 40 Gy及放疗结束后 3个月 ,颈淋巴结消退率分别为 :44% ,3 0 %和 88% ,73 % (P<0 .0 5 ) ,毒副反应均较轻。结论　博来霉素化疗同期进行放疗 ,有利于提高头颈部中晚期鳞癌患者淋巴结转移灶全消率 ,减少残存 ,是治疗头颈部中晚期鳞癌有效方法     

Comparison of helium-ion radiation therapy and split-course megavoltage irradiation for unresectable adenocarcinoma of the pancreas. Final report of a Northern California Oncology Group randomized prospective clinical trial

Forty-nine patients with locally advanced carcinoma of the pancreas were treated in a randomized, prospective study comparing definitive helium ion radiation therapy with conventional split-course megavoltage photon irradiation. Patients in each treatment arm underwent exploratory staging laparotomy followed by concurrent radiation therapy and 5-fluorouracil chemotherapy. Patients treated with photons received 6,000 cGy over a period of 10 weeks; patients treated with helium irradiation received a 6,000-7,000-cGy-equivalent dose over a period of 8-9 weeks. There was no significant difference in overall survival between patients in the two treatment arms (P = .29). Patients treated with helium ions had a slightly longer median survival (7.8 months) than the photon-treated patients (6.5 months). Local control rates were slightly higher in the helium-treated patients (10% vs 5%). Complications included one chemotherapy-related death. Four of the five helium-treated patients who survived longer than 18 months died of local failure without distant metastases. These results suggest that more aggressive local therapy could result in improved survival in helium-treated patients.     

Exclusive radiotherapy of locally advanced carcinoma of the larynx. Analysis of the caseload of Varese (1979-1986)

The authors analyse a retrospective series of 90 consecutive patients (pts) affected with locally advanced laryngeal carcinoma (T3-4, N0-3--TNM, UICC 1978) who were radically irradiated from November 1979 to December 1986 at the Radiotherapy Department of the General Hospital of Varese. All the patients were treated with 60Co and two opposed parallel lateral fields and progressive shrinkage: 66 with conventional fractionation (2 Gy once a day, 5 times a week), 24 with an accelerated hyperfractionated regimen (1.5 Gy twice a day, 5 times a week). The median total dose delivered to the tumor and clinically involved nodes was 64 Gy (1678 reu, CRE). Median follow-up was 21 months (range: 3-113). The 5-year overall survival (Kaplan-Meier) was 40.5%. The 5-year disease-free survival, for 47 patients in complete remission at the end of radiotherapy, was 51.9% after irradiation alone and 56.7% with salvage surgery. There were no statistically significant differences in survival according to local spread (T3 vs. T4), nodal status (N0 vs. N1-3) and dose fractionation regimen (conventional vs. accelerated hyperfractionated). Isoeffect (CRE) values above 1751 reu obtained a 3-year loco-regional control rate of 65%, while, for isoeffect values under 1600 reu, the 3-year loco-regional control rate was 33.3%. Relevant late sequelae were not observed. Our findings suggest that primary radiotherapy with salvage surgery in reserve could be considered as an effective choice for locally advanced laryngeal carcinoma, at least in selected groups of patients.     

Chemo-radiotherapy in advanced head and neck tumors. Personal experience]

From January 1981 through December 1983, 49 untreated patients with locally advanced head and neck cancers were randomized in two groups to receive different radiochemotherapy regimens. Group A, including 29 cases, received 4 cycles of induction chemotherapy with Bleomycin, Methotrexate and Hydroxyurea before definitive external radiotherapy (60 Gy); group B, including 20 patients, received the same total dose of radiotherapy but the 4 cycles of chemotherapy, as described above, were administered between the 20- and the 40-Gy doses. Both groups were compared with a control group treated in the same period with radiotherapy (60 Gy) alone. The response to treatment was evaluated at the end of chemotherapy or radiotherapy alone and at the end of combined regimens. Long-term survival rates were analyzed for all groups relative to complete tumor response, disease-free interval and time to disease progression. In our experience the radio-chemotherapy combination, according to the described schedules, failed to improve both local control and overall survival; the comparison with the control group does not suggest that induction or intercalated chemotherapy can increase long-term survival even if initial complete and partial response rates are high.     

Therapeutic effects of simultaneous intraluminal irradiation and intraluminal hyperthermia on oesophageal carcinoma

An applicator enabling simultaneous intraluminal radiotherapy and intraluminal hyperthermia delivery was developed to improve the treatment results for locally advanced oesophageal carcinoma. Eight inoperable cases were treated by this method. Six cases received 40 Gy external irradiation followed by simultaneous intraluminal hyperthermia and radiotherapy (3 Gy and 4 Gy in three cases each) once weekly for 3 weeks; the remaining two cases received 50 Gy external irradiation followed by simultaneous intraluminal hyperthermia and radiotherapy (4 Gy) once weekly for 2 weeks. Hyperthermia was delivered by a radiofrequency current thermotherapy instrument for 30 min at an output that raised the oesophageal mucosal surface temperature to 42-43 degrees C. Intraluminal radiotherapy was delivered with a microSelectron to a submucosal depth of 5 mm after the first 15 min of hyperthermia. Four cases achieved complete response, with all demonstrating local control. Partial response was obtained in four cases, and three of these patients died of local recurrence. There were no significant adverse side effects apart from fistula in one case. In conclusion, simultaneous intraluminal radiotherapy and hyperthermia may improve the current treatment results for locally advanced oesophageal carcinoma.     

Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma

PURPOSE: To study the efficacy of reirradiation as salvage treatment in patients with locally recurrent nasopharyngeal carcinoma. PATIENTS AND METHODS: Between 1993 and 2000, 20 consecutive patients (twelve males and eight females) with nasopharyngeal cancer, previously irradiated in different Hungarian institutions, were reirradiated for biopsy-proven locally recurrent tumor. Histologically, 85% of the patients had WHO type III, 5% type II, and 10% type I disease. Stages I-IV (AJCC 1997 staging system) were assigned to five (25%), seven (35%), five (25%), and three (15%) patients, respectively; none of them had distant metastases, and only eight (40%) displayed regional dissemination. The median time period between termination of primary treatment and local recurrence was 30 (range, 10-204) months.Brachytherapy was the method most frequently used: in ten cases alone (especially for rT1 tumors), and in eight cases in combination with external beam therapy. Two patients with locally advanced disease underwent external beam therapy only. The median dose in the event of brachytherapy alone was 20 Gy (4 x 5 Gy or 5 x 4 Gy, range, 16-36 Gy), and the dose range for exclusive external irradiation was 30-40 Gy. In cases of combined irradiation, a median 20-Gy brachytherapy (range, 16-40 Gy) was associated with 30-40 Gy of external irradiation. Radiotherapy was supplemented by neck dissection (six patients), nasopharyngectomy (one patient), or chemotherapy (eleven patients). RESULTS: 16 patients were reirradiated once, three twice, and one patient three times, with a median equivalent dose for tumor effect of 36 Gy (mean, 44 Gy; range, 19-117 Gy; the estimated alpha/beta-ratio was 10 Gy). The median equivalent dose of reirradiation for late effect on normal tissue (with an estimated 70% delivery of the tumor dose) amounted to 30 Gy (mean, 37 Gy; range, 13-101 Gy, estimated alpha/beta-ratio 3 Gy). After a median follow-up of 37 (range, 12-72) months, the overall survival was 60% (12/20). Seven of the twelve surviving patients are currently tumor-free. After primary irradiation, xerostomy occurred in all patients as an unavoidable side effect of treatment. Following reirradiation, a severe (grade 3 or higher) late toxicity (CTC criteria, version 2) has been observed in two tumor-free patients (10%) so far (necrosis of soft palate and paresis of glossopharyngeal nerve). CONCLUSION: Retreatment of nasopharyngeal carcinoma with radiotherapy (preferably a combined modality), can result in longterm local control and survival in a substantial proportion of patients, at the price of an acceptable morbidity.     

联合放、化疗与单一化疗对乳腺癌患者心电图的影响

目的分析联合放、化疗与单一化疗的乳腺癌患者心电图变化特点,为放、化疗联合治疗所致心脏毒性预测提供参考。方法1998年1月至2004年6月在我科住院接受含表阿霉素、紫杉醇方案化疗或联合放疗的术后乳腺癌患者共47例,其中联合放、化疗组(简称联合组)29例,单一化疗组(非联合组)18例。观察治疗后两组患者心电图变化特点及其相关因素,如年龄、既往史、肿瘤部位及表阿霉素、紫杉醇和放疗剂量等。结果联合组11例(37.9%)心电图异常,非联合组2例(11.1%),两组比较,差异有统计学意义(z=-1.977,P=0.048)。异常的心电图种类较多,没有特征性改变。联合组异常心电图出现的时间为放疗后序贯化疗2个周期后(总的化疗周期为4～5个周期),非联合组为化疗第5～7个周期出现。提示放、化疗联合治疗心脏受损的比例增加,从而降低患者对化疗的耐受性。年龄>60岁的患者出现异常心电图的比率高于年龄≤60岁患者(z=-2.094P=0.036)。统计学上没有显示心电图的异常与患者高血压病史、肿瘤部位、放化疗的剂量相关。但合并高血压的乳腺癌患者出现心电图异常比率(54.5%)高于无高血压病史者(27.8%)。结论放疗增加表阿霉素与紫杉醇的心脏毒性,降低了其耐受剂量,同时提示在放化疗期间定期复查心电图,尤其对年龄>60岁和有高血压病史的患者尤其     

Report on treatment of cancer of the ovary.

A malignant ovarian tumour has been diagnosed in 373 patients referred to the R.R.T.I. from January 1966 to Jun 1972. Serious ovarian carcinoma was the commonest type and occurred in 254 patients. The results in these patients are studied in detail after staging according to F.I.G.O. recommendations. Following surgery and postoperative radiotherapy, chemotherapy was started immediately in all patients with progressive disease and after randomization also in 50 per cent of the others. The three-year survival rate in Stage II patients tended to be more favourable following irridation ofthe pelvis and lumboaortic nodes (55 per cent ) than following radiotherapy restricted to the pelvic area (40 per cent). The dose should be 5-6 krad. The five-year survival was 68 per cent for Stage I, 26 per cent for Stage II and nearly zero for Stages III and IV, as well as for patients referred for treatment of a recurrence. In spite of whole-abdomen irradiation 50 per cent of the patients in the latter three groups were deceased within eight months; therefore chemotherapy should be preferred. The main problem in ovarian cancer is late diagnosis. Evaluation of results is difficult because numerous variable factors concerning pathology and treatment make it necessary to sub-divide the patients into groups too small for statistically reliable conclusions. Each treatment factor should be studied by a group of hospitals.     

Radiotherapy of carcinoma of the paranasal sinuses

Carcinomas of the paranasal sinuses are usually advanced when diagnosed and present a therapeutic challenge. During the period between February 1970 and June 1981 44 patients were treated. 22 received postoperative irradiation, seven in combination with chemotherapy. 18 patients were treated with radiation alone, eleven with concomitant chemotherapy. Four patients received preoperative irradiation, three in combination with chemotherapy. The three-year survival is 43% and the five-year survival 33%. For those 26 patients who were irradiated pre- or postoperatively with or without concomitant chemotherapy the five-year survival is 45%. We believe the patient will be afforded the greatest opportunity for cure with the combined efforts of the radiotherapist and the surgeon. The combination of chemotherapy and radiotherapy did not provide better results but increased acute and chronic toxicity of the therapy.     

柯兴氏病垂体照射治疗：附22例分析及文献复习

22 patients with Cushing's disease were treated in our hospital from 1976 to 1983. 18 patients were treated by adrenal surgery combined with pituitary irradiation, while 4 patients by radiotherapy of pituitary alone. Overall effective rate was 94%, 82% of patients were able to return to work. Adrenal resection followed by radiation of the pituitary had a relapse rate of 9.1%. The relapse rate was increased to 85.7%, if post-operative radiation was not given. The authors proposed that for young patients with mild disease, radiotherapy alone for pituitary yields good results. As post-operative radiotherapy radiation should be started 2 weeks to 2 months after adrenal operation. Two opposing lateral preauricular portals together with one prefrontal midline portal are preferable and can effectively reduce the dose to the normal brain, the recommended dose is DT 40-50 Gy.     

Die Strahlenbehandlung in der multimodalen Therapie des Ösophaguskarzinoms

Background

The curative potential of exclusively applied surgery or radiotherapy on esophageal carcinoma is exhausted. The 5-year survival rate of surgically treated esophageal carcinoma is stagnant at 20 to 30%, that for radiotherapeutically treated esophageal carcinoma at ≤10% The unchanged bad prognoses motivate the search for multimodal therapeutical concepts in order to improve the results of basic therapies.

Method, Results and Conclusions

While neither perioperative radiotherapy nor perioperative chemotherapy were able to improve the treatment results significantly, a progress in the field of primar and preoperative radiochemotherapy chemotherapy emerges. On locally restricted tumors the latest findings show that a simultaneous radiochemotherapy with Cisplatin is more effective than radiotherapy alone. 20 to 30% histologically verified complete remissions can be reached through preoperative radiochemotherapy. These results will influence future treatment concepts. Brachytherapy can be taken into consideration in highly palliative situations as exclusive method of treatment or for support of laser treatment or bouginage for removal of stenosis. As the number of clinically controlled studies is not sufficient the importance of the brachytherapy boost for potentially curative intentions is not yet clear. Up to now the intraluminal hyperthermia is a underestimated method for improving the results of radiotherapy. Our overview summarizes all presently published randomized studies and relevant phase I/II-studies.     

Radiotherapy of Hodgkin's disease in clinical stages I and II A: relapse of the disease and salvage therapy

The authors describe the results of 71 patients with clinical stage I A (40 patients) and II A (31 patients) primarily treated with radiotherapy alone (61 mantle fields and 10 subtotal-nodal plus spleen irradiation). All patients achieved complete remission at the end of the treatment; 31 (43.7%) patients (15 at stage I and 16 at stage II) relapsed during the follow-up, mostly for nodal or extranodal extensions (87% of relapses). In 21/31 relapsed patients chemotherapy +/- radiotherapy was utilized as salvage treatment. Three patients died for second solid tumors and 1 patient died for jatrogenic late effect (leukemia after 4 cycles of MOPP). Despite the high percent of relapses, the long term overall survival (83.4%) of these patients is quite satisfactory mostly for the efficacy of chemotherapy as salvage treatment. However the authors think that laparosplenectomy plus subtotal-nodal irradiation is the treatment of choice for patients with Hodgkin disease at stage I and II A. Chemotherapy, instead, must be primarily utilized only for patients with a worse prognosis for hilar adenopathies or "bulky" mediastinum.     

The role of postoperative radiotherapy in the treatment of hypernephroid carcinoma

The following results can be derived from the clinical and radiobiological literature as well as from the authors's own experiences with 91 patients analyzed retrospectively and evaluated with respect to their risk factors. 1. A postoperative irradiation is very probably sensible in patients with tumor perforation through the renal capsule (T3/T4) and with venous or lymph node manifestations. 2. The operation method is essential, above all the transabdominal technique and the quality of lymph dissection. 3. Prospective studies are necessary in order to clear up the role of radiotherapy in patients with lymph node manifestations and the other two risk factors mentioned in item 1. 4. Further studies on the tumor biology of the hypernephroid carcinoma are necessary in order to gain prognostic criteria allowing a pretherapeutic sensitivity recognition. 5. The effect of a supplementary radiotherapy can be only that of local recurrence prevention in case of a locally advanced tumor and the absence of demonstrable remote metastases. This seems justified, because the local recurrence rate in our own patients was only 3.3%.     

Self-expandable metallic stent placement for patients with inoperable esophageal carcinoma: investigation of the influence of prior radiotherapy and chemotherapy

Purpose The aim of this study was to evaluate the efficacy and complications of self-expandable metallic stent placement for patients with inoperable esophageal carcinoma after radiotherapy and/or chemotherapy. Materials and methods We obtained data from 19 patients with advanced or recurrent esophageal carcinoma between 1996 and 2000. In all patients, a self-expandable metallic stent was placed under fluoroscopic guidance. Dysphagia before and after stent placement was graded. Complications after stent placement were also evaluated. Data were compared between patients with and without prior radiotherapy and/or chemotherapy. Results The procedure was technically successful in all but one patient. The dysphagia grade improved in all patients. No life-threatening complications occurred. The other major complications such as mediastinitis occurred in two patients, and pneumonia and funnel phenomenon occurred in one patient each. These patients had a history of radiotherapy and/or chemotherapy prior to stent placement. Eight of the twelve patients with prior radiotherapy and/or chemotherapy compared with one of seven patients without prior therapy had persistent chest pain, which was a statistically significant difference (P < 0.05). Conclusion Placement of self-expandable metallic stents was effective for patients with advanced or recurrent esophageal carcinoma. However, prior irradiation and/or chemotherapy increased the risk of persistent chest pain after stent placement.