Analysis of the survival rate with cervical cancer using<Superscript>137</Superscript>Cs and<Superscript>192</Superscript>Ir afterloading brachytherapy

Objective

To analyze and compare the survival rate for stages II and III cervical cancer treated by external irradiation plus¹³⁷Cs or¹⁹²lr.

Methods

The patients with cervical cancer were treated by external irradiation plus¹³⁷Cs (group A, 427 patients) or plus¹⁹²lr (group B, 156 patients). There were 170 stage II cases and 413 stage III cases. The number of cancer types were as follows: squamous cell carcinoma, 524; adenocarcinoma, 34; and adenosquamous cell carcinoma, 25. The two groups received the same external irradiation using 8 or 10 MV of X-ray. After the whole pelvis received 25–35 Gy, the focus was given a total of 45–55 Gy by four divided fields. Intracavitary irradiation was performed with one fraction of 6–7 Gy in reference dose at A point every week and a total dose of 40 -60 Gy with 6 ~8 fractions for group A; every fraction of 5 -6 Gy in reference dose of A point and total dose of 30–42 Gy with 5~7 fractions for group B.

Results

The 5-year survival rate of stage II and III, and total were 82.9%, 62.2%, and 67.2% for group A respectively and 85.1%, 61.5% and 69.2% for group B respectively. There were significant differences between stage II and III in each group (P< 0.05) but there were no differences in the 5-year survival rate between the two groups (P> 0.05). The late complications of the therapy were rectitis and urocystitis and with an incidence rate of 7.3% and 6.3% for group A and 9.6% and 9.0% for group B (P> 0.05).

Conclusion

The long-term survival rate and complications of stages II and III cervical cancer are similar when treated with external irradiation plus¹³⁷Cs or plus¹⁹²lr.

     

Clinical study on radiotherapy combined with surgical treatment of 162 patients with cervical cancer

Objective: To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer.Methods: 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy.The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy.External irradiation used 60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of "B" point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used 192lr,the dose of "A" point was 5-15 Gy.Results: The 5-year survival rate of preoperative combined radiotherapy group was 78.0%(71/91), preoperative intracavitary radiotherapy group 64.9% (24/37), and postoperative radiotherapy group 35.3% (12/34).Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference (P＜0.05).The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% (32/91), 32.4% (12/37), 38.2% (13/34), respectively, and the differences were not statistically significant (P＞0.05).Conclusion: The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.     

Clinical Report on Californium-252 Neutron Intraluminal Brachylherapy Combined with External Irradiation for Cervical Carcinoma Treatment

OBJECTIVE To observe the curative effects and complications of californium-252 （^252Cf） neutron intraluminal brachytherapy （IBT） combined with external irradiation （El） for treatment of cervical carcinoma. METHODS From December 2000 to December 2004, 128 cases of cer vical carcinoma staged into IIA-IIIB according to the International Federation of Gynecology and Obstetrics （FIGO） standards were treated with ^252Cf neutron IBT using 8-10 Gy per fraction, once a week. The total dose at reference A point was 36-40 Gy in 4-5 fractions. From the second day after ^252Cf neutron IBT treatment, the whole pelvic cavity was treated with ^60Co y-ray El, applying 2 Gy per fraction, 4 times per week. After 20-25Gy of El, the center of the whole pelvic field was blocked with 4 cm of lead in width. The total dose of El was 45-50 Gy. RESULTS The short-term therapeutic effects were CR 95.3% and PR 4.7%. The 3 and 5-year local control rates were 93.5% and 87.9%. The overall 3-year survival rate was 87.5% and for Stages Ⅱ and Ⅲ , 90.9% and 81.5% respectively; the overall 5-year survival rate was 70% and for Stages II and III, 76.2% and 61% respectively. The rate of radiation complications was 4.7% for radiation cystitis, 7.8% for radiation proctitis, 6.3% for vagina contracture and adhesion and 5.5% for protracted radiation proctitis. CONCLUSION An combination of ^252Cf neutron IBT with El for treatment of cervical carcinoma can be well-tolerated by cervical carcinoma patients. The rate of local tumor control is high and radiation complications are few.     

Analysis of 80 Cases of Nasopharyngeal Carcinoma Treated by Intracavitary Brachytherapy Using A New- Type Applicator

OBJECTIVE To evaluate the results and complications associated with nasopharyngeal carcinoma （NPC） treated with combined external-beam radiotherapy （EBR） and intracavitary brachytherapy （IB） using a new-type applicator. METHODS Eighty patients with untreated NPC were divided into two groups based on therapy methods. An experimental group was treated with EBR plus IB and a control group was treated only with EBR. IB was given to the patients of the experimental group when the external radiotherapy dose amounted to more than 60～65 Gy. The total dose of IB was 6～20 Gy and the total dose of EBR of the control group was 70～75 Gy. RESULTS Follow-up was conducted for 97.5% of the patients with re- suits as follows： the overall response rates （ORR） for the experimental and the control groups were 92.5% and 75.3% respectively （P〈0.05）; the 3 and 5-year survival rates for the experimental group were 87.5% and 74.2% and for the control group, 65.0% and 55.6% （P〈0.05）; for the experimental group, the 3 and 5-year disease-free survival rates were 72.5% and 64.5% and for the control group, 60.0% and 52.8% （P〉0.05）.Some complications following radiotherapy showed a significant difference. CONCLUSION External irradiation plus intracavitary brachytherapy using a new-type applicator may improve the ORR and survival rates, reduce radiation complications and increase the quality of life.     

The investigation of <Superscript>125</Superscript>I seed implantation as a salvage modality for unresectable pancreatic carcinoma

Background

To assess the efficacy of intraoperative ultrasound-guided implantation of ¹²⁵I seeds for the treatment of unresectable pancreatic carcinoma, and analyze the associated prognostic factors.

Methods

Twenty-eight patients with pancreatic carcinoma who underwent laparotomy and were considered to have unresectable tumors were included in this study. Nine patients were pathologically diagnosed with Stage II disease, and nineteen patients with Stage III disease. Twenty-eight patients received intraoperative ultrasound-guided ¹²⁵I seed implantation and received a D₉₀ (at least 90% of the tumor volume received the reference dose) ranging from 60 to 163 Gy, with a median of 120 Gy. Seven patients received an additional 35–50 Gy external beam radiotherapy after seed implantation, and ten patients received two to ten cycles of chemotherapy. Overall survival of the patients was calculated and prognostic factors were evaluated.

Results

Of the patients, 94.1% (16/17) achieved good to medium pain relief. The tumor response rate was 78.6% (22/28), and local control was achieved in 85.7% (24/28) of patients. The 1-, 2- and 3-year survival rates were 30%, 11% and 4%, and the median survival was 10.1 months (95% CI: 9.0-10.9). Analysis using the Cox proportional hazards model suggested that patients younger than 60 years and patients who received a D₉₀ higher than 110 Gy may survive for a longer period.

Conclusions

I seed implantation provides a safe and effective method to relieve pain, control local tumor growth and, to some extent, prolong the survival of patients with stage II and III pancreatic disease, without additional complications. Age and accumulated dose may be factors predictive of a favorable outcome for patients with unresectable pancreatic carcinoma treated with ¹²⁵I seeds. These findings need to be validated by conducting further studies with larger cohorts.

     

Phase I/II trial of biweekly docetaxel and cisplatin with concurrent thoracic radiation for stage III non-small-cell lung cancer

Objectives: We conducted phase I and II studies of biweekly docetaxel and cisplatin with concurrent radiotherapy, followed by consolidation chemotherapy with the same drugs in patients with locally advanced, unresectable non-small-cell lung cancer (NSCLC). Our objectives were to define the maximum-tolerated dose and dose-limiting toxicity (DLT) in the phase I study, and to determine the response rate, toxicity, and survival rate at the recommended dose (RD) in the phase II study. Methods: Patients with unresectable stage IIIA and IIIB NSCLC were studied. Six to eight cycles of docetaxel and cisplatin were administered at 2-week intervals. In the phase I study, patients received four dose levels: level 1, docetaxel/cisplatin=30/40 mg/m²; level 2, 35/40; level 3, 40/40; and level 4, 45/40. Radiotherapy was delivered at a rate of 2 Gy per fraction/day up to a total dose of 60 Gy over the course of 6 weeks, during the first three cycles of chemotherapy. Results: DLT comprised neutropenia at level 4 in the phase I study (n=15), and level 3 was considered the RD. In the phase II study (n=46), two patients had a complete response (4.3%) and 34 had a partial response (73.9%), for an overall response rate of 78.2% [95% CI (66.3–90.2%)]. The survival rate was 69.1% at 1 year and 39.6% at 2 years, with a median survival time of 19.1 months. Leukopenia, neutropenia, anemia, and radiation esophagitis were the most common toxic reactions, with Grade ≥3 reactions occurring at rates of 77, 70, 17, and 8%, respectively. Conclusion: Biweekly docetaxel and cisplatin with concurrent RT was active and well tolerated in patients with unresectable stage III NSCLC.     

Prognostic value of CD57<Superscript>+</Superscript> T lymphocytes in the peripheral blood of patients with advanced gastric cancer

Background  Natural killer (NK)-like T cells comprising CD56⁺ T cells and CD57⁺ T cells belong to a subset of CD1d-independent NKT cells playing an important role in regulating immune responses. Although NK-like T cells are reported to increase in patients with advanced gastric carcinomas, it remains unknown how NK-like T cells are involved in disease progression in gastric cancer patients. Methods  The proportions of Th1 cells (interferon [IFN]-γ-producing CD4⁺ T cells), Th2 cells (IL-4-producing CD4⁺ T cells), and NK-like T cells (CD56⁺ T cells and CD57⁺ T cells) in the peripheral blood of 48 gastric cancer patients and 20 healthy controls were measured by two-color flow cytometry analysis and by intracellular cytokine analysis to investigate an association of these immune cells with the survival rate of gastric cancer patients. Results  Univariate analysis showed that Th1 cells and CD57⁺ T cells, as well as some clinicopathological factors, significantly influenced the survival rate. CD57-high (≧18%) patients survived for a significantly shorter period after surgery compared to CD57-low patients (P = 0.046; Kaplan-Meier, log-rank test) in the stage III–IV patients, but not in the stage I–II patients. Further, multivariate analysis showed that lymphatic invasion was a statistically significant independent risk factor in all the gastric cancer patients, but the proportion of CD57⁺ T cells as well as depth of tumor were statistically significant independent risk factors in patients with advanced carcinomas (stage III–IV). Conclusion  An increased proportion (≧18%) of CD57⁺ T cells in the peripheral blood of patients with advanced gastric carcinomas could indicate a poor prognosis.     

Study on Treating Glioblastoma with 125I Seed Implantation during Operations

OBJECTIVE To evaluate the therapeutic efficacy of treating glioblastoma with interstitial irradiation using radioactive seeds. METHODS First,the tumor was removed as completely as possible under an operating microscope.Then 125I seeds which had been selected were implanted in the tumor bed followed by routine radiotherapy after the operation.The time of progression(TTP)and overall survival(OS)of the patients were recorded,and statistical y compared with patients who had received only surgery and radiotherapy for glioblastoma during the same period. RESULTS Nineteen patients,who were diagnosed with glioblastoma for the first time,with a mean age of 51.2 years,were involved in this study. Radioactive seeds(8~20)were implanted into the tumor bed after tumorectomy with a mean surrounding therapeutic dose of 31.6 Gy,fol owed by an external irradiation dose of 42~54 Gy.The average TTP in the group with implanted seeds was 42.1±2.4 w(95%confidence interval,37.2~46.5 w),and 27.1±2.7 w(95%confidence interval,24.3~31.8 w)in the control group.The average OS was 66.3±3.2 w(95%confidence interval,61.9~70.4 w)and 47.7±2.6 w(95%confidence interval,44.4~50.5 w),respectively.Statistical analysis showed there was a significant difference between two groups. CONCLUSION The survival time of patients with glioblastoma can be prolonged through radioactive seed implantation at the time of operation. This therapeutic method can rapidly reduce the tumor volume with a minimum number of seeds to avoid excessive radiation exposure.Because of some shortcomings of this study,such as a smal number of patients,and because implantation was performed under the naked eye so that the seed alignment could not be verified accurately,the experience of combining implantation of seeds with external irradiation needs to be investigated further.     

Ⅰ、Ⅱ期鼻咽癌外照射加腔内放疗远期疗效的前瞻性研究

背景与目的:近距离放疗的空间剂量分布和外照射明显不同,两者联合使用可以优势互补,提高剂量分布的适形度.本研究旨在探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效差异.方法:将321例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组223例,外照射加腔内联合放疗组98例;单纯外照射组采用低熔点铅挡块不规则野照射,常规方法照射,常规分割,总剂量为66～74 Gy;联合放疗组采用同样的外照射方法,总剂量给与58～62 Gy,接着给予15～20 Gy腔内近距离放疗.结果:经过5年的随访,单纯外照射组鼻咽复发16例,死亡35例,Ⅰ、Ⅱ期鼻咽癌患者的5年生存率分别为90.63%和80.82%(P=O.018);联合照射组鼻咽复发1例,死亡6例,Ⅰ、Ⅱ期鼻咽癌的5年生存率分别为95.24%和93.36%(P=0.025).口干和张口困难的不良反应以联合照射组较轻.结论:Ⅰ、Ⅱ期鼻咽癌患者采用外照射加腔内放疗相对单纯外照射有较好的疗效并可减轻不良反应.     

153Sm-EDTMP治疗多发骨转移瘤的剂量效应关系初步观察

Objective： To calculate the focus absorption dose of ^153Sm-EDTMP with the Monte Carlo （MC） EGS4 method for treatment of bone metastases from nasopharyngeal carcinoma or breast cancer, and investigate the relationship between the focus absorption dose and painkilling effect of ^153Sm-EDTMP. Methods： Four patients with multiple bone metastases from nasopharyngeal or breast carcinoma and suffered from grade IV bone pain were treated with radionuclide internal irradiation of ^153Sm-EDTMP. The absorption dose and dose distribution of bone metastases and other targeted organs were calculated with MC EGS4 program based on the time-order SPECT/CT scanning and the measurement of the radioactivity in the urine accumulation. The release of bone pain and the improvement of life quality were observed. Results： Bone pain of the patients was significantly alleviated to grade II for 3-4 weeks after internal ^153Sm-EDTMP irradiation. The 3-dimensional absorption dose distribution image of bone metastases and targeted organs showed that the dose distribution in bone metastases was not asymmetrical. After injection of 0.65 × 37 MBq/kg ^153Sm-EDTMP, the highest absorption dose in bone lesions was about 4.9-5.9 Gy, and the dose in the lesion margin was about 2.0 Gy. Using the highest dose as reference dose point, the relative absorption dose values of bone marrow, vertebra and sex organ near lesions were 0.48-1.1 Gy, 0.51-0.85 Gy, and 0.01-0.14 Gy, respectively. Conclusion： The absorption dose of bone metastases is significantly lower than treatment dose of 30 Gy after single irradiation of ^153Sm-EDTMP. The painkilling effect is limited and in accordance with clinical observation.     

Concurrent gemcitabine and cisplatin combined with 3D conformal radiotherapy for stage III non-small cell lung cancer

Objective  To study the toxicities and efficacy of concurrent gemcitabine plus cisplatin combined with three-dimensional conformal radiotherapy for stage III non-small cell lung cancer (NSCLC). Methods  Thirty-six patients with pathologically diagnosed NSCLC received radiotherapy and concurrent chemotherapy. There were 22 patients with stage IIIa and 14 patients with IIIb. Radiotherapy was given a total of 60–70 Gy in conventional fractionation. Chemotherapy included gemcitabine (600 mg/m²) and cisplatin (20 mg/m²), once per week. Results  Thirty-two patients received a total dose of 60–72 Gy. Two patients received 56 Gy and another two patients received 58 Gy. Thirty-four patients received 4–6 weeks of chemotherapy, while two patients received only 2 weeks of chemotherapy. The overall response rate (CR + PR), complete response rate (CR), partially response rate (PR) were 83.3% (30/36), 11.1% (4/36) and 72.2% (26/36) respectively. The median follow-up duration was 18.4 months. The 1- and 2-year overall survival rates were 77.8% (28/36) and 55.6% (20/36), respectively. Conclusion  Concurrent gemcitabine and cisplatin combined with three-dimensional conformal radiotherapy for stage III non-small cell lung cancer is effective and well tolerated. Lone-term results need further study.     

Early stage nasopharyngeal carcinoma: radiotherapy dose and time factors in tumor control

OBJECTIVE: To evaluate radiotherapy dose and length of treatment in the control of early stage nasopharyngeal carcinoma (NPC) treated with a combination of external radiotherapy and brachytherapy, MATERIALS & METHODS: We reviewed the records of 133 patients with early stage nasopharyngeal carcinoma (stage I or II, AJC/UICC staging system) who received definitive radiotherapy in Chang Gung Memorial Hospital from 1979 to 1991. The median follow-up time was 7.1 years with a minimum of 2 years. All patients were treated with megavoltage external radiotherapy to the nasopharynx area (63-72 Gy) followed by high dose rate intracavitary brachytherapy (5-16.5 Gy in one to three fractions, spaced 1-2 weeks apart). The median total dose and time of irradiation was 75 Gy (69.8-81.4 Gy) and 11.6 weeks (7.8-20 weeks) respectively. Survival analysis was used to examine the effect of several variables on prognosis. RESULTS: The 5-year rates were 86.4% for local control, 84.7% for disease free survival, 88.5% for actuarial survival and 84.2% for overall survival. The treatment group (combination of time and dose of irradiation) was the most important prognostic factor according to Cox's proportional hazard model. Patients receiving radiation at a total dose of < or = 75 Gy completed in < 12 weeks showed the best prognosis. CONCLUSION: Treatment time and total treatment dose are both important factors in treating early stage NPC. Decreasing the total radiation time to < 12 weeks and not exceeding a radiation dose of 75 Gy gave the best results.      

Long-term results and prognostic analysis in advanced and recurrent/refractory epithelial ovarian cancer treated by high-dose cyclophosphamide, adriamycin, and cisplatin with autologous bone marrow transplantation

Background. The efficacy of high-dose chemotherapy (HDC) with autologous bone marrow transplantation (ABMT) was evaluated in patients with advanced or recurrent/refractory (r/r) epithelial ovarian cancer in terms of long-term results and prognostic analysis. Methods. Between 1984 and 1991, 47 patients were prescribed two courses of HDC, consisting of cyclophosphamide (1600–2400 mg/m²), adriamycin (80–100 mg/m²), and cisplatin (100–150 mg/m²) after maximal cytoreductive surgery. Prior to HDC, platinum-based chemotherapy was administered for optimal cytoreduction. Results. The 5- and 8-year overall survival (OS) rates (%) of the 47 patients were 44.7% and 40.4%, and the 5- and 8-year disease-free survival (DFS) rates (%) were 29.8% and 27.7%, respectively. The 5- and 8-year OS rates (%) by stage were: stage III, 60.0% and 52.0%; stage IV, 33.3% and 33.3%; and r/r, 20.0% and 20.0%. The 5- and 8-year DFS rates (%) by stage were: stage III, 40.0% and 36.0%; stage IV, 25.0% and 25.0%; and r/r, 10.0% and 10.0%, respectively. Significantly better long-term survival (P < 0.01) was obtained in the group with no residual disease or residual disease <0.5 cm than in the groups with residual disease of 0.5–2 cm and >2 cm. In the 32 stage III/IV patients, the group given two courses of 150 mg/m² cisplatin (n = 18) showed significantly better long-term survival (P < 0.05) than another group given two courses of 100 or 120 mg/m² cisplatin (n = 14). Conclusions. Administration of two courses of HDC con-taining 2400 mg/m² cyclophosphamide, 100 mg/m² adriamycin, and 150 mg/m² cisplatin per course followed by ABMT appears to be a promising procedure for achieving long-term survival in patients with chemosensitive advanced or r/r epithelial ovarian cancers with no or minimal residual disease. Received: October 22, 1998 / Accepted: May 6, 1999     

A phase I/II study of nedaplatin and 5-fluorouracil with concurrent radiotherapy in patients with esophageal cancer

Purpose: To determine the recommended dose (RD) of cis-diammine-glycolatoplatinum (nedaplatin) when given concurrently with 5-FU and high dose radiation therapy in the treatment of esophageal cancer. The purpose of the phase II trial is to determine efficacy and further define the side effect profile. Methods: Twenty-six patients with clinical stage I to IVA squamous cell carcinoma of the esophagus were enrolled in a non-surgical treatment comprised of a fixed dose of fluorouracil (400 mg/m² administered as continuous intravenous infusion on days 1–5 and days 8–12) plus escalating doses of nedaplatin (40 mg/m² in level 1, 50 mg/m² in level 2, or 60 mg/m² in level 3 on days 1 and 8), repeated twice every 3 weeks with concurrent radiotherapy (60 Gy). Results: Between July 1998 and February 2004, a total of 26 patients entered this trial, all of whom were considered evaluable for toxicity assessment. In phase I of the study, 12 patients were treated in sequential cohorts of three to six patients per dose level. The maximum tolerated dose was reached at level 3 with two grade 4 neutropenia and one grade 4 thrombocytopenia. Thus, the recommended dosing schedule is level 2. Of the 20 patients treated at the RD level 2, including 6 patients of the RD phase I portion, 8 out of 20 patients (40%) had grade 3–4 neutropenia, 5 patients (25.0%) had grade 3–4 thrombocytopenia, 4 patients (20.0%) had grade 3 anemia and 4 patients (20.0%) had grade 3–4 esophagitis. Other toxicities were relatively mild and usually of grade 2 or less. Objective responses were noted in the 26 patients (overall response rate, 88.5%) including 11 (42.3%) complete remissions. The 1- and 3-year survival rates were 65.1 and 37.2%, respectively, with a median survival time of 21.2 months. Conclusions: The combination of nedaplatin and 5-FU with radiation is a feasible regimen that shows promising antitumor activity with an acceptable safety profile in patients with esophageal cancer.     

The role of 18F-FDG-PET in the local/regional evaluation of women with breast cancer

Purpose. In women with breast cancer, knowledge of the local/regional extent of the tumor is essential for staging, treatment planning, monitoring response to therapy, and follow-up. Positron emission tomography (PET) is an important imaging test which can detect tumor at multiple sites in women with breast cancer. We compared the ability of PET to provide a comprehensive view of the local/regional extent of tumor in women with stage I, II and stage III, IV breast cancer. Materials and methods. Forty-six women with breast cancer underwent PET using ¹⁸F-FDG. ¹⁸FDG uptake in the breast primary tumor, associated skin, axillary and internal mammary lymph nodes, and the contralateral breast was determined qualitatively, and correlated with histologic, clinical and radiographic findings. Results. Twenty-four patients were premenopausal and 22 were postmenopausal, with the following distribution according to clinical stage: stage I – 2 patients, stage II – 16, stage III – 16, stage IV – 12 patients. Among stage I, II patients, the sensitivity for detection of the primary tumor was 83.3%, and for detection of axillary lymph node metastases was 42.9%. ¹⁸FDG-PET was negative for the breast skin, contralateral breast, and internal mammary lymph nodes in all stage I, II patients, in agreement with clinical and radiographic findings. Among 28 stage III, IV patients, the sensitivity of ¹⁸FDG-PET for detection of the primary tumor was 90.5%, and for detection of axillary lymph node metastases 83.3%. Fourteen patients had clinically advanced changes in the skin, and the sensitivity of PET for detection of skin changes was 76.9%. ¹⁸FDG-PET was positive in the internal mammary lymph nodes in 25.0%, and negative in the contralateral breast in all patients with stage III, IV breast cancer. ¹⁸FDG-PET was studied in 10 patients following neoadjuvant chemotherapy, and showed a strong correlation with clinical response, and with clinical and pathological findings post-treatment at multiple local/regional sites. Conclusion. ¹⁸FDG-PET can provide a comprehensive image of local/regional tumor in women with breast cancer. ¹⁸FDG-PET may play a greater role in women with stage III, IV breast cancer because of increased sensitivity and the increased involvement of multiple local/regional sites with tumor.     

Retrospective study of results of interstitial radiotherapy for cancer of the tongue

Background This retrospective study was carried out to clarify whether interstitial radiotherapy is effective in the management of carcinoma of the tongue. Methods The subjects were 65 previously untreated patients with invasive squamous cell carcinoma of the anterior two-thirds of the tongue who received mainly interstitial radiotherapy using¹³⁷Cs needles with or without external irradiation between 1977 and 1993. Results The local control rate was 80% for T1, 73% for T2, 57% for T3 and 73% overall. Thirteen of 16 patients for whom local control failed achieved good control by salvage surgery. The local control rates were slightly lower with combined radiotherapy (64%) than with the interstitial radiotherapy alone (78%), but there was no significant difference between external radiation (≤30 Gy) and external radiation (>30 Gy). Cervical lymph node metastases developed in 26% of patients with T1-3 NO. Neck control was achieved in 20 (74%) of 27 patients in whom pathologically positive nodes were found. Twenty-two patients developed soft tissue or/and mandibular complications for a total of 28 cases. Soft tissue complications were more likely to occur in patients who received interstitial radiotherapy alone. On the other hand, mandibular complications were likely to occur in patients who received external irradiation. The cumulative 5-year survival rate was 92% for T1, 72% for T2 and 33% for T3. The 5-year survival rate of patients with subsequent cervical node metastases was 41%, whereas in patients without subsequent cervical node metastases it was 89% (P<0.001). Conclusions Interstitial radiotherapy with or without external irradiation has useful implications in the local control of newly diagnosed cases of tongue cancer. If local recurrence develops, it is possible to control the primary lesion and prolong survival by salvage surgery. The most effective treatment modality for neck control and survival could not be determined from this study.     

Population-based survival-cure analysis of ER-negative breast cancer

This study investigated the trends over time in age and stage specific population-based survival of estrogen receptor negative (ER−) breast cancer patients by examining the fraction of cured patients and the median survival time for uncured patients. Cause-specific survival data from the Surveillance, Epidemiology, and End Results program for cases diagnosed during 1992–1998 were used in mixed survival cure models to evaluate the cure fraction and the extension in survival for uncured patients. Survival trends were compared with adjuvant chemotherapy data available from an overlapping patterns-of-care study. For stage II N+ disease, the largest increase in cure fraction was 44–60% (P = 0.0257) for women aged ≥70 in contrast to a 7–8% point increase for women aged <50 or 50–69 (P = 0.056 and 0.038, respectively). For women with stage III disease, the increases in the cure fraction were not statistically significant, although women aged 50–69 had a 10% point increase (P = 0.103). Increases in cure fraction correspond with increases in the use of adjuvant chemotherapy, particularly for the oldest age group. In this article, for the first time, we estimate the cure fraction for ER− patients. We notice that at age ≥70, the accelerated increase in cure fraction from 1992 to 1998 for women with stage II N+ compared with stage III suggests a selective benefit for chemotherapy in the lower stage group.     

Phase I/II study of cisplatin, ifosfamide and irinotecan with rhG-CSF support in patients with stage IIIB and IV non-small-cell lung cancer

Purpose: We conducted a phase I/II study in previously untreated patients with stage IIIB or IV non-small-cell lung cancer (NSCLC) to: (1) determine the maximum tolerated dose (MTD) of cisplatin combined with a fixed schedule of ifosfamide and irinotecan with rhG-CSF support; and (2) to determine the overall response rate and median survival of patients entered on this study. Methods: Ifosfamide (1.5 g/m²) and irinotecan (60 mg/m²) were administered at fixed doses on days 1–4 and on days 1, 8 and 15, respectively. Cisplatin was given on day 1 at 60 mg/m² and was increased in 10-mg/m² increments. This regimen was repeated every 4 weeks. rhG-CSF (nartograstim) was administered subcutaneously at a dose of 1 μg/kg on days 5–18 except on the day of irinotecan treatment. Results: Between June 1995 and April 1998, 46 patients were registered onto this phase I/II study. The MTD of cisplatin was defined according to toxicity and the dose during three courses was increased. Since at the 80 mg/m² dose level more than one-third of the patients were treated with dose modification, the dose of 70 mg/m² was recommended for phase II study. The dose-limiting toxicity was leukopenia. The overall response rate was 62.2% (95% CI 48.0–76.4%), the median response duration was 144 days, and the median survival time was 393 days. Conclusion: For phase II study, we recommend doses of cisplatin 70 mg/m² on day 1 combined with ifosfamide and irinotecan with rhG-CSF support. Both the response rate and preliminary survival data in this study suggest a high degree of activity of this combination in previously untreated NSCLC. Received: 29 April 1999 / Accepted: 15 September 1999     

Role of 10-Gy boost radiation after breast-conserving surgery for stage I–II breast cancer with a 5-mm negative margin

Background According to the Guidelines for breast-conserving therapy of the Japanese Breast Cancer Society, the surgical margin is “negative” when the minimum distance between the tumor edge and the margin of the resected specimen is more than 5 mm. The value of boost radiation for early breast cancer with a 5-mm negative margin remains unclear. Methods A total of 137 patients with stage I–II breast cancer underwent breast-conserving surgery between July 1987 and August 2002. All of the patients had negative margins according to the Japanese guidelines. Their median age was 50 years and the median follow-up period was 62 months. The entire ipsilateral breast was irradiated to a total dose of 50 Gy (25 fractions). Then an additional 10 Gy (5 fractions) was given to 79 patients, using 6- to 12-MeV electrons (boost group), while 58 patients (no-boost group) received no further radiation. Factors influencing local recurrence were evaluated by univariate and multivariate analyses. Results For the entire population, the 5-year overall survival, cause-specific survival, disease-free survival, and local recurrence rates were 96.0%, 96.8%, 94.2%, and 1.67%, respectively. Boost radiation reduced local recurrence, but the improvement was not significant (P = 0.070). Univariate and multivariate analyses failed to detect any factors that were significantly associated with local control. There were no severe complications in either group and there were no differences between the groups in the cosmetic outcome. Conclusion Boost radiation can be performed for stage I-II breast cancer with negative margins (Japanese guidelines), and showed a tendency to decrease local recurrence. A large randomized controlled study is necessary to establish final conclusions.