Treatment results in males with breast cancer

Because cancer of the male breast is rare knowledge about its biology and behavior is essentially due to a compilation of pooled experiences. Hence, a continued report of cases appears to be important. Therefore a retrospective review of patients suffering from male breast cancer was carried out. Twenty-four evaluable cases were analyzed. Eight patients (1 patient with bilateral Stage I carcinoma was included) were in Stage I, 7 in Stage II, 2 in Stage IIIa, 4 in Stage IIIb, and 3 in Stage IV. Of 23 patients who were treated with mastectomy, 22 had modified radical mastectomy and postoperative irradiation to the chest wall as well as to the peripheral lymphatic areas in most cases. One patient underwent radical mastectomy. Another patient had an excision biopsy only, followed by irradiation. One of 24 patients received tamoxifen; another received cyclophosphamide, methotrexate, 5-fluorouracil, predisone (CMF) regimen in an adjuvant setting. Local recurrence developed in one of 23 (4%) patients treated with mastectomy and radiation therapy to the chest wall and peripheral lymphatics. Four (17%) patients developed distant metastases. The 5-year overall survival (Kaplan-Maier) was 90% for the entire group, 100% for patients in Stage I–III disease, and 60% in Stage IV disease (P = <0.005). As observed in former reports the stage of disease at initial presentation seems to be a parameter that significantly contributes to survival in male breast cancer patients. To what extent improved local control by adequate local therapy, such as surgery and postoperative radiotherapy, may improve overall survival remains to be discussed. Correspondnce to: B. Pakisch     

Frequency of coexistent disease at CT in patients with prostate carcinoma selected for definitive radiation therapy: is limited treatment-planning CT adequate?

PURPOSE: To document the frequency of clinically important coexistent disease depicted at contrast material-enhanced abdominal and pelvic computed tomography (CT) in patients undergoing definitive radiation therapy for prostate carcinoma, as such lesions might be missed at limited nonenhanced treatment-planning CT. MATERIALS AND METHODS: Of 133 consecutive patients with prostate carcinoma who were referred to the radiation oncology division between January 1, 1994, and December 31, 1996, 77 underwent definitive radiation therapy that required either contrast-enhanced abdominal and pelvic CT (n = 67) or contrast-enhanced pelvic CT (n = 10). Results of these studies were reviewed and retrospectively categorized. RESULTS: Forty-eight (62%) of the 77 patients had either negative studies or minor abnormalities that did not require further follow-up. Only two patients (3%) had major abnormalities that required intervention. Five patients (6%) had new findings of clinically important coexistent disease, but no intervention was required. CONCLUSION: The incidence of clinically important coexistent disease in patients with prostate carcinoma who are referred for definitive radiation therapy is low. Therefore, contrast-enhanced abdominal and pelvic CT in addition to treatment-planning CT is of limited value.     

Radiotherapy in T1 epidermoid carcinomas of the vocal cords

In the last years radiotherapy has become the methodology of choice in the treatment of initial T1a and T1b glottis neoplasias, the reason being-it is as successful in controlling the disease as demolition surgery, but it saves the phonation function. Our experience in the "O. Alberti" Institute of "Spedali Civili" di Brescia from January 1, 1970 to December 31, 1984 is here reported. Out of the total figure of 195 patients treated with radiotherapy, 154 were T1a, and 41 T1b. Global survival rate after 5 years is 76,25%. Loco-regional relapses were on the whole 28: 24 on T, and 4 on N. Saving therapy allowed the retrieval of 15 patients (62,5%) with relapse on T. The total dose administered (greater than 60 Gy or 60 less than Gy), TDF values (greater than 95 or less than 95 on minimum), and field dimensions (greater than 5 x 5 cm2 or less than 5 x 5 cm2) were considered, in order to evaluate the chance of relapse. The only statistical data concerning the significant difference between the two groups of patients irradiated with fields less than 5 x 5 cm2 and more than 5 x 5 cm2, both with a total dose of more than 60 Gy. In the group of patients irradiated with smaller fields, the percentage of relapses is lower. This is probably due to the fact that the patients had more superficial lesions. The treatment had no severe side-effects, and never affected the quality of the voice. In order to obtain a high recovery-rate, in the meantime reducing side-effects and keeping a good phonation function, small fields and dose ranging between 64 and 68 Gray with 32-34 fractions, 5 per week, are thought to be the best. It is necessary, however, to watch out for penumbra and inaccuracy by immobilizing the patient with containing systems.     

Laser-radiation therapy for T2N0M0 laryngeal-glottic cancer

PURPOSE: To evaluate the laser-radiation combined therapy for T2N0M0 laryngeal-glottic cancer in order to preserve the larynx. METHODS AND MATERIALS: The subjects consisted of 52 patients with T2N0M0 laryngeal-glottic cancer treated with laser-radiation combined therapy between 1980 and 1999. Patients ranged in age from 40-88 years, with a median of 70 years, and included 51 men and one woman. During this period, treatment was administered with different radiation devices(60Co or 4 MV-X ray), and 40-72 Gy (median, 60 Gy) of radiation therapy ware administered. Tumor and treatment characteristics were correlated with local control at a median follow-up of 61 months(range 12-210 months). Concurrent chemotherapy was administered to 32 patient; 29 were treated with 5-FU and vitamin A(FAR), and 3 were treated with low-dose CDDP. Post treatment vocal function was examined in 37 patients. The voice was evaluated in terms of four parameters: maximum phonation time (MPT), mean air flow rate during phonation over a comfortable duration(MFR), fundamental frequency range of phonation(F0 range), and sound pressure level range of phonation (SPL range). RESULTS: The five-year cause-specific-survival rate was 98.0%, and the local control rate was 91.8%. Three of 4 patients who had locally relapsed were administered total laryngectomy as salvage therapy. One patient was administered the tracheostomy for late complication. The actuarial laryngeal preservation rate was 92.3%. We did not find any significant relationship between local relapse and extent of disease, subglottic extension, or anterior commissure involvement. Concurrent chemotherapy was not a significant prognostic factor. Laser debulking followed by radiation therapy did not change the voice significantly except the F0 range. CONCLUSION: We conclude that the laser-radiation combined therapy for T2N0M0 laryngeal-glottic cancer was effective therapy for not only preservation of the voice but also for vocal function.     

Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy-- a second chance to preserve the breast

PURPOSE: To perform and assess the effectiveness of local excision of recurrent tumor followed by postoperative pulse dose rate (PDR) brachytherapy. MATERIALS AND METHODS: From 1994 to 2000, 17 patients who had small recurrent breast carcinomas after initially undergoing breast-conserving therapy (BCT), which included postoperative radiation therapy, were treated with local tumor excision and PDR brachytherapy. Recurrences occurred at a median time of 50 months (range, 11-208 months) after primary treatment. Eight patients underwent a combination of PDR brachytherapy (total dose range, 12.5-28.0 Gy) and external-beam radiation therapy (EBT) (total dose range, 12-30 Gy). Nine patients underwent radiation therapy with 40.2-50.0-Gy PDR brachytherapy only. The prescribed radiation dose was 0.5-1.0 Gy per pulse. Patients were examined for local tumor control and treatment-related side effects. RESULTS: Twelve of 17 patients had no local tumor at a median follow-up time of 59 months (range, 20-84 months); two of these patients showed signs of having distant disease. One patient died after a cerebral stroke without evidence of tumor. Four women treated with combined EBT and brachytherapy had secondary local tumor recurrences 4, 8, 8, and 11 months after therapy and had to undergo mastectomy. Despite having undergone radiation therapy previously, patients had side effects limited to moderate (grade 1-2) fibrosis. CONCLUSION: Local tumor excision combined with PDR brachytherapy for small local-regional tumor recurrences after primary BCT is feasible and well tolerated and might obviate mastectomy. Preliminary experiences are encouraging. Further studies are required for appropriate patient selection.     

Early-stage glottic cancer: importance of dose fractionation in radiation therapy.

The treatment results in 85 patients with T1N0M0 squamous cell carcinoma of the glottic larynx who were treated with primary radiation therapy were reviewed to analyze for local control. After a minimum follow-up period of 2 years, 13 patients had local recurrence of disease, which yielded a local control rate of 84.7%. Local control was then reassessed as a function of substages (T1a and T1b) and dose fractionation. No difference in local control was seen in T1a and T1b neoplasms. However, after undergoing standard once-a-day fractionation, patients treated with fractions of 200 cGy had a local control rate of 96%, while those receiving 180 cGy had a local control rate of 79% (P = .05). Mean total dose for each patient group was comparable, and the median number of days of treatment interruption was the same for both groups. These data corroborate the recent findings of other authors regarding the importance of fraction size in facilitating local control of early-stage glottic cancer.     

Clinical assessment of tumor clearance during radiotherapy as a prognostic factor of early glottic carcinoma.

From 1967 through 1985, 358 cases of early glottic carcinoma were treated with telecobalt therapy at the Department of Radiology, Osaka University Medical School. Among 278 cases treated with 2 Gy a day, the tumor response of 262 cases at 40, 50 and 60 Gy were evaluated by direct or indirect laryngoscope. The five-year local control rates of these evaluable cases of T1 and T2 glottic carcinoma were 79% and 70%, respectively. The local control rates of T1 glottic carcinoma with tumor clearance and persistence at 40 Gy were 83% (119/143) and 64% (43/67), and those of T2 cases were 86% (18/21) and 58% (18/31), respectively. The local control rates of the cases with tumor clearance and persistence at 40 Gy were same between T1 and T2 cases. The tumor clearance rates of T1 cases were significantly higher than those of T2 cases (p < 0.005). T2 glottic carcinoma had larger tumor volumes and slower tumor regression and resulted in lower control rates compared with T1 glottic carcinoma. The difference in the radiation dose of T1 and T2 glottic carcinoma with the same clearance rate was estimated as 15 Gy using logit analysis.     

Stage I and II breast carcinoma: treatment with limited surgery and radiation therapy versus mastectomy

Between 1980 and 1986, 2,140 patients with surgical stage I or II breast carcinoma were treated including 1,179 patients with T1-2N0 disease and 961 patients with T1-2N1 disease. Among the 1,179 patients without node involvement, 215 underwent limited surgery (complete excision and axillary node dissection) and radiation therapy; 964 patients underwent modified radical mastectomy only. Of the 961 patients with node involvement, 106 were treated by means of limited surgery and radiation therapy; of these, 48 also received chemotherapy. The remaining 855 patients underwent mastectomy; of these, 381 also received chemotherapy and/or hormone therapy. The 5-year survival rates for patients with no node involvement were 96% for the group treated by means of limited surgery and radiation therapy and 88% for the group treated by means of mastectomy (P greater than .05). The 5-year survival rates for patients with node involvement were 96% for the group treated by means of limited surgery and radiation therapy with or without chemotherapy and 77% for the group treated by means of mastectomy with or without chemotherapy (P less than .01). This study demonstrates no disadvantage from treatment by means of limited surgery and radiation therapy and suggests that adjuvant radiation therapy may be important in increasing survival among patients with T1-2 breast carcinoma and positive axillary nodes.     

Radiotherapy in the treatment of locoregional relapses of breast cancer

Locoregional recurrences of breast cancer are associated with considerable morbidity and frequently present with concurrent metastatic disease. Yet patients without systemic spread can be treated with curative intent. In a retrospective analysis, the results of treatment of these patients have been evaluated at our institution. Between 1987 and 1996, 113 patients with locoregional breast cancer relapse, without systemic manifestation, received irradiation after local tumour excision. 13 patients (11.5%) had already received radiotherapy as part of their primary treatment. In these cases, only the area involved was treated. In all other patients, the chest wall and the ipsilateral lymph nodes were irradiated. Median dose was 50 Gy (range 20-65 Gy). Median follow-up was 4.4 years. 76 patients (67.3%) presented with chest wall recurrence only, 25 patients (22.1%) with nodal relapse only and 12 patients (10.6%) with combined relapses. 93% of patients had local control of disease after treatment. Local control rate after 5 years was 59%. 63 patients (55.8%) died within the follow-up interval, 45 patients (39.8%) owing to metastases, 4 patients (3.5%) owing to local failure and 8 patients (7%) owing to causes unrelated to tumour. Overall survival after 5 years was 43%. In multivariate analysis, positive hormone receptor status, small tumours on relapse and chest wall relapses alone were associated with improved survival. Radical local therapy is necessary in order to achieve and maintain local control and to prevent secondary dissemination in patients with only local recurrence of breast cancer.     

The management of soft tissue sarcomas in adults: surgery and postoperative radiotherapy.

Traditionally soft tissue sarcomas have been managed by surgery, because they were considered radioresistant. Experience has shown that the local recurrence rate after a simple excision is 90 per cent and 30 per cent after radical surgical procedures. The treatment of soft tissue sarcomas by radical ratiation therapy alone is also unrewarding-the local recurrence rate being 66 per cent. In order to preserve a functional limb, a selected group of patients was treated using a conservative surgical excision of the gross tumor (usually a simple "shelling out"), and immediate postoperative radiation therapy. The rationale for removing all gross tumor by conservative surgical excision is that the remaining subclinical disease can be destroyed with moderate doses of postoperative irradiation. In 70 patients with soft tissue sarcomas of the extremities, all local failures occurred in tumors of the fleshy parts with a recurrence rate of 17.2 per cent, independent of the histological type. In spite of generous radiation fields, 4 of the 12 local recurrences were outside of the irradiated volume, some more than 5 cm from the margin of the field. This documents the tendency of soft tissue sarcomas to spread along the fascial planes for a great distance. To avoid complications only part of the entire circumference of an extremity must be irradiated since a severe constricting fibrosis may result with varying degrees of edema distal to the irradiated volume when all of most of the circumference is irradiated. This retrospective review of patients treated for extremity lesions by conservative excision and postoperative radiotherapy shows that a functionnal limb can be preserved in 80 per cent of the patients.     

Fibrous dysplasia: magnetic resonance imaging appearance at 1.5 tesla

Fibrous dysplasia has been described in a small number of cases in the literature as showing low signal intensity on T1- and T2-weighted magnetic resonance images. We reviewed magnetic resonance scans of 13 patients with fibrous dysplasia to determine if there might be a characteristic appearance. All lesions had sharply defined borders and were of intermediate signal intensity on T1-weighted images. With T2 weighting, six lesions (46%) showed high signal intensity, four (31%) showed persistent intermediate signal intensity, and three (23%) showed mixed intermediate and high signal intensity. Ten lesions (77%) had inhomogeneous signal intensity and three (23%) had homogeneous signal intensity. We concluded that fibrous dysplasia does not have a characteristic appearance on magnetic resonance imaging. However, magnetic resonance may be helpful in establishing the diagnosis of fibrous dysplasia if low to intermediate signal intensity is seen on both T1- and T2-weighted images. This situation occurred in 54% of our cases, whereas the other 46% had nonspecific signal characteristics indistinguishable from many other bone lesions.     

Ovarian Function Following Pelvic Irradiation in Prepubertal and Pubertal Girls and Young Adult Women

PURPOSE: To analyze the effect of pelvic radiotherapy on ovarian function in prepubertal and pubertal girls and young adult women. PATIENTS AND METHODS: In a retrospective monoinstitutional analysis, patients < 30 years of age at diagnosis were included who had been irradiated between 1979 and 1998. The main tumor types were Hodgkin's disease (38%), Ewing's sarcoma (20%) and nephroblastoma (11%). Patients were classified into three groups according to the position of the ovary in relation to the radiation portals. Group 1 was defined by direct irradiation of both ovaries. Group 2 patients were included with both ovaries potentially located in the radiation portals. In group 3, at least one ovary was not directly irradiated. The median follow-up was 128 months. RESULTS: 16 of 55 analyzed patients were categorized in group 1. In ten of these patients, hormone status was evaluable. The ovarian doses were >/= 15 Gy. Except for one patient treated with 15 Gy all developed hormone failure. Eight of 14 patients of group 2 were evaluable. Seven of these patients developed ovarian failure. 19 of 24 patients in group 3 were evaluable. Nine of these patients developed ovarian failure. The observed difference in the rate of ovarian failure between the groups is statistically significant (p = 0.045). CONCLUSION: All patients receiving > 15 Gy to the ovaries developed hormone failure. In one case of a patient receiving an ovarian dose of 15 Gy, hormone failure was not found. In case of pelvic irradiation excluding at least one ovary, approximately half of the patients developed ovarian dysfunction, probably also due to the effects of polychemotherapy.     

Post-treatment complications of soft tissue tumours

Purpose

To identify local and distant complications of patients with soft tissue tumours and evaluate their relationships to types of therapy.

Methods and materials

Fifty-one patients (29 males and 22 females, ages 14–80 years) with 34 malignant and 17 benign soft tissue tumours were evaluated for local and distant complications after resection or amputation only (26 patients) or after the addition of radiotherapy (25 patients: 17 patients had external beam therapy, 7 patients had external beam therapy and brachytherapy, and one patient had extracorporeal irradiation and reimplantation). Duration of follow-up averaged 3.75 years for malignant tumours and 2.79 years for benign tumours. Follow-up studies included radiography, T1- and T2-weighted magnetic resonance (MR) imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), computed tomography for thoracic and abdominal metastases, and 3-phase technetium-99m-labeled-methylene-diphosphonate scintigraphy for bone metastases.

Results

Recurrent tumours were 2.2 times more frequent in patients who had undergone their initial resection at an outside hospital as compared with those first treated at the university hospital. Nine of 11 recurrences occurred after marginal surgery. Metastases from soft tissue sarcomas, most commonly to lung (nine patients) and to bone and muscle (five patients), showed no specific relationship to type of therapy. DCE-MRI differentiated rapidly enhancing soft tissue recurrences (11 patients) and residual tumours (6 patients) from slowly enhancing muscle inflammation, and non-enhancing fibrosis and seromas that usually did not enhance. Seromas developed in 76% of patients who had postoperative radiation therapy and in 7.7% of patients who had only surgery. Subcutaneous and cutaneous oedema and muscle inflammation was at least four times more frequent after adjunct radiotherapy than after resection alone. Irrespective of the type of treatment, inflammatory changes in muscle and subcutaneous and cutaneous tissue and the majority of seromas were evident at the first follow-up study. Although seromas after resection and external beam therapy resolved with time, seromas after additional brachytherapy persisted. Inflammatory changes in muscle and cutaneous and subcutaneous tissue after resection alone disappeared by the second follow-up study, whereas these changes after radiotherapy resolved months to years after treatment. Fourteen of 51 patients showed MR findings of chronic muscular atrophy, predominantly located in the lower extremity. Heterotopic ossification was seen in three patients after resection and amputation without radiotherapy. Except for one patient with aggressive fibromatosis, bone and nerve complications occurred in patients with soft tissue malignancy. Twelve patients had osteoporosis. Six patients sustained fractures in irradiated osteoporotic bone of the lower extremity, and one patient had a vertebral fracture in radiographically normal but irradiated bone. In addition, one patient was found to have a medullary infarct in an irradiated femur. In nerve entrapment, DCE-MRI demonstrated the rapidly enhancing recurrent tumour or non-enhancing fibrosis surrounding the slowly enhancing nerve. T1- and T2-weighted MR images displayed the acute and chronic sequelae of nerve entrapment and nerve transection with denervation as T2-hyperintense acute muscle atrophy or T1-hypertense chronic fatty muscular atrophy with decrease in muscle volume.

Conclusion

This study suggests a possible relationship between types of treatment of soft tissue tumours and subsequent complications. Postoperative radiotherapy was associated with a significant number of patients with seromas, muscle, cutaneous and subcutaneous inflammation, and fractures. Incomplete or difficult surgery resulted in residual or recurrent tumours and heterotopic ossification. Muscle atrophy and nerve entrapment were related to both treatments (resection alone or radiotherapy after resection). Diligent follow-up of patients with soft tissue tumours with recognition of these complications and their differentiation from recurrent or residual tumour can help guide clinical care and may negate the need for surgery when benign disease is defined.     

Bilateral stage Ib glottic carcinoma: results of radiation therapy

Bilateral early carcinoma of the true vocal cords (stage T1bN0M0) makes up about 15% of all stage I carcinomas. Twenty-four patients with stage Ib glottic carcinoma (18 with involvement of the anterior commissure and six without) received a radical course of radiation therapy with the median dose of 6,600 rad (66 Gy) in 33 fractions calculated at midpoint. In 19 patients (80%) radiation therapy alone produced complete local control of the disease. In the five patients in whom treatment failed, the recurrent tumors were confined to the larynx and were noticed within 3 years of treatment. Surgery was subsequently performed in three of the five patients but was successful in only one. In 19 of the 24 patients, the voice sounded relatively normal after radiation therapy.     

Recombinant human TSH-aided radioiodine treatment of advanced differentiated thyroid carcinoma: a single-centre study of 54 patients

We sought to evaluate the efficacy, biochemical effects, safety and outcome of recombinant human thyroid-stimulating hormone (rhTSH) as an adjunct to radioiodine treatment of advanced differentiated thyroid carcinoma (DTC). We also sought to determine whether rhTSH is useful as an adjunct to radioiodine treatment following isotretinoin re-differentiation therapy of DTC metastases that have lost function. Therefore, in 54 consecutive patients who had retained bulky metastatic and/or locoregional lesions of DTC despite the exhaustion of other therapeutic options, we gave one to four courses of two consecutive daily intramuscular injections of rhTSH, 0.9 mg, followed by a therapeutic activity of (131)I per os on day 3. Fifty patients had received prior radioiodine treatment aided by l-thyroxine (T(4)) withdrawal. We included in the study 23 patients who had received a trial of isotretinoin therapy for re-differentiation of confirmed de-differentiated metastases. In a blinded, within-patient comparison of post-therapy whole-body scans after the first rhTSH-aided and latest withdrawal-aided treatments in patients with functional metastases at baseline, 18 of 27 (67%) scan pairs were concordant, four (15%) were discordant in favour of the rhTSH-aided scan and five (19%) were discordant in favour of the withdrawal-aided scan. In total, 37 (74%) of 50 paired scans were concordant, eight (16%) favoured rhTSH and five (10%) favoured withdrawal. All differences appeared to be attributable to clinical causes, not to any difference between endogenous and exogenous TSH stimulation. Reflecting the biochemical activity of rhTSH and the release of thyroglobulin (Tg) due to tumour destruction, median serum Tg concentration rose approximately fourfold between baseline and day 6 of the rhTSH-aided treatment course. rhTSH was well tolerated, with mostly minor, transient toxicity, except for neck oedema in three patients with neck infiltrates and pathological spine fracture in one patient with a large vertebral metastasis. At 6 months, complete response occurred in one (2%), partial response in 12 (26%) and disease stabilisation in 19 (40%) of 47 evaluable patients. The rate of complete + partial response was 41% and that of disease stabilisation, 30%, in the 27 evaluable patients with functional metastases at baseline; the corresponding rates were 10% and 55% in the 20 evaluable patients with non-functional metastases at baseline. Although within-patient comparison of early outcome after both modalities is limited by a significantly greater median number of courses and a greater median cumulative activity of radioiodine given under withdrawal, response to rhTSH-aided and withdrawal-aided treatment was similar in 23 (52%) of 44 evaluable patients, superior with rhTSH in 12 (27%) and superior with withdrawal in seven (16%). In two patients, a superior response was obtained after isotretinoin pretreatment and rhTSH and attributed to re-differentiation therapy. In conclusion, our study provides preliminary evidence that rhTSH safely and effectively aids radioiodine treatment of advanced DTC, and does so to an at least equivalent degree as does T(4) withdrawal.     

Long-term outcomes of photodynamic therapy for a positive resection margin after conization for cervical intraepithelial neoplasia grade 3

BackgroundPositive resection margins after conization or loop electrosurgical excision procedure (conization/LEEP) are associated with increased risks of recurrence or residual cervical intraepithelial neoplasia (CIN). Herein, we investigated the long-term outcomes of photodynamic therapy (PDT) for incomplete excision of CIN3.MethodsWe retrospectively reviewed the medical charts of 73 patients treated with PDT between 2000 and 2011. Patients who underwent conization/LEEP before PDT within 6 months were included. The primary outcomes were the complete response (CR) rate after 1 year and human papillomavirus (HPV) eradication rate at 6 months after PDT.ResultsA total of 34 patients with positive resection margins were finally enrolled. The median patient age was 33 years. Carcinoma in situ was diagnosed in 25 patients and CIN3 in 7 patients. The CR rate was 97.1% after 1 year. Except for one case of a persistent disease, there was no recurrence or newly developed disease during the median follow-up of 84 months (range, 12–224 months). The HPV eradication rate of PDT following conization/LEEP after 6 months was 96.9% (31/32). Photosensitivity was identified in five patients and cervical stenosis in one patient.ConclusionsIn conclusion, PDT could be an effective therapeutic option for patients with a positive resection margin after conization/LEEP for CIN3. It could reduce the residual or recurrence rate of CIN lesions with tolerable adverse events.     

Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine

PurposeAdvances in stereotactic radiosurgery have improved local control of spine metastases, but local failure is still a problem and repeat irradiation is limited by normal tissue tolerance. A novel high-dose-rate (HDR) brachytherapy technique has been developed to treat these previously irradiated lesions.Methods and MaterialsFive patients with progressive disease at previously irradiated sites in the spine who were not amenable to further external beam radiation were treated. Catheters were placed intraoperatively in 2 patients and percutaneously implanted in 3 patients with image-guided techniques. Conformal plans were generated to deliver dose to target tissues and spare critical structures. Patients received single-fraction treatment using HDR iridium-192 brachytherapy.ResultsMedian dose was 14 Gy (range, 12–18 Gy) with a median gross total volume D₉₀ of 75% (range, 31–94%); spinal cord/cauda equina dose constraints were met. At a median followup of 9 months, no local progression of disease has been observed. Four patients had reduction in pain 1–4 weeks after treatment. No brachytherapy-related complications have been observed.ConclusionsIntraoperative and percutaneous iridium-192 HDR spine brachytherapy techniques were not associated with complications or acute toxicity. There has been no local progression at treated sites, and most patients experienced reduction in cancer-related pain.     

Primäre Strahlentherapie des Larynxkarzinoms

Purpose

In the treatment of laryngeal carcinoma definitive radiotherapy results in a similar outcome as surgical treatment in the early stages with a lower morbidity rate and good functional results. In fact no randomized studies exist, so far, and the optimal treatment concept for the different stages is not well defined. The following study analyses retrospectively the treatment results and the recurrence data in patients with a squamous cell carcinoma of the larynx treated with definitive radiotherapy.

Patients and Method

Two hundreds and eighty-three patients with carcinoma of the larynx were treated with radiation therapy in the department of radiology of the LMU München between September 1971 and June 1986. Twenty-six patients (9.2%) were female and 257 (73.1%) male. The median age was 68.5 years, respectively 70 years. All patients had a histologically confirmed squamous cell carcinoma of the larynx. No true subglottic cases were observed. Forty-one (14.5%) tumors were localized supraglottically, 207 (73.1%) glottically. Thirty-five patients had a T4 tumor with glottic and supraglottic involvement. In 147 patients the histopathological grading was evaluable: 32 tumors were classified as G1, 95 as G2, 15 as G3 and 5 as G4. According to the UICC classification of 1979 25 patients had a carcinoma in situ (Tis), 93 patients had a stage T1, 90 stage T2, 40 stage T3 and 35 stage T4. Two hundreds and thirty-three of 283 (82.3%) had no lymph node involvement. In 50 patients clinically a lymph node involvement was observed. 22 patients had a stage N1, 5 patients stage N2 and 23 patients stage N3. An external beam radiation mostly with cobalt-60 was performed with a mean dose of 61.9 Gy.

Results

The 5-years relapse free survival for the whole group was 61.7%. The probability for “no evidence of disease” (NED) depended on tumor stage and-localisation (glottic tumors: Tis/T1 90.5%; T2 59.4%; T3 39.6%; [5-year NED]; supraglottic tumors: T1 64.2%; T2/3 28.6%; T4/N3 24.7% [3-year NED]). Other signifikant prognostic factors besides T-stage were N-stage (N0 vs. N1–3: 3-year recurrence-free survival 68% vs. 37.2%, p<0.001) and histopathologic grading (G1 vs. G3/4: 3-year recurrence-free survival 74% vs. 37.1%, p<0.01). One hundred and twenty-two (43.1%) patients had a recurrence, which occurred in 75.4% local, in 12.3% locoregional, in 8.2% with distant metastases and 4.1% combined. In 50 patients with a recurrent disease a salvage-therapy was carried out. Thereby 17 patients achieved a complete response.

Conclusion

Even for the here described negatively selected patient group with a high median age and multimorbidity, good local controlrates could be achieved escpecially in early stages with definitive radiation therapy. In more advanced stages even in elderly patients a combined surgical-radiotherapeutic treatment should be performed.     

Carcinoma of the male breast: a review of adjuvant therapy

The purpose of the present paper was to evaluate the characteristics and outcomes of male breast cancer patients seen for adjuvant therapy at a single institution. A retrospective review of computerized records in the Departments of Medical and Radiation Oncology at the Royal Prince Alfred Hospital (RPAH) was undertaken. Between 1983 and 1996, 24 men were referred for treatment of breast cancer. Of these, 19 had localized breast cancer, four had metastatic disease and one had ductal carcinoma in situ (DCIS). The median age was 57.5 years (range: 26-78) and median follow-up was 6.2 years (range: 0.6-36). Pathological staging was performed. Survival was assessed using actuarial life table analysis. Of the 19 patients who presented with localized disease, there were 12 T1, five T2 and two T4 cancers. Eleven patients had axillary lymph node involvement. Ten patients were oestrogen receptor (ER) positive, two patients were ER negative and seven patients had unknown receptor status. All patients underwent surgery. Eleven patients received radiotherapy. The median dose and dose per fraction were 50 Gy and 2 Gy, respectively. Adjuvant systemic therapy was delivered to 10 patients, of whom nine were node-positive. Four patients received chemotherapy alone, three patients received chemotherapy and tamoxifen, and three patients received tamoxifen only. Seven patients relapsed (one local, five distant, one both). Of the two patients with local relapses, one had received radiotherapy. Of the distant failures, four of six patients had no systemic therapy. There were only two node-positive patients who were not given systemic treatment and both relapsed. Median survival in all patients with invasive cancer was 7.5 years, and in those with localized disease it was 7.6 years. The median survival of node-positive patients was 3.8 years. In node-negative patients the median survival had not been reached at a median follow-up of 6.2 years. The majority of patients (12/14) with known receptor status were ER+, a finding that parallels those of other studies. Local control rates were 88% (7/8) in patients who had mastectomy alone and 91% (10/11) in those patients receiving adjuvant radiotherapy. Systemic therapy was found to be beneficial in patients with node-positive disease. Chemotherapy was administered more frequently than hormonal therapy. The median survivals were consistent with those reported in other series.     

The supraclavicular recurrence of breast carcinoma

Between January 1970 and December 1978 39 patients with isolated supraclavicular recurrence of breast cancer were referred to the Department of Radiotherapy and Radiobiology, University of Vienna. All patients have had mastectomy as primary treatment. In 46% of the patients a surgical excision of involved lymph node has been performed before irradiation. The median interval between mastectomy and supraclavicular recurrence was 26 months. The cumulative incidence after three years was 75%. 15 patients have shown complete local response during the whole follow-up time. In 38 patients, osseous and/or visceral metastasis were observed after a median interval of eight months. After two years, 87% of the patients presented distant disease. 15 patients suffered on local pain in the supraclavicular region or in the ipsilateral shoulder with lymph oedema of the arm. The median survival after therapy was 18 months. The death rate after three years was 77%. Patients with a recurrence-free interval after mastectomy less than two years had a median survival time of eleven months whereas patients with a recurrence-free interval had 26 months.